Age itself is not an illness, and older people with wounds are just as able to heal, writes Michael Woodward.

The Australian population is aging. Already 13 per cent of Australians are over age 65 and this is rapidly increasing to 25 per cent – a proportion already achieved in Japan.

There are numerous changes of aging, but disease is also more common as we age and both normal aging and morbidity can impact on wounds in older people.

With older people, it is even more important to assess the whole patient, not just the hole in the patient. This usually requires a multidisciplinary approach with access to a doctor skilled in older patients (such as a geriatrician), other specialists as needed (for example, vascular surgeon, dermatologist, plastic surgeon) a nurse, podiatrist, dietitian, orthotists and pharmacist.

These are not always easily accessed in the community or residential care, and the specialist multidisciplinary wound clinic provides a valuable service for those older patients needing more comprehensive management. Fortunately most major cities have such clinics, but there may be long waiting periods to access them and people with limited mobility may find access difficult.

The wound clinician can attend to some of these issues without necessarily requiring the multidisciplinary approach. The person’s nutritional status can be assessed with a nutritional assessment screen.

Hydration is best assessed through axillary sweating- if a piece of absorbent paper placed in the axilla remains dry after a minute or two, the person is likely to be dehydrated- this is more useful than postural hypotension/tachycardia, skin turgor or sunken eyes. Pallor can be indicative of anaemia but is best confirmed with a haemoglobin level. A full list of medications may reveal polypharmacy and in particular if the person is taking agents that may delay wound healing- these include steroids and NSAIDs (which may be over the counter such as Neurofen). A home visit is the best way to obtain a full list of all the medications the person is using. Peripheral sensation can easily be assessed using a monofilament.

While the astute nurse can carry out much of the initial assessment, the other members of the team may be needed. A doctor is more suitable to assess neurological conditions, including cognitive impairment and other diseases that could impact on wound healing. The pharmacist is a valuable resource to assess drug interactions and adverse effects, and the podiatrist can provide a detailed assessment of the feet and footwear. Caring for older people with wounds requires the maximal utilisation of the team that is available, and referral lines if some specialties are not at hand.

Socioeconomic factors can particularly affect older people. They may not be able to afford the dressings or even the cost of nursing visits, and they may not have transport to attend health professionals or to go out to purchase wound products or basic food items. They may be isolated and have nobody to assist in applying tight pressure stockings.

Nurses are well equipped in assessing and providing solutions to overcome many of these issues, but again may need other members of the team – such as involvement of the Aged Care Assessment Team.

The good news is that age itself is not an illness, and older people with wounds are just as able to heal, and remain healed, as younger people. It usually requires a more comprehensive, team-based approach, but that is both the challenge and reward of successful health care – and the nurse providing wound care is well trained in this interdisciplinary approach.

Associate Professor Michael Woodward is president of the Australian Wound Management Association.