Pressure Injury and Chronic Wounds

Chronic wounds in older persons include a spectrum of pathologies and generally occur with a backdrop of multiple comorbidities rendering them a model geriatric syndrome. Care of chronic wounds is interdisciplinary and involves nursing, nutrition, rehabilitation, and surgical subspecialties. Complications include pain, decreased quality of life, longer hospital stay, increased chance of readmission within 30 days after hospital discharge, increased chance of admission to a long-term care facility, and increased risk of death. Infectious complications include cellulitis, abscess, sepsis, pyarthrosis, osteomyelitis, and necrotizing soft tissue infection. Chronic wounds require surgical procedures including debridements, endovascular interventions, myocutaneous flaps, amputations, and ostomies for fecal diversion. A vexing variety of treatments is available with few studies to prove efficacy of one over the other. The standard of care for chronic wounds is evolving, and geriatricians need to be aware of prevention strategies, documentation standards, treatment choices, and how to co-manage wounds with other disciplines. Treatment strategies include a palliative care approach, which can avoid unnecessary and futile procedures, improve quality of life, preserve dignity, and curtail health care costs.