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Guest Editorial: Wound Healing: A Rose in the Desert
Americans are aging in record numbers. By 2030, the estimated 35 million older persons living today will double as baby boomers pass through their 60s, 70s, and 80s.1 In the coming decades, it may not be unusual for most seniors to flourish well into their 90s — 100-year-old patients may some day represent the norm.
Many elderly patients will reside in nursing or extended care facilities. As part of the natural aging process, many will develop fragile skin with predilection toward skin tears. This seemingly innocuous malady may lead to substantial disability, pain, and infection, among other complications. In this issue of Ostomy Wound Management, Jane Fore, MD, presents a comprehensive review of normal skin anatomy and physiology, followed by a chronology of skin changes associated with aging. Dena Bank and Denise Nix discuss the results of a study conducted in a 209-bed urban nursing and rehabilitation center involving the clinical effectiveness of a preventive skin protocol.
With more than 1 million new cases diagnosed every year, diabetes remains a formidable clinical opponent. Of the population with diabetes, 15% will develop foot ulcers in their lifetimes2 and many will succumb to the ravages of wound complications including amputation, sepsis, and death. Obesity and sedentary life style appear at the forefront of this epidemic — persons age 50 years and older are among the most sedentary segment of the American population.3 Carl Van Gils, DPM, addresses physiologic, socio-economic, and individualized prevention factors that clinicians dealing with elderly patients presenting with diabetic foot ulcers should consider.
Clinical, behavioral, and social risk factors for health and longevity are being identified and their role throughout a person’s life documented.4 My article addresses the importance of evaluating associated stresses, social support, and coping experienced by elderly patients with painful recalcitrant venous leg ulcers; this information may be extrapolated to include other disease states such as diabetic foot ulcers.
In an age when many clinicians appear disgruntled by the pressures of managed care, the burdens of increasing patient visits, and the management of patients with increasing comorbidities, wound healing professionals often are unscathed. Wound care appears to be a rose in the desert, with wound care clinicians remaining focused and passionate despite adversity. But as the groundswell of patients from the baby boomer generation files into our clinics, are we prepared to handle the idiosyncrasies and challenges of their care? If we remain vigilant to our collaborative, disease-specific algorithms and continue as lifelong learners and mentors, the answer is a resounding “yes.”
The September and October issues of OWM provide information and insights to help foster those goals. I am grateful to the contributing authors for the hard work and insights contained in this first of two issues of OWM to focus on geriatric care.
Professionally,
Robert J. Snyder, DPM, FACFAS, CWS
1. Ory MG. Emerging issues in geriatric care: aging and public health perspectives. Available at: www.medscape.com/viewarticle/498939. Accessed August 16, 2006.
2. Snyder R. Graftskin (Apligraf) and Regranex gel: an overview. Podiatr Manage. 2001;Nov-Dec:39–50.
3. Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention. Physical activity and older Americans: benefits and strategies. June 2002. Available at: http://www.ahrq.gov/ppip/activity.htm. Accessed November 25, 2004.
4. Ory MG, Hoffman M, Hawkins M, et al. Challenging aging stereotypes: strategies for creating a more active society. Am J Prevent Med. 2003;25(3S2):164–171.
