Skin, soft tissue, and wound healing in the elderly

Abstract

Aging leads to significant changes that predispose people to problems with their skin. Aging-related alterations in skin can be classified into “intrinsic” changes that are simply related to the natural aging processes and “extrinsic” effects that are due to exposure to the ultraviolet rays of the sun. The elderly tend to have a thinner dermis, flattening of the dermal-epidermal junction, and decreases in the dermal appendages. These changes lead to an increased propensity of skin to tear and shear. The decreased density of appendages impairs the ability to reepithelialize superficial wounds. As everyone knows, the skin also tends to stretch (or sag) which allows for contraction of wounds with less functional impairments. There are also body composition changes to the muscle and fat stores that decrease padding that increase the risk for pressure damage. Age-related disease processes such as urinary incontinence, diabetes mellitus, vascular disease, malignancy and its treatment, and other neurologic diseases predispose patients to increased risk. As people age, their reaction times may decrease to prevent injury, and confusion may lead to increased risky behavior. The incidence of pressure ulcers, arterial ulcers, venous stasis ulcers, and diabetic ulcers increases with age. This chapter will cover the pathophysiology of aging of the skin, the risks that increase the risk for wounds in the elderly, chronic wounds, prevention of wounds, and the outcomes of the elderly with wounds.