Clinical Approach to Chronic Wound Management in Older Adults

Wahila Alam MD; Jonathan Hasson MD, MBA; May Reed MD


J Am Geriatr Soc. 2021;69(8):2327-2334. 

In This Article

Chronic Wounds in Older Adults

Older adults are at high risk of developing chronic wounds due to numerous changes that occur with aging. These include a higher prevalence of chronic conditions, such as cardiovascular disease and diabetes, impaired mobility, incontinence, low weight, poor nutritional status, and cognitive impairment. These co-morbidities are often concurrent with additional risk factors including acute exacerbation of illness, multiple medication use, dehydration, and hospitalization.[7] The age-associated changes in the basic biology of the skin also play a significant role in wound formation, chronicity, and healing.[5] Intrinsic changes in skin wound healing that are affected by age include: alterations in the body's inflammatory response, lower levels of supportive extracellular matrix (ECM) and growth factors, delayed epithelialization, and decreased angiogenic activity. All contribute to a lower rate of wound closure in older adults.[8] It is reasonable to consider chronic wounds as one of the geriatric syndromes[9]—highly prevalent, multifactorial, and associated with substantial morbidity and mortality.[10]

Management of chronic wounds should be similar to the approach taken with other geriatric syndromes and encompass a comprehensive and multidisciplinary approach that takes into account many variables. These include changes with age, patient co-morbidities and preferences, medication use, functional and cognitive status, social support, and quality of life.[11]

In this article, we discuss the pathophysiology of chronic wounds and common wounds in older adults, including pressure, vascular and neuropathic wounds. We review their classification, approach to evaluation, and a multidisciplinary approach to management.