Proactive Approaches to Help Prevent and Treat Chronic Wounds 

By Mary Litchford

There are many risk factors associated with chronic wound development, with age being an unchangeable one. The good news is, there are also changeable risk factors. Understanding how to prevent and treat a chronic wound is crucial when caring for older adults. To help older adults, caregivers, and the professionals working with them, below are answers to some common questions about chronic wounds and tips for how to educate on risk factors.

What is a chronic wound?

There is no true definition for a chronic wound, but it is typically a wound that does not progress normally through stages of healing and has not healed within four weeks. There are many different types of chronic wounds, examples include diabetic foot ulcers, venous leg ulcers, and pressure injuries.

What is the prevalence of chronic wounds and why are older adults more susceptible?

Chronic wounds affect more than 5 million people each year, and it is projected that 1-2% of the population will experience a chronic wound during their lifetime. Common co-morbidities that affect older adults – such as diabetes, cardiovascular disease, pulmonary disease, obesity and malnutrition – increase the risk of developing a chronic wound.

Older adults are more susceptible to develop a chronic wound because of age-related changes in the skin. As people age, their skin becomes thinner due to medications such as anticoagulants, steroids, antibiotics, vasoconstrictors and antidepressants. Skin also becomes dryer with aging. The dryness of skin may be related to the climate, inadequate intake of water and other beverages, or changes due to the make of the skin and oil glands. Thin, dry skin is more easily injured by very hot water, prolonged exposure to sunlight, tumbles and trauma.

What contributes to the development of a chronic wound?

Wound healing is complex. There are extrinsic (unchangeable) and intrinsic (changeable) risk factors that can affect wound healing. Some of the risk factors are unchangeable, but may be managed with nursing care, medications and diet.

Unchangeable or chronic risk factors include:

  • Age
  • Impaired mobility

Potentially manageable chronic risk factors include:

  • Poor cardiovascular function
  • Vascular disease
  • Bowel incontinence

Changeable or preventable risk factors include:

  • Diet
  • Unplanned weight loss
  • Poor glycemic (blood sugar) control
  • Smoking
  • Poor hygiene
  • Non-adherence to prevention and treatment plans

In general, individuals with multiple risk factors, whether these are extrinsic or intrinsic, are at a higher risk for developing a chronic wound. These factors can also negatively affect how a chronic wound heals and lengthen the treatment process.

What education is beneficial for older adults and their families/caregivers, to prevent and treat chronic wounds?

Educating older adults and their families/caregivers on changeable and manageable risk factors can help prevent and treat chronic wounds. Some education tips are:

  • Diet is a highly modifiable risk factor. Nutrition tips to promote wound healing, prevent unplanned weight loss and prevent the development of a chronic wound include: sufficient calories, optimum amounts of protein, and adequate hydration, and controlling blood sugar levels for those with diabetes.
  • Older adults with diabetes often have impaired sensation in their feet due to neuropathy. Diet is helpful to improve blood sugar control. A registered dietitian nutritionist (RDN) can help older adults and their caregivers plan diets that promote better blood sugar control.
  • Promoting a healthy lifestyle overall can help address other changeable risk factors that are not diet-related. For example, educating older adults on frequent physical activity and the avoidance of smoking can support chronic wound prevention and treatment.
  • Encourage older adults to stay in touch with providers to ensure the wound treatment and/or prevention plans are being followed. Older adults can work with providers to address both changeable, manageable and unchangeable risk factors. While there are some unchangeable risk factors that affect wound healing, these factors still should be addressed so that the wounds don’t worsen.

Chronic wounds are a healthcare concern for the aging population, and it is important that providers, caregivers, and older adults are aware of risk factors that can promote chronic wound development and interfere with the healing process.

Mary Litchford, PhD, RDN, LDN, immediate past president of NPUAP, nutrition entrepreneur and president of CASE Software & Books.