Prevention, Diagnosis, and Management of Chronic Wounds in Older Adults.

Chronic wounds are common, disproportionately affect older adults, and are likely to be encountered by providers across all specialties and care settings. All providers should be familiar with basic wound prevention, identification, classification, and treatment approach, all of which are outlined in this article.

A retrospective cohort study of factors that affect healing in long-term care residents with chronic wounds.

Chronic ulcers such as pressure, ischemic, and venous ulcers are common in long-term care (LTC) and frequently do not heal. A retrospective medical records review of all LTC residents referred to a wound consultative service between April 1999 and January 2007 was conducted to assess predictors of 6-month healing outcome. Variables abstracted and analyzed included wound, resident demographic, and laboratory values at diagnosis and comorbid medical illnesses. The average age of study participants (n = 397) was 78.1 years (+/- 11), 47% were men, 48% had more than one wound, and the most common wound diagnosis was pressure ulcer (n = 163). After 6 months, 66% of ulcers were not healed. The odds ratio for nonhealing was significantly higher in residents who had more wounds, a larger wound area, diabetes mellitus, or peripheral vascular disease and lower in residents with increased age and hemoglobin values and/or a history of stroke, depression, dementia, degenerative arthritis, peripheral neuropathy, and falls. After adjustment in the multivariate model, only the number of wounds and hemoglobin level remained significant predictors of healing status. A higher number of chronic ulcers and lower hemoglobin counts increased the risk of nonhealing after 6 months of care. Including these variables in LTC resident assessments may help clinicians ascertain expected outcomes of care.

Six-month mortality risks in long-term care residents with chronic ulcers.

Chronic ulcers are a common problem in long-term care. Residents with ongoing ulcers are often frail and at risk for mortality. This study evaluated the relationship between wound characteristics and other health predictors with 6-month mortality in nursing home residents. The subjects included were nursing home residents seen by the wound consult service from 1998 to 2007 with an ongoing chronic ulcer. This was a retrospective cohort study. Data were manually and electronically abstracted for each resident. Six-month mortality was collected as the primary outcome. Statistical comparisons were made using logistic regression with a final multivariant model. Four hundred and forty residents were seen with 411 records reviewed. Ulcer area was not associated with mortality; however, chronic ulcer number was associated with 6-month mortality with an odds ratio of 1.32 (95% CI 1.07-1.63). Other significant risk factors included heart failure, dementia, cancer, depression and blindness with all factors having an odds ratio greater than 1.75. Higher haemoglobin and venous insufficiency were protective of 6-month mortality. Ulcer number is an important predictor for 6-month mortality. The presence of multiple ulcers and comorbid health concerns may influence discussion of prognosis for healing and for potential end of life discussions.

Wound management of chronic diabetic foot ulcers: from the basics to regenerative medicine.

BACKGROUND: Hospital-based studies have shown that mortality rates in individuals with diabetic foot ulcers are about twice those observed in individuals with diabetes without foot ulcers. OBJECTIVE: To assess the etiology and management of chronic diabetic foot ulcers. STUDY DESIGN: Literature review. METHODS: Systematic review of the literature discussing management of diabetic foot ulcers. Since there were only a few randomized controlled trials on this topic, articles were selected to attempt to be comprehensive rather than a formal assessment of study quality. RESULTS: Chronic nonhealing foot ulcers occur in approximately 15% of patients with diabetes. Many factors contribute to impaired diabetic wound healing. Risk factors include peripheral neuropathy, peripheral arterial disease, limited joint mobility, foot deformities, abnormal foot pressures, minor trauma, a history of ulceration or amputation, and impaired visual acuity. With the current treatment for nonhealing diabetic foot ulcers, a significant number of patients require amputation. CONCLUSION: Diabetic foot ulcers are optimally managed by a multidisciplinary integrated team. Offloading and preventative management are important. Dressings play an adjunctive role. There is a critical need to develop novel treatments to improve healing of diabetic foot ulcers. The goal is to have wounds heal and remain healed. CLINICAL RELEVANCE: Diabetic neuropathy and peripheral arterial disease are major factors involved in a diabetic foot ulcer. Despite current treatment modalities for nonhealing diabetic foot ulcers, there are a significant number of patients who require amputations. No known therapy will be effective without concomitant management of ischemia, infection, and adequate offloading.

Wound care for elderly patients: advances and clinical applications for practicing physicians.

Chronic ulcers (wounds) are commonly encountered in medical practice, particularly in elderly patients who have chronic medical conditions. Health care providers must be adept at diagnosing chronic ulcers and optimizing medical treatment. We describe the best medical practice for the 4 common types of chronic ulcers: pressure ulcers, ischemic ulcers, venous ulcers, and neuropathic ulcers. We emphasize the importance of nutrition and proper wound care as a foundation for the management of all chronic ulcers. There is a unique therapeutic goal for each chronic ulcer. Pressure relief should be provided for both pressure ulcers and neuropathic ulcers. Ischemic ulcers require revascularization. Patients with venous ulcers need adequate edema control. We outline advances in each of these areas and discuss the newest developments in wound care, including growth factors, hyperbaric oxygen, and vacuum-assisted devices. Chronic ulcers in elderly patients can heal with proper diagnosis and good medical care.