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March/April 2024

March/April 2024 Issue

Wound Care: An Evolution in Wound Care
By Keith Loria
Today’s Geriatric Medicine
Vol. 17 No. 2 P. 6

New technology, products, and practices are improving wound care for geriatric patients.

In recent years, there have been notable advancements in wound care for older patients. These improvements can be attributed to advancements in medical technology, wound dressings, and evidence-based practices. Health care professionals now have access to modern tools like laser therapy, negative pressure wound therapy, and advanced imaging techniques, which enable more accurate assessment of wounds and allow for the application of targeted treatments.

Additionally, specialized wound dressings, such as antimicrobial dressings and those that promote moist wound healing, have greatly improved the outcomes of wound care. These dressings create an ideal environment for healing, minimizing the risk of infections and promoting tissue regeneration.

Furthermore, health care professionals and caregivers are now more aware of the specific needs of geriatric patients, leading to improved preventive measures and timely interventions. These efforts include remote monitoring and telemedicine, which enhance outcomes in wound management for this vulnerable population.

Still, challenges still exist for proper wound care, and not all older patients understand how important it is.

Ruchi Reyes, a registered nurse and wound care clinical specialist at United Hebrew, a campus of comprehensive senior care in New Rochelle, New York, notes proper wound care is not merely important, it’s vital in promoting wound healing.

“When you reach the age of 65 or older, one’s body systems are at higher risk for comorbidities and chronic diseases,” she explains. “Skin loses its elasticity and collagen, which makes the skin more fragile and not only delays wound healing but puts this group at higher risk for poor wound healing.”

So strong wound care management prevents complications, such as infection, and reduces pain and discomfort for the older population.

“When we receive a new geriatric patient or resident at United Hebrew, one of the first things we do is a thorough skin assessment,” Reyes says. “Our nursing staff are trained in wound care, and we typically have two nurses conduct the assessment using the Braden Scale. Together with clinical judgment, this tool is used to assess risk of a patient/resident developing a pressure ulcer or any surgical wounds present. This information assists in determining modalities we want to provide.”

The team is looking to identify the type of support surfaces to use with patients, such as mattresses, and ensures that the patients are on training and positioning and toileting programs.

“The assessment and modalities are conducted and communicated to nursing leadership as soon as the patient is received in the unit to ensure expeditious follow through on our care plan,” Reyes says.

Kevin Huffman, a doctor of osteopathic medicine in Ohio and the CEO of On the Rocks Climbing Gym, notes taking good care of wounds is of utmost importance for older patients because their bodies undergo physiological changes as they age. “These changes include a decrease in skin elasticity and a weakened immune response, which make them more vulnerable to infections,” he says. “Due to these factors, wounds in geriatric patients tend to heal slower and are more prone to complications such as infections and ulcers.”

Therefore, it’s crucial to provide careful and attentive wound care to prevent serious consequences. It’s particularly important for geriatric patients because aging skin and prevalent comorbidities can slow the healing process.

“Neglecting wound care can lead to severe complications like infections, further impairing overall health and mobility,” agrees Cara Dobbertin, PT, DPT, a doctor of physical therapy with Practitionr. “Therefore, attentive wound management is essential not just for physical recovery, but also for maintaining a patient’s functional independence.”

Challenges to Proper Care
Several factors often keep older adults from getting the prompt and thorough wound care they need. First, they may not understand the potential gravity of the situation, leading them to delay that essential trip to the doctor. Then, there’s the issue of physical limitations; it’s not easy for everyone to get to a health care facility or to properly take care of wounds at home.

“One major obstacle they encounter is the struggle to access timely and appropriate wound care,” Huffman says. “Limited mobility, cognitive impairments, or lack of social support can hinder their ability to seek medical attention promptly.”

Another challenge is that often patients must rely on family to help them attend follow-up visits and manage wound care, and a lack of education and training may result in a worsening or reoccurrence of the wound.

“There are other instances where an individual, age notwithstanding, may be recuperating from a stroke or CVA [cerebral vascular accident] or they may be obese,” Reyes says. “If these individuals are not offloading weight from certain areas of the body, in as little as two hours, a deep tissue pressure injury can occur, and the patient may not feel it until it has progressed to an external wound.”

