Ageing: An independent risk factor in the management of lower extremity wounds

Age has presented as an independent risk factor for reducing the frequency of wound closure in the lower extremities.¹ This is evident during the maturation phase of wound healing as higher instances of infection can occur due to age-related comorbidities such as diabetes mellitus, critical lower limb ischaemia and peripheral neuropathy.^2-5 The maturation phase of wound healing is defined as the process from granulation to the formation of scar tissue.⁶

Wicke et al.¹ define the elderly demographic as equal to, and over the age of 70. This categorisation of age group is problematic as it highlights the dichotomy between ‘older age patients’ and ‘elderly patients’. Moreover, the study does not clearly define the end point for ‘younger patients’; therefore, comparisons made between different age groups are inadequate.^{1, 7, 8}

Both previous and recent research^{9, 10} support the conclusion by Wicke et al.¹ that age was an independent risk factor for less frequent wound closure occurring, citing a statistically higher proportion of patients over the age of 70 experiencing less frequent wound closure.

On the other hand, Wicke et al.¹ acknowledge the non-linear relationship between age and proportion of wound closure. This suggests that the ageing process plays a bigger part than the specific age category. Previous research supports this argument by suggesting that key indicators of less frequent wound closure comprise wounds of a recurrent nature, longer duration, presence of multiple wounds and the frequency of infection.^{11, 12} Recent research reinforces this by suggesting that reduced synthesis of collagen type 1 and 2, due to cellular fibroblast ageing, result in defective mechanical stimulation of chronically ageing skin.¹³ Moreover, reduced replenishment of collagen is due in part to collagen-degrading matrix metalloproteinases.¹⁴ During the ageing process, these enzymes cause the collagen to fragment during the maturation phase of wound healing, causing tissue viability (^{15, 16}).

On the other hand, age is interlinked with other risk factors in reducing the frequency of wound closure such as psychosocial factors including depression, stress and poor lifestyle choices.^{17, 18} Research suggests these factors can be intertwined with detriments to coping strategies as well as existing comorbidities, both of which can alter a patient's motivation and physiological impairments, causing greater potential for neglect of self-care.^19-21

Conclusively, the findings from Wicke et al.¹ contribute in several ways to our understanding of the relationship between age and less frequent wound closure. Both previous and recent research provide consensus that age is a significant factor in less frequent wound closure.³ Although, it must be acknowledged that age encompasses the influence of psychosocial and comorbidities of which it is interwoven. Overall, melded with the intrinsic pathophysiological and psychosocial components of the ageing process, age is an independent risk factor for less frequent wound closure during the maturation phase of wound healing.