Facilitating positive outcomes in older adults with wounds.

Older people with wounds are not the same as younger people with wounds. Older people experience biologic differences in wound healing that result in delayed healing, increased wound infection, and a greater incidence of dehiscence. Clinicians need to assess the risk of dehiscence in the older population, looking for serous drainage from the incision line and the absence of a palpable healing ridge. It is critical to recognize that older persons' presentation of wound infection is atypical. More subtle signs such as alteration in cognitive status and changes in function may indicate the presence of infection. The clinician who cares for older persons must be an exquisite detective when such changes occur to identify the source of the problem. As part of the normal trajectory of aging, older persons experience sensory loss and so may require accommodation when explanations are given to them about their wound and their wound care choices. Health care providers must consider hearing and vision changes that occur in older adults and tailor their explanations and teaching so that the message reaches the older adult and is successfully processed. Older persons have a higher incidence of cognitive changes and functional decline than do their younger counterparts, and these changes need to be assessed before a plan of care is developed to care for the older person with a wound. Limited data are available to help the clinician know the cognitive and functional level that is critical for older persons to understand their wound care choices, perform their own wound care, and to make choices about who will provide the care if they are unable to perform self-care. These seemingly basic issues raise questions for clinicians as we strive to provide evidence-based care to this ever-increasing population of older Americans.