Editor’s Note: There are no financial disclosures related to this article.
The US is in the midst of a profound demographic change with the rapid aging of its population — a steep increase reflected by the estimated 75 million baby boomers who will move into the ranks of the geriatric healthcare population during the next 20 years. This demographic change is having a major impact on the organization and delivery of healthcare itself, particularly in the shift from acute to chronic illnesses that require healthcare providers to have an increased understanding of basic principles related to aging. Among the most impacted arenas of healthcare as the population gets older and medicine allows people to live longer with comorbid conditions will be outpatient wound centers. Chronic wounds have great impact on quality of life, and experts have estimated the cost of their care to be in excess of $25 billion.1 In order to provide the highest quality of care and cost-effective treatment with this patient population, wound care clinicians must consider the biologic and psychosocial complexities of aging. Because many nonhealing wounds are the consequence of functional changes and diseases that accompany aging, it is of paramount importance that outpatient wound centers be equipped with the knowledge and infrastructure to meet this challenge and take a comprehensive, multidisciplinary approach to care. This article will provide guidance related to changes associated with aging skin as well as altered physiology and comorbidities that impact wound healing.
Nonhealing chronic wounds among long-term care (LTC) residents continue to be a concern in the US. Up to 11% of patients in this setting are living with pressure ulcers, according to the National Nursing Home Survey. LTC remains a common environment for wounds due to populations of older residents who are often ill, functionally disabled, and/or at the end stages of disease states. According to the National Center for Health Statistics, prevalence of pressure ulcers in LTC can range from 2-28%.1 Many of these patients will require repeated visits to the outpatient wound clinic in order to achieve wound closure. This places outpatient wound centers in the unique position of playing key roles to the LTC treatment overview because many wounds do not heal with conservative measures. Additionally, the federal government uses pressure ulcers as a quality indicator in the LTC environment and nursing homes are required to report the presence or development of pressure ulcers through the Minimum Data Set 3.0,2 further increasing the likelihood of transfers as a method of best practice.
Wound care providers know that a patient’s nutritional status can have a profound effect on wound healing. Unfortunately, research has provided few definite answers as to exactly which nutritional interventions are most effective.
Nutrition assessment, diagnosis, intervention, monitoring, and evaluation are commonplace for patients within hospitals and long-term care (LTC) facilities. Unfortunately, most outpatient wound clinics don’t have protocols in place for evaluating a patient’s nutritional status and implementing timely nutritional interventions. This can be a cause for concern in instances when patients are being seen conjunctively by an outpatient wound clinic and an LTC facility. Wound care clinicians may be unfamiliar with the criteria used to determine whether nutritional status is compromised and may be unsure of which interventions are most useful if ongoing communication with LTC staff is not occurring. Additionally, many wound clinics don’t have access to a registered dietitian (RD) whose expertise is needed in evaluating and treating patients living with chronic wounds. Each patient that presents to the wound clinic will have unique nutritional needs, so clinical judgment is critical when making nutritional recommendations for all patients living with chronic wounds — particularly older adults. Comprehensive nutritional assessment can identify those needs, and regular monitoring and evaluation of weight and food intake can help determine if changes in the nutritional plan of care are needed to help facilitate wound healing.
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