Thematic review on aging and geriatric medicinePrevention, Diagnosis, and Management of Chronic Wounds in Older Adults
Section snippets
Pressure Injuries
Pressure injuries (formerly termed pressure ulcers) result from tissue trauma occurring at sites of increased mechanical force (pressure, shear, or friction).5 Most commonly, pressure injuries are found on bony prominences, where force is increased upon the adjacent tissues, particularly the sacrum and heel.5 Prevalence of pressure injuries in US care facilities was estimated at 8.8% in 2015.6
Pressure injuries can be classified into 4 stages of increasing depth and severity using the National
Venous Ulcers
Venous ulcers of the leg result from chronic venous insufficiency and consequent edema. They are the most common wound type and likely affect millions of people in the United States at any given point in time.21 Clinical course is often chronic, with prolonged healing time and significant risk for recurrence.22 Venous ulcers have a marked impact on health-related quality of life as well as significant financial impact at both patient and societal levels, with an estimated yearly cost to US
Neuropathic Ulcers
Neuropathic ulcers commonly occur in the feet of patients with sensory loss, often caused by peripheral neuropathy. They are frequently found on the toes or metatarsal heads and may be preceded by formation of callus in areas of pressure. Pain is characteristically absent. Neuropathic ulcers frequently occur in the context of diabetes, and ulcers account for much of the morbidity associated with this illness. Diabetes can cause both neuropathy and ischemic disease; as a result, many ulcers have
Ischemic Ulcers
Ischemic ulcers of the leg most often occur in the context of peripheral arterial disease (PAD). They are frequently seen in patients with cardiovascular risk factors (smoking, diabetes mellitus, hypertension, hyperlipidemia, advanced age, family history of atherosclerotic vascular disease), and thus aggressive modification of these risk factors, particularly in patients who already have known PAD, is the best preventive strategy. Aspirin, for example, delays progression of PAD and reduces need
Choice of Wound Dressing
Healing of any wound is a highly organized and complex process involving hemostasis, inflammatory response, proliferation, and remodeling. For wound healing to occur, multiple factors—including adequate tissue perfusion, an intact immune system, appropriate level of wound hydration, removal of necrotic/nonviable tissue, and management of infection, if present—must be addressed. These factors heavily influence dressing choice. Other factors to consider include protecting periwound skin, forming
Conclusion
Chronic wounds are common and disproportionately affect older adults. Proper treatment requires identification, appropriate classification of the etiology, management of underlying contributing conditions, local therapies/dressings, and consideration of adjunctive therapies. Both primary and secondary prevention are also important. Providers in multiple specialties and across care settings, especially those caring for older adults, are likely to encounter chronic wounds and thus should be
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Cited by (21)
Nanomaterials and nanomaterials-based drug delivery to promote cutaneous wound healing
2023, Advanced Drug Delivery ReviewsCitation Excerpt :Human body is born with the ability to rapidly initiate the wound repair process to recover skin integrity [4]. However, under some circumstances, such as wound infection, uncontrolled wound inflammation, and vascular/nervous dysfunction, the wound healing process would be delayed and develop into chronic wounds [5,6]. There are roughly 6.5 million people suffering from chronic wounds annually in America [7].
Mycosynthesis of nanobiomaterials and their wound healing, antimicrobial, and biofilm inhibitory activities
2023, Bioengineered Nanomaterials for Wound Healing and Infection ControlChronic wounds and tissue engineering: Prospective and promise
2022, Tissue Engineering: Current Status and ChallengesNanomaterials applied in wound healing: Mechanisms, limitations and perspectives
2021, Journal of Controlled ReleaseCitation Excerpt :There are signs of healing in most of these wounds within 3 months due to the self-healing properties of the organism. However, in some cases, such as an uncontrolled infection, these acute wounds can develop into chronic wounds, which last for months or even years [2]. Recently, with the prevalence of chronic diseases such as obesity, diabetes and vascular dysfunction that have risen significantly over time, an increasing number of patients suffer from chronic wounds.
The research status and prospects of nanomaterials in wound healing: A scientometric study
2024, Medicine (United States)
Grant Support: The authors report no grant support for this project.
Potential Competing Interests: The authors report no competing interests.