Why There Is Delayed Wound Healing in Older People - A Discussion

Introduction

The healing of wounds is a biological process that comprises a series of changes like inflammation, proliferation, angiogenesis, epidermal regrowth, wound healing or contraction, and the remodeling phase. Aging has a higher impact on these phases of wound healing resulting in slow or delayed healing of the wounds. The article describes how wound healing is delayed with aging, how it influences the quality of life of older age groups, and what current novel approaches or therapies are advocated to promote the wound healing process in older age groups. Read the article to know more about how aging impacts the wound-healing process.

What Is the Basic Science Behind Wound Healing?

The healing of wounds undergoes a series of pathophysiological events for the complete repair, regeneration, and remodeling of chronic wounds. Different phases or changes that occur during the beginning to the end of the wound healing process are:

1. Inflammatory Phase: In this phase neutrophil and monocyte infiltration occur along with lymphocytes.

2. Proliferation Phase: In this phase formation of granulocyte tissue and collagen fibers occurs with the proliferation of basal cells.

3. Angiogenesis: Growth of blood vessels.

4. Epidermal Regrowth: It occurs through the stimulation of endothelial growth factors (epidermal growth factor) and keratinocytes.

5. Wound Contraction: Contraction of the wound occurs in this phase to reduce the size of the defects (it occurs in response to myofibroblasts).

6. Repair and Remodeling Phase: This phase is also known as the “maturation phase”. In this phase there is the formation of cellular connective tissue, strengthening of the new epithelial layer, and contraction of the wound occurs.

A protein named MMP or matrix metalloproteinases are involved in each of these phases and play a crucial role in wound healing from the beginning to the end of the wound healing process.

Does Aging Impact the Wound Healing Process?

Healing of wounds is a slowly progressing process that is important for the complete repair and regeneration of the wounds. However, the efficiency of wound healing reduces drastically with age resulting in incomplete repair and remodeling of chronic wounds, thereby impacting the quality of life of older people. Furthermore, the phases of wound healing reduce with age because of the hampering of different phases that are involved in the wound healing process resulting in reducing the overall healing process. A few changes or disturbances that occur in the normal series or events of the wound healing phases that result in delayed wound healing are:

• Reduction in the inflammatory response: An increase in the levels of cytokines (proinflammatory) such as interleukin-6 (IL-6) and alpha tumor necrosis factor is responsible for the reduction in the growth factors required for the efficient wound healing process.

• Reduction in the proliferative process of healing.

• Hampering the remodeling process to some extent.

• Increased expression of matrix metalloproteinases delays the healing process.

• Reduction in the expression of beta transforming growth factor.

• Weak cellular response.

• Increase elastase or collagenase expression.

• Reduced microcirculation (arteries, veins, and capillaries) in the skin of older age people is another cause of delay in wound healing.

What Changes in the Body Affect the Wound Healing Mechanism?

With increasing age, the body undergoes a wide variety of changes that hamper and slows down the wound-healing process drastically. A few changes in the body that occurs, resulting in delayed wound healing are:

• Reduction in the overall energy with aging.

• The nutritional deficit in adults.

• Degeneration of neurons.

• Homeostatic (capability to maintain static balance within internal body organs) imbalance with an age-like increase in proinflammatory cytokines and reduction in antioxidants.

• Other intrinsic factors include skin changes with age, dermis thinning, and keratinocyte proliferation and migration reduction.

What Are the Current Novel Approaches and Therapeutic Techniques Developed for Managing Delayed Wound Healing in the Elderly?

According to current research and the trials, different therapeutic approaches are developed for overcoming the delayed wound healing process, such as:

• Tissue-engineered Products: According to clinical trials, cellular or tissue-engineered products such as topical wound spray have shown efficacy in wound healing in patients with venous leg ulcers.

• Hyperbaric Oxygen (HBO) Therapy: According to clinical research, hyperbaric oxygen therapy helps to combat hypervascularity and hypocellularity, thereby improving the microcirculation or vascularity (hypervascularity) to the area of the wound, improving the wound healing process. It also helps to improve oxygen content in the area of wounds, thereby promoting the wound-healing process. Hyperbaric oxygen therapy mostly targets pluripotent stem cells. These stem cells help in the repair and regeneration of the wound.

• Negative Pressure Wound Therapy: There are few pieces of research supporting negative pressure wound therapy for improvement in wound healing. However, a few studies indicate improved wound contraction in the older age groups. Furthermore, research and clinical trials are needed to completely understand the importance of negative pressure wound therapy in the improvement of wound healing in adults.

• Electrical Stimulation Therapy: A few studies and clinical trials suggest that electrotherapy helps in promoting the wound healing process by increasing the vascular supply (blood supply) in the wound area. It also helps to improve blood circulation to the graft or flaps covering the wound and reduces the risk of wound necrosis.

• Low-Frequency Ultrasound: According to current research, a low-frequency ultrasound (22 to 35 kHz) helps reduce the infection in the area of wounds and promotes the healing process of the wound.

• Nutritional Care: Nutrition is one of the factors resulting in compromised wound healing in older patients; as with aging, the diet and nutrition are affected due to various causes like indigestion or underlying systemic illness. So, a complete nutritional and balanced diet full of effective vitamins like vitamin C and vitamin K improves the wound healing process.

Conclusion

A significant impact of delayed healing of the wound has been observed in older people affecting the quality of life among the older age groups. Different therapeutic techniques and novel approaches have been developed for the betterment of the wound-healing process in the elderly, especially among those with underlying systemic diseases like diabetes and metabolic disorders. However, further clinical trials and research are yet to be developed and implemented to overcome the challenges faced by healthcare professionals and patients during the wound healing process in the older age group.