Neuropathic diabetic foot ulcers in the elderly: clinical outcomes and healing
DOI:
https://doi.org/10.15277/bjd.2023.414Keywords:
elderly, diabetes foot ulcer, healing outcomesAbstract
There is little evidence on healing outcomes of neuropathic foot ulcers in elderly patients.
Aims: To determine the healing rates of neuropathic diabetic foot ulcers at 12 and 24 weeks achieved by standard care provided at an established multidisciplinary diabetes foot clinic in patients aged 65 years and above. Data on the incidence of falls and hypoglycaemia were also collected due to their perceived clinical risk in the group studied.
Methods: This was a retrospective observational study looking at clinical outcomes of neuropathic foot ulcers. Patients aged 65 years or more presenting with a non-infected neuropathic ulcer at the time of their initial review were identified and classified into two groups: Group E patients were aged above 80 years and Group Y patients 65-80 years.
Results: A total of 97 patients, presenting with 106 ulcer episodes, were identified. Mean HbA1c was 60 mmol/mol in Group Y and 55 mmol/mol in Group E. Healing rates of all ulcers at 12 and 24 weeks in the elderly group lagged behind rates in the younger group (67.6% at 12 weeks and 73% at 24 weeks in Group E vs. 78.2% at both intervals in Group Y).
The elderly group had more falls, 11% vs. 2% in Group Y. In all, 50% of the falls in Group E were attributed to their prescribed pressure relief (off-loading) devices.
Conclusions: With standard foot care given in a multi- disciplinary foot service, neuropathic diabetic foot ulcers can heal in the elderly despite their age-related skin changes.
The rate of healing of neuropathic ulcers noted in our study provides a benchmark for healing outcomes and enables comparison with other age groups and centres. Our study identifies a risk of falls associated with off-loading devices and highlights the need for structured falls risk and mobility assessments in this group.
References
Pataky Z, Vischer U. Diabetic foot disease in the elderly. Diabetes Metab 2007;33:S56-65. https://doi.org/10.1016/s1262-3636(07)80057-7
Plummer ES, Albert SG. Diabetic foot management in the elderly. Clin Geriatr Med 2008;24(3):551-67. https://doi.org/10.1016/j.cger.2008.03.009
Beard JR, Officer A, de Carvalho IA, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet 2016;387(10033):2145-54. https://doi.org/10.1016/S0140-6736(15)
-4. Epub 2015 Oct 29. PMID: 26520231; PMCID: PMC4848186.
Bonifant H, Holloway S. A review of the effects of ageing on skin integrity and wound healing. Br J Community Nurs 2019; 24(Sup3): S28-S33. https://doi.org/10.12968/bjcn.2019.24.Sup3.S28. PMID: 30817191.
Ince P, Game F, Jeffcoate W. Rate of healing of neuropathic ulcers of the foot in diabetes and its relationship to ulcer duration and ulcer area. Diabetes Care 2007;30(3):660-3. https://doi.org/10.2337/dc06-2043
Gershater MA, Apelqvist J. Elderly individuals with diabetes and foot ulcer have a probability for healing despite extensive comorbidity and dependency. Expert Rev Pharmacoecon Outcomes Res 2021;21(2):277-84. https://doi.org/10.1080/14737167.2020.1773804. Epub 2020 Jun 12. PMID: 32448021.
NICE Clinical guideline (CG161). Falls in older people: assessing risk and prevention. Published date: 12 June 2013.
Nandy S, Parsons S, Cryer C, et al. Development and preliminary examination of the predictive validity of the Falls Risk Assessment Tool (FRAT) for use in primary care. J Public Health (Oxf) 2004; 26(2):138-43. https://doi.org/10.1093/pubmed/fdh132
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