How the 5Ms and Shared Decision-Making Improve Skin Care for Older Adults
How doctors can better care for older skin: a practical guide
As we get older, our skin changes and so do the kinds of skin problems we face. Daniel Butler, MD, who studies how aging affects inflammatory skin conditions, recently spoke about how ideas from geriatric medicine can make dermatology visits more useful and kinder for older adults (Source: Interview with Daniel Butler, MD).
Short summary
Instead of jumping straight to a treatment, Butler recommends starting by asking what the person actually wants. He also suggests using a simple geriatric checklist called the 5Ms to guide care, watching for new options to treat chronic itch, and looking for chances to safely stop medicines that may no longer be needed. These steps help match treatment to what matters most for each person (Source: Interview with Daniel Butler, MD).
Start with what the patient wants
Good care begins with one basic question: what do you want the treatment to do? For some people the priority is clearing a patch of psoriasis. For others it may be stopping itch, fixing painful joints that affect the skin, or getting rid of flaky scalp that’s embarrassing or uncomfortable.
After hearing the person’s goals, the clinician should explain the possible approaches and why one option might be better than another. Butler recommends offering a “menu of options” rather than a single plan so people can choose what fits their priorities and lifestyle (Source: Interview with Daniel Butler, MD).
This matters for many conditions. For example, when treating a skin cancer, possible choices include:
- Mohs micrographic surgery (a precise technique that removes cancer layer by layer),
- excision (surgically cutting it out),
- electrodesiccation and curettage (scraping and cauterizing),
- or, when appropriate, active surveillance (watching the spot closely instead of immediate treatment).
Explaining the trade-offs (healing time, risk of recurrence, recovery needs) helps people pick what matters most to them (Source: Interview with Daniel Butler, MD).
The 5Ms: an easy checklist for older adults
Butler suggests borrowing a simple framework from geriatric medicine called the 5Ms. These are quick checkpoints clinicians can use when caring for older patients:
- Mobility — Can the person move around easily? This affects wound care, dressing changes, and whether a treatment that requires frequent visits is realistic.
- What matters most — What outcomes are most important to the person (appearance, comfort, avoiding procedures)?
- Medications — Is the person taking many drugs that could interact or cause side effects?
- Mentation — Are there memory or thinking problems that affect the ability to follow a treatment plan?
- Multicomplexity — Does the person have multiple health issues that make some treatments riskier or harder to manage?
You don’t need to cover all five points at every visit. Instead, think of them as things to check now and then so treatment choices match the person’s whole life, not just the skin problem (Source: Interview with Daniel Butler, MD).
Itch is getting more attention
Pruritus (itch) is one of the top reasons people over 50 go to a dermatologist, but until recently there were no medicines approved specifically to treat itch itself. As researchers learn more about why itch happens in different conditions, new targeted treatments are starting to appear. That means clinicians may soon have better options to help people who suffer from chronic itch (Source: Interview with Daniel Butler, MD).
Butler finds this development encouraging because many older adults have had limited, non-specific choices for relief. Even so, treatment decisions should be discussed with a clinician who can explain benefits and risks for each person (Source: Interview with Daniel Butler, MD).
Deprescribing: less can be more
Deprescribing means stopping medicines that aren’t needed or that overlap with other treatments. It’s especially important for older adults, who often take multiple drugs.
In dermatology, people sometimes come in already taking several therapies given by different clinicians. For example, someone with hives or another itchy condition might be taking several antihistamines plus a short steroid course like prednisone. When a dermatologist offers a more targeted treatment, it may be possible to stop some of those older medicines to reduce side effects and simplify care (Source: Interview with Daniel Butler, MD).
Dermatologists can unintentionally add to the medication burden, so thinking about what can be safely removed is part of responsible care. The goal is not to add treatments automatically but to match care to individual goals and reduce unnecessary medicines when possible (Source: Interview with Daniel Butler, MD).
Keeping an eye on visible changes
It can help to track spots, rashes, or other visible skin changes over time. Taking photos or keeping a simple journal of when something started, whether it itches or bleeds, and how it changes can make visits more useful and help you describe concerns clearly to your clinician. This can be especially helpful if you plan to discuss treatment options or surveillance (Source: Interview with Daniel Butler, MD).
When to see a doctor
Talk with a clinician if you notice any worrying signs, such as a changing or new mole, a sore that won’t heal, bleeding, pain, signs of infection (redness, warmth, pus), or skin changes that grow quickly. If you’re unsure, it’s better to ask — especially when decisions about treatment or stopping medicines are being considered.
Important note
This article is based on a recent interview and is meant to explain ideas that may help you talk with your dermatologist (Source: Interview with Daniel Butler, MD). It is not medical advice. Treatment choices should always be discussed with your doctor or dermatologist, who can consider your personal health history and needs.
Sources
- Interview with Daniel Butler, MD, vice chair of education at the University of Arizona and leader of the Inflammatory and Aging Skin Research Program (recent interview).