Older adults are at high risk of developing chronic
wounds due to numerous changes that occur with aging. It is reasonable to consider chronic
wounds as a geriatric syndrome-highly prevalent, multifactorial, and associated with substantial morbidity and mortality. Due to the morbidity and cost associated with chronic
wounds, prevention, early diagnosis, and treatment are important. The most common chronic
wounds presenting in older adults are pressure and vascular
wounds, including those associated with diabetes. Atypical
wounds are also common and should raise the suspicion for skin
malignancy. Diagnosis is primarily clinical and assessment should include documentation of
wound characteristics, such as location, size and depth, presence of slough, drainage, odor, and
infection. The mainstay of treatment is based on the TIME principle: Tissue
debridement, Infection control, Moisture balance, and optimal
wound Edges. The use of
protein supplements has been shown to improve wound healing in subsets of older adults. In addition to
wound care and optimizing nutrition, disease-specific
wound therapy forms an integral part of
wound management. Pressure reduction for
pressure injury, compression
therapy for venous
wounds, evaluation of arterial circulation with ABI or arterial Doppler and iCC for diabetic
ulcers form the mainstays of
therapy. Atypical
wounds may present as chronic
ulcers and should be biopsied. The goals of treatment should be realistic and for some older adults, palliative
wound management may be more appropriate.