Wound care in the geriatric client

Abstract

With our aging population, chronic diseases that compromise skin integrity such as diabetes, peripheral vascular disease (venous hypertension, arterial insufficiency) are becoming increasingly common. Skin breakdown with ulcer and chronic wound formation is a frequent consequence of these diseases. Types of ulcers include pressure ulcers, vascular ulcers (arterial and venous hypertension), and neuropathic ulcers. Treatment of these ulcers involves recognizing the four stages of healing: coagulation, inflammation, proliferation, and maturation. Chronic wounds are frequently stalled in the inflammatory stage. Moving past the inflammation stage requires considering the bacterial burden, necrotic tissue, and moisture balance of the wound being treated. Bacterial overgrowth or infection needs to be treated with topical or systemic agents. In most cases, necrotic tissue needs to be debrided and moisture balance needs to be addressed by wetting dry tissue and drying wet tissue. Special dressings have been developed to accomplish these tasks. They include films, hydrocolloids, hydrogel dressings, foams, hydrofibers, composite and alginate dressings.

Next Science Wound Gel Technology, a Novel Agent That Inhibits Biofilm Development by Gram-Positive and Gram-Negative Wound Pathogens

“…Among patients with thermal injuries involving Ͼ15% of total body surface area, the rates of deaths resulting from infections reach 25% (1). Chronic wounds, such as pressure ulcers, venous leg ulcers, diabetic foot ulcers, and neuropathic ulcers, occur in geriatric patients, persons with perivascular disease, and persons with diabetes mellitus (3)(4)(5). Chronic wounds, which are stalled at the inflammatory phase of healing, begin as superficial ulcers and may become deep, sometimes extending to bone (3,4,6).…”

“…Chronic wounds, such as pressure ulcers, venous leg ulcers, diabetic foot ulcers, and neuropathic ulcers, occur in geriatric patients, persons with perivascular disease, and persons with diabetes mellitus (3)(4)(5). Chronic wounds, which are stalled at the inflammatory phase of healing, begin as superficial ulcers and may become deep, sometimes extending to bone (3,4,6). Deep wounds are more difficult to treat than superficial wounds and may never heal completely (3,4).…”

“…Chronic wounds, which are stalled at the inflammatory phase of healing, begin as superficial ulcers and may become deep, sometimes extending to bone (3,4,6). Deep wounds are more difficult to treat than superficial wounds and may never heal completely (3,4). Chronic deep infections of nontraumatic lower-limb ulcers lead to amputation in 60% of patients, with the majority being related to diabetes (3,5).…”

“…Deep wounds are more difficult to treat than superficial wounds and may never heal completely (3,4). Chronic deep infections of nontraumatic lower-limb ulcers lead to amputation in 60% of patients, with the majority being related to diabetes (3,5). Thus, chronic wounds represent a serious problem, causing longterm pain and discomfort to patients and requiring costly treatment.…”

“…Compared with their planktonic counterparts, microorganisms within a biofilm are highly resistant to environmental stresses and host immune responses and are tolerant to antimicrobials (10)(11)(12)(13). Most of these infections begin with colonization with Gram-positive cocci, followed by different genera of Gram-negative bacilli from the host or the environment; over time, the infections become polymicrobial, consisting of numerous species, including obligate anaerobes (1,3,4,8). Once formed, the biofilm mechanically prevents wound contracture and epithelialization, dysregulates the host immune response by affecting intracellular signaling, and damages the tissue through a combination of chronic inflammation and microbial virulence factors (4,6,(14)(15)(16).…”