Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jan-Feb;23(1):1-13.
doi: 10.1111/wrr.12245. Epub 2015 Feb 13.

Chronic wound repair and healing in older adults: current status and future research

Lisa Gould  1 , Peter Abadir, Harold Brem, Marissa Carter, Teresa Conner-Kerr, Jeff Davidson, Luisa DiPietro, Vincent Falanga, Caroline Fife, Sue Gardner, Elizabeth Grice, John Harmon, William R Hazzard, Kevin P High, Pamela Houghton, Nasreen Jacobson, Robert S Kirsner, Elizabeth J Kovacs, David Margolis, Frances McFarland Horne, May J Reed, Dennis H Sullivan, Stephen Thom, Marjana Tomic-Canic, Jeremy Walston, JoAnne Whitney, John Williams, Susan Zieman, Kenneth Schmader
Affiliations

Chronic wound repair and healing in older adults: current status and future research

Lisa Gould et al. Wound Repair Regen. 2015 Jan-Feb.

Abstract

The incidence of chronic wounds is increased among older adults, and the impact of chronic wounds on quality of life is particularly profound in this population. It is well established that wound healing slows with age. However, the basic biology underlying chronic wounds and the influence of age-associated changes on wound healing are poorly understood. Most studies have used in vitro approaches and various animal models, but observed changes translate poorly to human healing conditions. The impact of age and accompanying multi-morbidity on the effectiveness of existing and emerging treatment approaches for chronic wounds is also unknown, and older adults tend to be excluded from randomized clinical trials. Poorly defined outcomes and variables, lack of standardization in data collection, and variations in the definition, measurement, and treatment of wounds also hamper clinical studies. The Association of Specialty Professors, in conjunction with the National Institute on Aging and the Wound Healing Society, held a workshop, summarized in this paper, to explore the current state of knowledge and research challenges, engage investigators across disciplines, and identify key research questions to guide future study of age-associated changes in chronic wound healing.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest were acknowledged as follows:

Dr. Gould reports non-financial support from MiMedx, Cytomedix, Celleration, and Cardinal Health.

Dr. Abadir has a patent Novel, protective, anti-inflammatory receptor and its use in preservation of mitochondrial function, wound healing and repair pending.

Dr. Davidson reports grants from National Institutes of Health and the Department of Veterans Affairs.

Dr. Fife is the Executive Director of The Chronic Disease Registry (d/b/a the U.S. Wound Registry, USWR), a 501C(3) organization which provided some of the data for this presentation, specifically the data on the use of biological dressings among older patients and their associated healing rates.

Dr. Grice reports grants from Janssen Research and Development; personal fees from GOJO, Amway International, GlaxoSmithKline, and L'Oreal.

Dr. High reports grants from Chimerix, Sanofi-Pasteur, Optimer, Astellas, is a consultant for University of Virginia and the University of Minnesota, other financial or material support from McGraw-Hill Publishers and Uptodate, Inc.

Dr. Jacobson is a Smith and Nephew employee which produces the cell therapy product described in the presentation.

Dr. McFarland Horne reports grants from John A. Hartford Foundation during the conduct of the study.

Dr. Tomic-Canic reports grants from NIH, Organogenesis Inc, Novan, and Smith & Nephew; is a Scientific Board Member for Molnlycke. In addition, Dr. Tomic-Canic has the following patents: Methods and compositions for promoting wound healing issued to Hospital for Special Surgery; GM-CSF ceosmeceutical compositions and methods of use thereof issued to NYU School of Medicine; Biological markers of chronic wound tissue and methods of using for criteria in surgical debridement pending to NYU School of Medicine; Denovo synthesis of glucocortocoid in the epidermis and it uses and applications patent pending to NYU School of Medicine; and Growth factor mediated cosmeceuticals and use of thereof to enhances skin quality patent pending to NYU School of Medicine.

H.Brem, M.Carter, T. Conner-Kerr, L.DiPietro, V.Falanga, S.Gardner, J.Harmon, W. Hazzard, P.Houghton, R. Kirsner, E.Kovacs, D.Margolis, M.Reed, K.Schmader, D.Sullivan, S.Thom, J.Walston, J.Whitney, J.Williams, S.Zieman: No conflicts to disclose

Figures

Figure 1
Figure 1
Burn wound repair is delayed in aged mice. A. Wound area was evaluated 0, 3, 7, 14 and 21 days following burn injury in 2 month old (young) vs 2 year old C57BL/6J mice. B. Bone marrow-derived angiogenic cells were identified by FACS as CXCR4+/Sca-1+. C. HIF1 concentrations in response to burn injury are reduced in aged mice, compared with younger ones. D. Bone marrow-derived angiogenic cells transferred from young male mice show impaired homing in older recipient mice, compared with younger ones. Donor cells were identified using the Sry gene as a marker. N, normal; B, burned. Adapted from: Zhang X et al. Aging impairs the mobilization and homing of bone marrow-derived angiogenic cells to burn wounds. J Mol Med. 2011;89(10):985-95.
Figure 2
Figure 2
Implications of age-associated inflammation for infection. In a mouse model, older mice inoculated with Staphylococcus aureus fail to clear infection, compared with younger mice. Source: Brubaker AL, Rendon JL, Ramirez L, Choudhry MA, Kovacs EJ. Reduced neutrophil chemotaxis and infiltration contributes to delayed resolution of cutaneous wound infection with advanced age. Journal of immunology 2013;190(4):1746-57. Copyright 2013. The American Association of Immunologists, Inc.
See this image and copyright information in PMC

References

    1. Margolis DJ, Bilker W, Santanna J, Baumgarten M. Venous leg ulcer: incidence and prevalence in the elderly. Journal of the American Academy of Dermatology. 2002;46(3):381–386. - PubMed
    1. Margolis DJ, Bilker W, Knauss J, Baumgarten M, Strom BL. The incidence and prevalence of pressure ulcers among elderly patients in general medical practice. Annals of epidemiology. 2002;12(5):321–325. - PubMed
    1. Bickers DR, Lim HW, Margolis D, Weinstock MA, Goodman C, Faulkner E, et al. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. Journal of the American Academy of Dermatology. 2006;55(3):490–500. - PubMed
    1. Badia JG, Santos AB, Contel Segura JC, Teren CA, Gonzalez LC, Ramirez EL, et al. Predictors of mortality among elderly dependent home care patients. BMC health services research. 2013;13:316. - PMC - PubMed
    1. Hopman WM, Harrison MB, Coo H, Friedberg E, Buchanan M, VanDenKerkhof EG. Associations between chronic disease, age and physical and mental health status. Chronic diseases in Canada. 2009;29(3):108–116. - PubMed

Publication types

MeSH terms

Substances