Chronic wound repair and healing in older adults: Current status and future research

Abstract

The incidence of chronic wounds is increased among older adults, and the impact of chronic wounds on quality of life is particularly profound in this population. It is well established that wound healing slows with age. However, the basic biology underlying chronic wounds and the influence of age-associated changes on wound healing are poorly understood. Most studies have used in vitro approaches and various animal models, but observed changes translate poorly to human healing conditions. The impact of age and accompanying multi-morbidity on the effectiveness of existing and emerging treatment approaches for chronic wounds is also unknown, and older adults tend to be excluded from randomized clinical trials. Poorly defined outcomes and variables, lack of standardization in data collection, and variations in the definition, measurement, and treatment of wounds also hamper clinical studies. The Association of Specialty Professors, in conjunction with the National Institute on Aging and the Wound Healing Society, held a workshop, summarized in this paper, to explore the current state of knowledge and research challenges, engage investigators across disciplines, and identify key research questions to guide future study of age-associated changes in chronic wound healing.

Factors associated with the incidence of pressure ulcer during hospital stay

“…Although the patient's nutritional status is considered a potential risk factor for PU development (24)(25)27) , no significant association was demonstrated in this study. Evidence that dietary interventions and dietary supplements can effectively prevent or accelerate the healing process of PU are conflicting and require more scientific research (27) .…”

“…However, demographic data show that women have a higher life expectancy than men (78.6 and 71.3 years, respectively) (23) , so therefore they live longer periods with disabilities and chronic diseases, which could increase PU incidence in females (21) . Regarding the association between age and PU, some authors affirm that age group over 60 years is a risk factor for developing PU due to changes in skin and subcutaneous tissue inherent to aging (21,(24)(25) . Such lesions can be considered mortality predictors in advanced-aged individuals, regardless of other risk factors (26) .…”

Prevalência E Caracterização De Feridas Crônicas Em Idosos Assistidos Na Atenção Básica

“…Ainda permanecem questões fundamentais sobre o efeito do envelhecimento na cicatrização e nos mecanismos de reparo das lesões, bem como a regeneração dos tecidos em idosos (2) . Dentre os tipos de feridas crônicas mais frequentemente encontrados nos serviços da atenção básica de saúde, encontram-se as úlceras vasculogênicas (UV) e as lesões por pressão (LP), que geralmente são de longa evolução e de resposta terapêutica variável.…”

Impaired wound healing: facts and hypotheses for multi-professional considerations in predictive, preventive and personalised medicine

“…Hence, they demonstrate an altered inflammatory response characterised by sustained elevation of proinflammatory cytokines such as IL-6 and TNFα and by declined levels of growth factors. This combination leads to high levels of TGF-β that may play a role in transforming wounds from acute to chronic ones by inhibiting the reepithelialisation [35]. Accelerated and advanced ageing is also associated with slowed macrophage and T cell infiltration to the wound area and reduced macrophage function [36,37].…”

“…Aged subpopulations frequently demonstrate chronic nonhealing wounds, and their impaired WH is a major medical care issue [35]. Individuals experiencing accelerated ageing, for example, in the case of Down syndrome or progeroid syndromes are also at great risk for slowed down and impaired wound healing [11,24].…”