Comprehensive and multidisciplinary clinical approaches to chronic wound care are important to the management of wounds in older adults, according to a recent review.
Chronic wounds can be defined as wounds that fail to re-establish anatomic and functional skin integrity over 1–3 months through a timely reparative process. Overlapping descriptions and different wound categories makes understanding the prevalence of chronic wounds difficult, but data published in 2017 revealed that chronic wounds affect 5.7 million Americans and incur annual costs of $20 billion.
Changes associated with aging that leave older adults at risk for chronic wounds include a higher prevalence of chronic comorbidities such as cardiovascular disease and diabetes, impaired mobility, incontinence, low weight, poor nutritional status, and cognitive impairment. These conditions give way to additional risk factors such as acute exacerbation of illness, multiple medication use, dehydration, and hospitalization, the review said.
Intrinsic changes in skin wound healing that occur with aging affect wound formation, chronicity, and healing, and contribute to a lower rate of wound closure in older adults. These intrinsic changes include alterations in the body’s inflammatory response, lower levels of supportive extracellular matrix and growth factors, delayed epithelialization, and decreased angiogenic activity.
Chronic wounds can be considered a geriatric syndrome, given their association with substantial morbidity and mortality, and their highly prevalent, multifactorial nature. Prevention, early diagnosis, and treatment of chronic wounds is crucial because of the morbidity, high cost, and reduced quality of life associated with them, which may lead to pain, loss of function, distress, embarrassment, social isolation, hospitalization, and death.
Clinical approaches to chronic wound care in older adults should be comprehensive and multidisciplinary, and consider variables such as age, patient comorbidities and preferences, medication use, functional and cognitive status, social support, and quality of life.
Clinical diagnosis and assessment of wounds should include documentation of wound characteristics like location, size and depth, presence of slough, drainage, odor, and infection. Treatment should follow the TIME principle: Tissue debridement, Infection control, Moisture balance, and optimal wound Edges.
Chronic wounds can be divided into pressure, diabetic, venous, and arterial wounds, with the most common wound observed in older adults being pressure and vascular wounds. Disease-specific wound therapy, such as practices involving pressure reduction for pressure injury, compression therapy for venous wounds, evaluation of arterial circulation with ABI or arterial Doppler and iCC for diabetic ulcers, is critical to wound management. Atypical wounds are common and may present as chronic ulcers that should be biopsied.
The intake of protein supplements has been associated with improved wound healing in subsets of older adults, as well.
The goals of chronic wound treatment should be realistic and consistent with the preferences of care in older adults, the authors wrote. For those who seek a comfort-focused approach, palliative wound management may be the best method of treatment. In palliative situations, dressings that require less frequent changes but control the amount of moisture in the wound bed are commonly used.
Alam W, Hasson J, Reed M. Clinical approach to chronic wound management in older adults. J Am Geriatr Soc. 2021;1–8. doi:10.1111/jgs.17177