Risk of Recurrence
Older patients, particularly those who are immobile for extended periods, face a higher risk of recurring wounds in commonly affected areas such as pressure points. In the geriatric community, high-risk areas typically involve pressure points such as the sacrum, heels, and elbows, Dobbertin notes. These are locations prone to pressure sores, particularly for individuals with limited mobility.

“This is problematic because each time a wound reappears, it’s often harder to treat than before,” she says. “With recurring wounds, complications like infections become more likely and can become more difficult to treat.”

Nelly Darbois, PT, MSc, who specializes in geriatrics, notes the immune system tends to weaken with age, which can slow the body’s natural healing processes, so older adults are more vulnerable to wounds and reoccurrences.

“Older adults often have underlying health conditions, such as diabetes or circulatory problems, which can impede the healing process,” she says. “Chronic wounds, if not managed effectively, can lead to recurrence and can be challenging to treat.”

She adds that people often think that their wounds will heal quickly, just as they did when they were younger. It’s rare for patients to take the initiative to seek special care unless health care professionals are there to point out that their wounds may take longer to heal.

Foot Ulcers
In patients with diabetes, feet are commonly affected areas due to peripheral neuropathy and circulatory issues.

“Pressure injuries and diabetic foot ulcers are prevalent concerns in this population due to the loss of sensation and blood circulation issues,” Darbois says.

Some new research by the Indiana University School of Medicine on diabetic foot ulcers looked at the risk of wound recurrence and offered a new approach to help health care providers measure the likelihood that a wound would reopen in the future.

Chandan K. Sen, PhD, director of the McGowan Institute for Regenerative Medicine and associate vice chancellor for life sciences innovation and commercialization for Pitt Health Sciences, led the study when he was chair of surgery at the IU School of Medicine.

“Over time, as we age, there are factors that set in, one of which is skin thinning. As it does, it loses properties, where a minor problem could end up killing the skin,” he says. “The premise of our study involves the critical endpoint of wound closure.”

He explains that diabetic foot ulcers develop in patients with diabetic neuropathy, a condition that causes numbness in the foot; the nerves in the skin become dysfunctional, which can cause patients to injure the affected foot without feeling it. Those untreated wounds can lead to infections, and if an infection is not treated quickly, an amputation may be necessary.

During the 16-week study, patients who had diabetic foot ulcers that had healed were tested to better identify a biomarker that would predict recurrence during the process of standard wound care. This was accomplished though measuring transepidermal water loss (TEWL), which looked at how much bodily fluid was leaking through the skin using a small penlike device.

“If a wound closes but the function of the skin is not restored, that’s measured at high TEWL,” Sen says. “Those wounds are more likely to occur.” Sen and his research team discovered that patients with a high TEWL reading, registering more than 30 g/m2/hour, had twice the incidence of wound recurrence than those with lower numbers.

Evolving Care
“It’s become more common to have a team of health care professionals, from doctors to physical therapists, working together to provide well-rounded care,” Dobbertin says. “There is also a bigger push to educate not just patients but also their caregivers on how to spot problems early and handle wound care at home.”

With advanced training and specialization in wound care, health care professionals have better tools and knowledge to address this issue, particularly among older adults .

“Technology, specialized wound care products, and advancements in support services, have also contributed to better wound care among geriatric patients,” Reyes says. “For suitable patients with stage 3 and 4 level wounds, we also utilize vacuum-assisted closure therapy (wound VAC), which speeds up wound healing by removing air pressure over the area of the wound and helps to pull the edges of the wound together.”

Darbois notes dozens of new studies are published each month on this topic in peer-reviewed medical journals. Governments are also implementing plans and funding primary prevention and secondary prevention in this sector.

Wound care for geriatric patients, she says, has also improved due to a better understanding of geriatric wound management. “There is a growing emphasis on prevention, early intervention, and holistic care.”

— Keith Loria is a D.C.-based award-winning journalist who has been writing for major publications for nearly 20 years on topics as diverse as real estate, travel, Broadway, and health care.