Diabetic neuropathy and peripheral arterial disease are major factors involved in a diabetic foot ulcer. Despite current treatment modalities for nonhealing diabetic foot ulcers, there are a significant number of patients who require amputations. No known therapy will be effective without concomitant management of ischemia, infection, and adequate offloading.

Chronic wounds are common, disproportionately affect older adults, and are likely to be encountered by providers across all specialties and care settings. All providers should be familiar with basic wound prevention, identification, classification, and treatment approach, all of which are outlined in this article.

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Introduction Chronic ulcers are a common problem in long term care. Residents with ongoing ulcers are often frail and at risk for mortality. Aim This study evaluated the relationship between wound characteristics and other health predictors with 6-month mortality in nursing home residents. Subjects Nursing home residents seen by the wound consult service from 1998-2007 with an ongoing chronic ulcer. Methods This was a retrospective cohort study. Data was manually and electronically abstracted for each resident. 6-month mortality was collected as the primary outcome. Statistical comparisons were made using logistic regression with a final multivariant model. Results 440 residents were seen with 411 records reviewed. Ulcer area was not associated with mortality; however, chronic ulcer number was associated with 6 month mortality with an odds ratio of 1.32 [95% CI 1.07-1.63]. Other significant risk factors included heart failure, dementia, cancer, depression and blindness with all factors having an odds ratio greater than 1.75. Higher hemoglobin and venous insufficiency were protective of 6 month mortality. Discussion Ulcer number is an important predictor for 6-month mortality. The presence of multiple ulcers and comorbid health concerns may influence discussion of prognosis for healing and for potential end of life discussions.

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