Elsevier

Mayo Clinic Proceedings

Volume 95, Issue 9, September 2020, Pages 2021-2034
Mayo Clinic Proceedings

Thematic review on aging and geriatric medicine
Prevention, Diagnosis, and Management of Chronic Wounds in Older Adults

https://doi.org/10.1016/j.mayocp.2019.10.014Get rights and content

Abstract

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.

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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    Grant Support: The authors report no grant support for this project.

    Potential Competing Interests: The authors report no competing interests.

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