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Comment & Response
September 2018

Toenail Examination Reveals Unmet Care Needs—Reply

Author Affiliations
  • 1New England GRECC (Geriatric Research, Education, and Clinical Center), Division of Geriatrics and Palliative Care, VA Boston HealthCare System, Boston, Massachusetts
JAMA Intern Med. 2018;178(9):1283. doi:10.1001/jamainternmed.2018.4285

In Reply We thank Dr Perry for sharing the tragic story about the recent death of her patient’s grandson. The story was elicited after Dr Perry noticed the patient's long toenails; the grandson had been the one to help with the intimate activity of toenail care.

The intention in sharing our own patient’s story in our article1 was to highlight that the simple physical examination finding of long toenails can provide an opportunity for the clinician to ask important questions about personal care. Long and uncared for toenails can point to problems with dexterity, mobility, vision, cognition or mood, or, as illustrated by Dr Perry’s patient, the loss of a caregiver.

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