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Habit reversal is successful for atopic eczema in the elderly without any major modification of the protocol for The Combined Approach for Adults and Older Children.

However with increasing age the skin takes longer to heal, and learning can take longer to achieve. While in younger adults the programme usually needs to be maintained for five to seven weeks, in old age it may require longer, perhaps seven to nine weeks.

While in the very young habit reversal can effectively modify scratching behaviour in only a few days, in young adults up to two or three weeks may be required, sometimes longer. With increasing age more time and persistence may be required.

At all ages involving others when using habit reversal can be important. This is essential for the very young, when the hand tally counter is replaced by the observations of others, and habit reversal is achieved by positive interventions by others.

With the elderly, involving others can be crucial if habit reversal is otherwise difficult to explain, or to remember. With cognitive impairment in the elderly, the preliminary registration of scratching using a hand tally counter may need to be supplemented or replaced by a period of observation by others. Carers need to chart over a few representative days the frequency of scratching and rubbing episodes, and note the different circumstances that are especially associated with this behaviour.

Then, as with the very young, habit reversal can be achieved by planned positive interventions, using diversion and distraction, and introducing skin-safe behaviours when otherwise rubbing and scratching occurs. Initially this should be intensive, involving others in continuing attendance over several days at least, followed by consistent reinforcement over several weeks.

This article is part of a series: Atopic eczema in the elderly

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