Poor wound repair and issues with healing are common issues in older adults and patients with diabetes. Gould et al. (2015) conducted a study investigating the incidence of chronic wounds in older adults that show that wound healing slows with age, noting that clinical trials that address issues of wound healing often exclude older adults. This research concludes that wound healing processes slow with age, particularly due to the reduced blood flow to the extremes and changes in blood pressure that occur with age.
In this case, Norma James is at risk for impaired skin integrity and impaired wound healing in several domains. The first is that she is a regular smoker, and smokers typically experience worse blood flow and poor healing rates. The second is her age, which as noted by Gould et al. (2015) is a major risk factor for slow wound healing. She is also a diabetic, which is commonly associated with poor wound healing, particularly in the extremities.
The history for her present illness is complex. She has a long history of type 2 diabetes mellitus, and she is taking medication to control blood glucose. She also has hypertension, for which she takes warfarin. She also experiences atrial fibrillation, and she sees multiple different healthcare providers in order to deal with these various health problems. It is also noted in the case study that Norma does not always take her medications correctly, partly because of the cost of these medications.
In terms of recommendations for this patient, the first would be to assess whether she is eligible for any government scheme that can help her to reduce the cost of her medications. It would also be useful to provide patient education to Norma to ensure that she is aware of the importance of her medications to her health. From the vignettes talking to her husband, it may also be worthwhile getting a psychological consultation for grief and to help Norma to make friends and ensure that she has some company.
- Gould, L., Abadir, P., Brem, H., Carter, M., Conner-Kerr, T., Davidson, J., … Schmader, K. (2015). Chronic wound repair and healing in older adults: Current status and future research. Wound Repair and Regeneration, 23(1), 1–13. https://doi.org/10.1111/wrr.12245