Untrimmed Toenails: A Marker of Functional Status in Older Patients?
Clinicians should interpret the finding of untrimmed toenails as a sign of possible unmet care needs, according to a Perspective piece published in JAMA Internal Medicine.
In the article, the authors write that for older patients, toenail length can provide important insight into a patient's functional status. Like hemoglobin A1C is to diabetes, the authors state that toenail length can be used as measure of function and frailty.
While looking at the feet during a physical exam may be common practice for clinicians caring for older patients, the authors note that the toenails specifically can provide "a unique window into an individual's functional status." For example, if the toenails are long because the patient is having a hard time reaching them, then the clinician can work on ways to improve the conditions that may limit flexibility and muscle strength (i.e., arthritis, sarcopenia). Long toenails may also indicate caregiver burnout or reveal the loss of executive function in patients with cognitive impairment.
"Examining the feet, and asking the question 'How do you get your toenails cut?' may open the door to important conversations between the patient and clinician; the reasons for the untrimmed nails can help tailor treatment plans to the patient's needs," conclude the authors.
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