Clinical Care  Chronic Wound Morbidites in the Elderly
Chronic wounds progress in stages; their pathogenesis has been clearly delineated.78,79 Overall, the elderly experience a higher percentage of chronic wounds than the remainder of the population.80 A critical reasons for the higher prevalence of wounds among the elderly is the impaired angiogenic response that accompanies increasing age, resulting in a weakened inflammatory response to a wound. Increased incident of chronic wounds in the elderly is also correlated with a gradual diminishment of the immune system, which similarly results in a decreased ability to respond to bacterial or viral attack.
As many as 15% of all patients with diabetes will suffer a diabetic foot ulcer;81 a high percentage of these patients are elderly. In one study, sepsis among 847 patients was measured, demonstrating that age is directly correlated with incidence and severity.82 In particular, sepsis was shown to increase 100-fold with age (.2/1,000 in children to 26.2/1,000 in adults over age 85). The sepsis-based mortality rate was found to be directly correlated to age as well, increasing from 10% in children to 38.4% in those over age 85.
Amputations are another serious morbidity of chronic wounds, especially diabetic foot ulcers. Between 2000 and 2001, more than 82,000 lower limb amputations were performed on patients with diabetes in the United States,83 and statistics indicate that more than 50% of those amputations were on elderly patients.84 When left untreated, chronic wounds will progress to advanced stages and are often associated with damaging pathologies that can ultimately result in death. Specifically, 7.4% of all patients with lower limb amputations performed between 1997 and 1999 suffered mortality.85
While sepsis and amputations are two of the most lethal comorbidities experienced by patients with chronic wounds, additional comorbidities may indicate that the wound has progressed to an advanced stage. The following table summarizes the most serious chronic wound comorbidities:86
| Comorbidity | Association |
|---|
| Lower limb amputation | Diabetic foot ulcer |
| Neuropathy | Diabetic foot ulcer |
| Bacteremia | Pressure ulcer |
| Cellulitis | Diabetic foot ulcer & pressure ulcer |
| Peripheral arterial disease | Diabetic foot ulcer |
| Sepsis | Any chronic wound |
| Osteomyelitis | Pressure ulcer & diabetic foot ulcer |
| Nectrotizing fasciitis | Pressure ulcer & diabetic foot ulcer |
| Renal failure | Diabetic foot ulcer |
| Pyrathrosis | Pressure ulcer |
| Vascular insufficiency | Venous ulcer |
| Secondary infection (pneumonia, endocarditis, etc.) | Pressure ulcer & diabetic foot ulcer |
|
