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Ace Your Certification: Wound Care in Elderly Patients
Journal of the American College of Clinical Wound Specialists (2015) 6, 29–30
COLUMN
Ace Your Certification: Wound Care in Elderly Patients Jayesh Shah, MD, CWS, FACCWS, FAPWCA, UHM, FACHM* NE Baptist Wound Healing Center, NE Baptist Hospital, 8811 Village Drive, San Antonio, TX 78217, USA
1. Following statement are true about wound care in elderly patients except a. Venous stasis ulcer incidence is three to four times higher in persons older than 80 years compared with persons aged 65–70 year old b. Pressure ulcer incidence is 5–7 times higher persons older than 80 years compared with persons aged 65–70 year old c. Disproportionate and increasing number of older adults undergoes surgery and is at risk for wound complications d. Studies indicate the incidence of chronic wounds decreases with age even into late life 2. Following statements about cost of care in elderly patient in USA is true except a. USA spends 4–5 times more than European countries in elderly care b. One out of 4 health care dollars are spent in the last year of life c. Care for chronic wounds costs about $50 billion annually d. Wound care in adult’s aged 65 and older accounts for the majority of these costs 3. Elderly skin has a. Increased fatty layers b. Increase time to epidermal regeneration c. Increase size of Rete Ridges d. Increase collagen and elastin fibers 4. Properties in skin of elderly includes all except
* Corresponding author. E-mail address: [email protected] 2213-5103/$ - see front matter http://dx.doi.org/10.1016/j.jccw.2015.08.004
a. b. c. d.
Prolonged inflammation Increased MMP and elastase expression Increased expression of TGF-Beta Weakened cellular response in an atrophic extracellular matrix 5. Scarless healing is found in a. Fetal b. Juvenile c. Early adult d. Aged adult Answers: 1. d, 2. c, 3. c, 4. c, 5. a Question 1. Answer (d) Studies using the General Practice Research Database in the United Kingdom have found that VLU incidence is three to four times higher and Pressure ulcer incidence five to seven times higher in persons older than 80 years compared with persons aged 65–70 years.1–3 Chronic wounds which include venous leg ulcer (VLU), diabetic foot ulcers (DFUs), arterial insufficiency, and pressure ulcers (PU) disproportionately affect older adults. Also there is increasing number of older adults undergo surgery and are at risk for wound complications.3 Question 2. Answer (c) Care for chronic wound costs about $10 billion annually.3,4 USA spends at least 4–5 times more in elderly care than European countries and CMS data’s shows that 1 out of every 4 dollar is spent in last year of life.5
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Journal of the American College of Clinical Wound Specialists, Vol 6, No 1-2
Question 3. Answer (c) Elderly skin has decreased fatty layers; Increase time for epidermal regeneration, decrease size of rete ridges and increase collagen and elastin fibers.6 Question 4. Answer (c) Properties in skin of elderly includes a) prolonged inflammation b) Increased, MMP and Elastase expression c) decreased expression of TGF Beta and d) Weakened cellular response in an atrophic extracellular matrix.3,7 Question 5. Answer (a) Scarless healing is found in fetus.3,7
References 1. Margolis DJ, et al. Venous leg ulcer: incidence and prevalence in the elderly. J Am Acad Dermatol 2002;46:381–6. 2. Margolis DJ, et al. The incidence and prevalence of pressure ulcers among elderly patients in general medical practice. Ann Epidemiol 2002;12:321–5. 3. Gould, et al. Chronic wound repair and healing in older adults: current status and future research. Wound Repair Regen Jan–Feb 2015;23(1):1–13. 4. Bickers DR, et al. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol 2006;55:490–500. 5. CMS Medicare data 2003. 6. Shah JB. Chapter 3, Anatomy of skin. In: Wound care certification study guide. Best Publishing; 2011. p. 21–3. 7. Gurtner GC, et al. Wound repair and regeneration. Nature 2008;453: 314–21.
COLUMN
Ace Your Certification: Wound Care in Elderly Patients Jayesh Shah, MD, CWS, FACCWS, FAPWCA, UHM, FACHM* NE Baptist Wound Healing Center, NE Baptist Hospital, 8811 Village Drive, San Antonio, TX 78217, USA
1. Following statement are true about wound care in elderly patients except a. Venous stasis ulcer incidence is three to four times higher in persons older than 80 years compared with persons aged 65–70 year old b. Pressure ulcer incidence is 5–7 times higher persons older than 80 years compared with persons aged 65–70 year old c. Disproportionate and increasing number of older adults undergoes surgery and is at risk for wound complications d. Studies indicate the incidence of chronic wounds decreases with age even into late life 2. Following statements about cost of care in elderly patient in USA is true except a. USA spends 4–5 times more than European countries in elderly care b. One out of 4 health care dollars are spent in the last year of life c. Care for chronic wounds costs about $50 billion annually d. Wound care in adult’s aged 65 and older accounts for the majority of these costs 3. Elderly skin has a. Increased fatty layers b. Increase time to epidermal regeneration c. Increase size of Rete Ridges d. Increase collagen and elastin fibers 4. Properties in skin of elderly includes all except
* Corresponding author. E-mail address: [email protected] 2213-5103/$ - see front matter http://dx.doi.org/10.1016/j.jccw.2015.08.004
a. b. c. d.
Prolonged inflammation Increased MMP and elastase expression Increased expression of TGF-Beta Weakened cellular response in an atrophic extracellular matrix 5. Scarless healing is found in a. Fetal b. Juvenile c. Early adult d. Aged adult Answers: 1. d, 2. c, 3. c, 4. c, 5. a Question 1. Answer (d) Studies using the General Practice Research Database in the United Kingdom have found that VLU incidence is three to four times higher and Pressure ulcer incidence five to seven times higher in persons older than 80 years compared with persons aged 65–70 years.1–3 Chronic wounds which include venous leg ulcer (VLU), diabetic foot ulcers (DFUs), arterial insufficiency, and pressure ulcers (PU) disproportionately affect older adults. Also there is increasing number of older adults undergo surgery and are at risk for wound complications.3 Question 2. Answer (c) Care for chronic wound costs about $10 billion annually.3,4 USA spends at least 4–5 times more in elderly care than European countries and CMS data’s shows that 1 out of every 4 dollar is spent in last year of life.5
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Journal of the American College of Clinical Wound Specialists, Vol 6, No 1-2
Question 3. Answer (c) Elderly skin has decreased fatty layers; Increase time for epidermal regeneration, decrease size of rete ridges and increase collagen and elastin fibers.6 Question 4. Answer (c) Properties in skin of elderly includes a) prolonged inflammation b) Increased, MMP and Elastase expression c) decreased expression of TGF Beta and d) Weakened cellular response in an atrophic extracellular matrix.3,7 Question 5. Answer (a) Scarless healing is found in fetus.3,7
References 1. Margolis DJ, et al. Venous leg ulcer: incidence and prevalence in the elderly. J Am Acad Dermatol 2002;46:381–6. 2. Margolis DJ, et al. The incidence and prevalence of pressure ulcers among elderly patients in general medical practice. Ann Epidemiol 2002;12:321–5. 3. Gould, et al. Chronic wound repair and healing in older adults: current status and future research. Wound Repair Regen Jan–Feb 2015;23(1):1–13. 4. Bickers DR, et al. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol 2006;55:490–500. 5. CMS Medicare data 2003. 6. Shah JB. Chapter 3, Anatomy of skin. In: Wound care certification study guide. Best Publishing; 2011. p. 21–3. 7. Gurtner GC, et al. Wound repair and regeneration. Nature 2008;453: 314–21.