How do wounds intersect with various chronic conditions, and what impact does that have on care?
As we discussed in Part One of this series [INSERT LINK HERE], a huge majority of Americans over sixty-five have more than one chronic conditions. Many of these people will have five or more chronic conditions, which means higher rates of emergency room visits, hospitalizations, and prescriptions. These patients are also more likely to have physical disabilities and to experience social isolation.
There are a variety of common age-related chronic diseases, including cardio-vascular, diabetes, lung, renal, musculoskeletal, neurodegenerative diseases. It’s critical to understand how these diseases impact wound formation, healing, and treatment, and how their combined effects can amplify the effects of pressure injuries in a long-term care setting.
Let’s examine two of the most common: diabetes and cardiovascular disease.
Diabetes is the chronic disease most commonly identified and associated as a risk factor for pressure injuries in any care setting. In many different studies - including both hospital-acquired and facility pressure injuries - diabetic patients are more substantially more likely to develop pressure injuries than non-diabetic patients.
What’s more, the prevalence of diabetes in the population generally has been increasing over the past several decades, and that trend seems likely to continue and accelerate. It can be difficult to distinguish among pressure injuries, diabetic, and ischemic ulcers, and the impact of diabetic neuropathy can seriously contribute to the formation and complication of non-healing wounds. Diabetes also impacts the immune system, making infections more common and complicating wound healing.
Heel ulcers are particularly prevalent among diabetic patients, but diabetes also causes stiffer, thinner skin, which means patients are at high risk for pressure injuries beyond just their feet. Good nutrition, strengthening the muscles in the lower extremities, minimizing bed rest when possible, and skin moisturizing are all important in the prevention of pressure injuries. Avoiding conditions that dry the skin - like hot baths or showers, dry conditions, or dehydration - will also help prevention and healing. In some immobilized patients, of course, pressure injuries will be unavoidable, so tracking bony prominences and likely wound sites will be essential from a very early stage, as wounds are likely to develop sooner and progress more rapidly in diabetic patients.
Older adults are commonly affected by atherosclerosis - often caused by smoking, high blood pressure, hyperlipedemia, diabetes, and/or sedentary lifestyles. As atherosclerosis progresses, it decreases blood perfusion to all parts of the body, but decreased perfusion to the skin can contribute to pressure injury development.
Any cardiovascular disease that results in poor perfusion and reduced circulation results in slower tissue repair, a decrease in lymphatic drainage, and less resilient skin that is more likely to develop a pressure injury. Other associated factors include the side-effects of cardiac, diurectic, and cholesterol medications, edema or dehydration as the result of congestive heart failure, or other comorbidities.
Stroke patients who are immobilized are likely to develop pressure injuries, but if that stroke is resulting from atherosclerotic cerebrovascular disease, then poor perfusion is an additional concern.
Although this article focuses on only the two most common chronic disease categories - diabetes and cardiovascular disease - CPD, kidney disease, musculoskeletal disease, and neurodegenerative diseases all impact pressure injury formation and healing. Understanding how a particular disease impacts skin integrity can help in spotting risk factors and issues early, or helping coordinate care to heal wounds more quickly.
In Part Three of this series, we’ll focus on our philosophy of healing, and what drives our approach to care.
Read PART ONE > More patients, older patients, sicker patients: What’s it mean?
Skilled Wound Care is a mobile surgical practice committed to transforming the chronic wound care model in nursing facilities. Wound care experts make weekly bedside visits to patients in long-term care facilities, avoiding transfers to hospitals or clinics. Our expert physicians give patients the most up-to-date and effective wound treatments, and educate facility staff on how to help patients continue to heal quickly and effectively between visits. This model of collaborative care allows SWC’s physicians to improve patients’ lives and health outcomes, to empower nursing staff, and to raise public awareness. Skilled Wound Care, along with its nurse and nursing home partners, is working every day to positively transform traditional nursing home wound care.