Chronic wounds in the elderly: Decubitus, leg ulcers, and ulcers of rare aetiology

The ageing processes, primarily after the age of 60, bring about a number of important changes that affect the skin’s protective function. These changes directly and indirectly increase its vulnerability and impair its ability to heal. Hence, the incidence of chronic wounds increases in the elderly population. Dry skin, often accompanied by itching and consequent scratching, can lead to the development of wounds. The skin’s ability to regenerate itself is also impaired by the atrophy that affects all the three layers of the skin, the epidermis, dermis, and subcutis. The deterioration of vascularisation and innervation increases the chance of ulcer formation and impaired healing of existing wounds. Together these lead to the development of chronic lower limb ulcers in elderly patients or decubitus in older bedridden patients. Bedsores are more likely to develop in older patients with reduced body weight due to their decreased amount of adipose tissue capable of pressure-relieving. This latter negative tendency may be exacerbated by the presence of reduced mobility, impaired muscle strength, and frequent incontinence. In all respects, the propensity to heal is worse than in younger age, thus in many cases a chronic process is expected, and in some cases halting the progression may be a significant outcome. Ulcers of rare aetiology can occur at any age, so pyoderma gangrenosum, vasculitis, and other ulcers with rare aetiology in the elderly population should also be considered.