With age comes increased concern about many things. Seniors must contend with financial decisions about how best to prepare for retirement. Where to retire is another decision that many seniors face. There may be concerns about staying healthy and when, if at all, to hire home health care. And of course, there are health concerns.
When we speak of health concerns for seniors, things like cancer, heart disease, dementia, and arthritis likely come to mind. However, there is a concern that imposes a significant and often underappreciated burden to the individual, the healthcare system and society as a whole.
I’m talking about chronic wounds. Chronic wounds are wounds that fail to follow the normal, or expected course of healing, and may lead to increased hospital stays, readmission, and certainly increased costs.
Increasing Numbers
One analysis found that 8.2 million people had wounds with or without infections, 6.5 of which were chronic. This number is driven by the growing prevalence of pre-existing conditions that often impair wound healing. Some of these include diabetes, obesity, and kidney and liver disease.
The report goes on to say that, due to the prevalence of chronic wounds, in 2019, advanced wound care products dominated the wound care market. The wound care market comprises surgical wound care, traditional wound care, and advanced wound care products. While the first two segments have remained relatively stable, advanced wound care has seen significant increases due to the rising incidence of hard-to-heal wounds.
Within the advanced wound care market, a market that attends to wounds like venous leg ulcers, pressure ulcers, traumatic wounds and burns, diabetic foot ulcers occupy the largest percentage.
As far as facilities to treat chronic wounds, which consist of long-term care facilities, home care setting and hospitals and clinics, hospitals and clinics represent the largest segment. This can be attributed to the increased need to address critical cases, increasing incidence of hospital-acquired infections (HAIs) and a growing number of surgical procedures.
Globally, the wound care market is largest in North America, a fact that many experts attribute to the rising incidence of diabetes, a growing geriatric population, and the availability of advanced wound care facilities, professionals and facilities.
Increasing Complications
As noted above, chronic wounds are those that do not progress through a normal, predicted, and timely process of repair. Because chronic wounds do not heal like traditional wounds, they are often incorrectly treated. This is evidenced by increased morbidity and increased cost.
One example is lower extremity wounds which include arterial, diabetic, pressure, and venous ulcers. While all patients with a nonhealing lower extremity ulcer should have a vascular assessment, including documentation of wound location, size, depth, drainage, and tissue type; palpation of pedal pulses; and measurement of the ankle-brachial index, this is often not the case.
Further, non healing wounds may require a biopsy to identify any additional treatment measures that may be required. While the TIME principle – tissue debridement, infection control, moisture balance, and edges of the wound – should guide treatment, treatment also needs to be specific to the type of wound.
Referral to a vascular surgeon, for example, is recommended for patients with arterial ulcers. Venous ulcers, on the other hand, call for compression and elevation of the lower extremities, as well as exercise. Lastly, diabetic foot ulcers and pressure ulcers both require offloading of the affected area.
Increasing Costs
Because chronic wounds do not heal as expected, and require increased time, treatment and hospitalization, it is no surprise that they also cost much more to treat than traditional wounds. Even in wealthy societies, it has been proven that chronic wounds account for the large proportion of costs in the healthcare system.
While the management of chronic wounds reaches a total of 2-4 percent of the health budget in western countries, what must also be accounted for is the treatment of underlying conditions that may be contributing to the chronic wound. The requirement of a multidisciplinary approach adds to the increased cost of treating a chronic wound.
In 2014, wound care for Medicare beneficiaries cost an estimated $28 billion to $96.8 billion. A more recent report by Wound Care Market forecasts that by 2024, the cost of chronic wound care will reach 24.8 -- up from 19.8 billion in 2019.
The highest expenses were for surgical wounds followed by diabetic foot ulcers As many experts note, with an increasing incidence of diabetes and obesity, the percentage of diabetic foot ulcers is only expected to rise. Moreover, underlying conditions ranging from malnutrition, to stress, to metabolic syndrome that predispose patients to chronic, non healing wounds contribute to increased cost of treatment for chronic wounds. The result is a substantial clinical, social, and economic challenge.
Unlike conditions like cancer or heart disease, chronic wounds are not given nearly as much attention, and often slip under the radar. Yet, they are a significant burden to the health care system, and unappreciated not only because the numbers are expected to rise, but also because they come with increased complications and underlying conditions that require a broader based, and longer lasting treatment approach. What is clear, is that more attention to chronic wounds is needed, both in prevention and treatment.
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