Assessment and management of chronic venous, arterial, and diabetic wounds in older adults

• 成果类型: Review
• 署名作者: Dowling, Caitlin; Chu, Lucy; Etkin, Yana; Oropallo, Alisha
• 署名单位: Northwell Health; Northwell Health
• 刊物名称: SEMINARS IN VASCULAR SURGERY
• ISSN/ISSBN: 0895-7967; 1558-4518
• DOI: 10.1053/j.semvascsurg.2025.06.007
• 发表日期: 2025-09
• 页码: 281-290
• 关键词: Chronic wounds; Wound care; Older adult; Geriatric; Venous ulcer; Diabetic foot ulcer; FOOT ULCERS; HYPERBARIC-OXYGEN; LEG ULCERS; therapy; diagnosis; RISK; CLASSIFICATION; multicenter; prevention; disorders

摘要

Nonhealing wounds are increasingly prevalent, present in 1% to 2% of the global population, with higher incidence in geriatric patients. These chronic wounds pose challenges to older adult patients owing to physiologic changes that hinder healing, common medical comorbidities that promote inflammation and damage microcirculation, poor nutritional status and mobility, and psychosocial barriers to receiving care. In this literature review, the epidemiology, pathophysiology, systems costs, and management of chronic venous leg ulcers, arterial ulcers, and diabetic foot wounds in older adult patients are investigated. Evolving skin structure, pro-inflammatory cellular changes, and propensity for infection place the geriatric population at risk for all wound types. Strategies to differentiate between nonhealing wounds through physical examination, standardized tools, and patient-specific characteristics are outlined. Optimal wound care management principles for each wound type, including wound bed debridement, moisture optimization, biofilm control, and management of edema are addressed. Venous leg ulcers secondary to venous insufficiency are particularly common in older adults and often recur, requiring innovative techniques in compression and tissue substitutes. Emerging therapies, including skin grafts, hyperbaric and topical oxygen, and bedside imaging devices, are discussed. Finally, older adult patients are susceptible to social circumstances that place them at risk for suboptimal wound care and poor healing. The combination of access gaps to regular caretakers, immobility, nociceptive and neuropathic pain, and frailty must be acknowledged and addressed in older adult patients with wounds. The aims of this literature review were to clarify these factors to consolidate awareness and to advocate for a multidisciplinary approach to wound care management. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.