Are chronic wounds a feature of frailty?

Ferris, Amy; Harding, Keith G

doi:10.3399/bjgp20x709829

Cited by 9 publications

(9 citation statements)

References 13 publications

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“…Polypharmacy, another critical issue in frail individuals, might also have a direct effect on tissue repair. In fact, drugs like steroids, nicorandil, diuretics, antihypertensive agents, and immunosuppressants are known to slow down wound healing (20). It is also possible that the exhausted homeostatic reserves characterizing the frail individual may play a role in the nonhealing of the DFUs.…”

Section: Discussionmentioning

confidence: 99%

Frailty Is Associated with Impaired Diabetic Foot Ulcer Healing and All-Cause Re-Hospitalization

Maltese

Basile

Meehan

et al. 2022

The Journal of nutrition, health and aging

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Background Diabetic Foot Ulcers (DFUs) are a common and feared complication of type 1 and type 2 diabetes. People with DFUs often present a significant clinical complexity due to multimorbidity, frailty, polypharmacy, and disabling conditions. Frailty, defined using the accumulation of health deficits model, has shown to predict worsening health status, hospitalizations, and death in older persons. There are no clinical studies, to date, that have examined the prevalence and effect of frailty on DFUs outcomes. The aim of our study was to explore the impact of frailty on DFUs healing and re-hospitalization in a cohort of patients hospitalized with DFUs. Design prospective cohort study. Setting and Participants The frailty status of 76 consecutive hospitalized patients with DFUs was assessed by using the Frailty Index (FI). Measurements The primary outcome was the non-healing of the DFU. Secondary outcome was re-hospitalization events (for any cause) within 6 months from hospital discharge. Frailty was defined as FI>0.25. Results Out of 76 patients (median age 65 years, range 31–84), 56 (74%) were frail. At six months, 81.5% of frail patients had nonhealing of the DFU compared to 55% in non-frail patients (p=0.02). The rate of of re-hospitalization was also higher in frail compared to non-frail (90.3% vs 54%, respectively; p=0.01) patients. In multivariable analyses, frailty was significantly associated with a more than fivefold increased risk of DFU non-healing [odds ratio 5.54 (95% confidence interval 1.28–23.91), p=0.02]. Similarly, re-hospitalization was also significantly higher in frail patients compared to the non-frail ones. Conclusions In hospitalized patients with DFUs, frailty was highly prevalent. Frailty emerged as an independent risk factor for DFU non-healing and re-hospitalization events. Patients with DFUs require a comprehensive assessment of their frailty status which would enable personalization of their management and interventions.

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Section: Discussionmentioning

confidence: 99%

Frailty Is Associated with Impaired Diabetic Foot Ulcer Healing and All-Cause Re-Hospitalization

Maltese

Basile

Meehan

et al. 2022

The Journal of nutrition, health and aging

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“… 5 , 7 The concern is that despite the longevity of our understanding of the pathological processes involved in wound repair, and the large array of treatment modalities available, many wounds remain unhealed, thereby compounding the challenges outlined. 14 The fundamentals of care involve accurate and ongoing patient and wound assessment to identify pertinent information needed to make a correct diagnosis and from there to plan an effective care plan for treatment. 15 However, despite availability of these gold standard principles, Guest et al, 3 identified substantial deviations from agreed standards, with 30% of patients in their study lacking a differential diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…Wounds and their associated problems are a substantial and ‘snowballing’ health care concern, significantly impacting negatively on the individual and on scarce health care resources 5,7 . The concern is that despite the longevity of our understanding of the pathological processes involved in wound repair, and the large array of treatment modalities available, many wounds remain unhealed, thereby compounding the challenges outlined 14 . The fundamentals of care involve accurate and ongoing patient and wound assessment to identify pertinent information needed to make a correct diagnosis and from there to plan an effective care plan for treatment 15 .…”

Section: Introductionmentioning

confidence: 99%

A Clinical Support App for routine wound management: reducing practice variation, improving clinician confidence and increasing formulary compliance

Moore

Aynge

Carr

et al. 2022

International Wound Journal

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Wounds continue to be of a global concern. Therefore, a more focussed, evidence‐based approach to wound assessment and management is required. The WOUND COMPASS™ Clinical Support App (CSA) is designed to support the health care professional with wound assessment and management at the point of care. This real‐world pilot study aimed to determine the utility of the CSA during routine wound management, in multiple care settings. A non‐interventional, real‐world pilot programme of the CSA was conducted at four sites. Patients received routine wound management. The CSA was programmed to replicate the site's formulary for evidence‐based wound management. Anonymised pre‐ and post‐pilot clinician opinion surveys on useability and impact of the CSA were collected and reported. Wound Specialists (n = 7 [100%]) and Non‐Wound Specialists (NWS) (n = 58 [82%]) indicated that competence and confidence in wound assessment were enhanced with use of the CSA (100%; 82%). Furthermore, practice variation was reduced because of a greater compliance to their local formulary (n = 7 [100%]; 79% [54%]). This real‐world pilot shows the positive impact of the CSA, and the improvements that can be potentially realised via reduction in practice variation, improvement in NWSs confidence when managing wounds and increased formulary compliance.

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“…Por otro lado, investigaciones previas anteriores indican una asociación entre fragilidad y riesgo de desarrollar lesiones relacionadas con la dependencia (LRD) (11)(12)(13). Las LRD engloban diferentes tipos de lesiones que hasta la fecha se consideraban como úlceras por presión, pero que tienen diferentes mecanismos de producción (úlceras por presión, lesiones por cizalla, lesiones asociadas a la humedad, lesiones por roce y fricción y lesiones mixtas) (14).…”

Section: Introductionunclassified

Validez convergente y discriminativa del índice Frágil-VIG con la escala de Braden en personas atendidas en atención domiciliaria

Zamora-Sánchez

Zabaleta‐del‐Olmo

Gea-Caballero

et al. 2022

Revista Española de Geriatría y Gerontología

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Are chronic wounds a feature of frailty?

Cited by 9 publications

References 13 publications

Frailty Is Associated with Impaired Diabetic Foot Ulcer Healing and All-Cause Re-Hospitalization

Frailty Is Associated with Impaired Diabetic Foot Ulcer Healing and All-Cause Re-Hospitalization

A Clinical Support App for routine wound management: reducing practice variation, improving clinician confidence and increasing formulary compliance

Validez convergente y discriminativa del índice Frágil-VIG con la escala de Braden en personas atendidas en atención domiciliaria

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