Foot health in older adults with dementia and in long-term care: burden, consequences and gaps in care

Foot health deteriorates with age, yet foot problems receive little attention in the care of older adults with dementia and in long-term care. This narrative review synthesizes the literature published between 2016 and 2025 on the burden of foot and nail problems, their functional consequences and the current approaches to foot care in these populations. Scopus, PubMed, OpenAlex and Crossref were searched and the evidence was organized into five thematic axes. Foot problems affect a large proportion of older adults, and older adults with dementia show poorer foot health than cognitively intact peers. Nail disorders, hyperkeratosis, toe deformities and foot pain are frequent, and they associate with reduced mobility, impaired balance, falls and lower quality of life. Cognitive impairment and the organization of long-term care create specific barriers, because self-care is lost, pain is under-reported, staff training is limited and access to podiatry is scarce. Structured foot care protocols delivered by nurses or care workers, the integration of foot assessment into comprehensive geriatric assessment and footwear interventions improve intermediate outcomes, although their effect on falls remains inconsistent. Studies are needed that measure foot problems in dementia specifically, test routine foot care models in care homes and evaluate pain in people who cannot report it.