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Why you should read this article: • To enhance your understanding of age-related skin changes and susceptibility to wounds in older age • To increase your awareness of the principles of wound assessment and management in older people • To recognise that wound healing is not always achievable or realistic in an older person. Age-related skin changes lead to increased susceptibility to skin damage and delayed wound healing, which is exacerbated by comorbidities such as cardiovascular disease and diabetes mellitus. In some cases, wound healing is not achievable or realistic and this needs to be reflected in the wound management plan. To improve outcomes and experience in older people presenting with wounds it is important to select wound management products that protect the wound bed and surrounding skin, minimise trauma, reduce symptoms and/or promote healing. This article explores how conducting holistic wound assessments, setting realistic treatment aims, and using wound management strategies tailored to each person’s needs and wishes can have a positive effect on older people’s quality of life. [ABSTRACT FROM AUTHOR]

New standards on record-keeping and documentation in wound care should be available for use by nurses later in the year. [ABSTRACT FROM AUTHOR]

The article discusses the things nurses in the United Kingdom (UK) to improve treatment and facilitate the healing of patients with ulcers and chronic wounds. Also cited are a study on the cost of serious wound management incurred by the National Health Service (NHS) annually, and the comment of Legs Matter chairperson Leanne Atkin on the need to support nurses in caring for patients with chronic wounds.

The article discusses the results of a study on the effectiveness of automated ankle-brachial pressure index (ABPI) devices in providing care for patients with lower limb wounds. Topics mentioned include the reduction in the number of referrals of patients in general practice to other services, the comparison of wound management costs for general practice surgeries in 2019 and 2019, and some recommendations for practice for the ABPI devices.

Like many general practices across the country, Angel Hill Surgery had a large cohort of patients attending for leg ulcer dressings for many weeks before they had a Doppler scan and received compression bandaging. Healing rates were poor and patient satisfaction was low. Consequently, the nursing team was dispirited. [ABSTRACT FROM AUTHOR]

A venous leg ulcer (VLU) is defined as the loss of skin below the knee on the leg or foot in the presence of venous disease, which takes more than two weeks to heal. The prevalence of VLUs is increasing, especially in older people, which will increase the demand for nursing care. Development of a lower leg ulcer should trigger immediate assessment of risk factors for chronic venous disease followed by action to identify the cause and initiate treatment, which should prevent progression to more complex and chronic problems. Justification for choice of appropriate wound management and application of compression therapy should be based on the assessment and diagnosis. Management of patients with VLUs can be cyclical and lifelong, which highlights the importance of helping patients to understand the rationale for management strategies so that cooperation in self-care is achieved. [ABSTRACT FROM AUTHOR]

Chronic inflammation in a wound is often associated with infection and biofilm, which are linked to raised matrix metalloproteinases (elevated protease activity) and reduced cell production along with growth hormones in the wound bed. This causes persistent challenges to healthcare professionals and increases the costs of wound management; the related symptoms also affect the quality of life (QoL) of patients living with wounds that are hard to heal. Electrical energy known as the 'current of injury' is required to assist in tissue repair. It allows different cell types, such as white blood cells, growth factors, enzymes and fibroblasts, into the wound to allow for stimulation of cell proliferation and collagen synthesis. In chronic wounds, the current of injury becomes disrupted due to biofilms, infection and unhealthy tissue in the wound bed. This prevents the wound from going through normal physiological healing. Use of electrical stimulation and electroceutical treatment effectively restores the current of injury, expediting normal healing and reducing chronic inflammation, biofilms, infection and associated symptoms, such as pain and high exudate. Clinical outcomes and QoL are improved and there are also economic benefits. [ABSTRACT FROM AUTHOR]

Venous leg ulcers cause significant problems for patients and can have a serious effect on quality of life. The cost of treatment in the UK is huge and recurrence is common. This article examines the evidence for compression therapy in treating venous leg ulcers and the different types of compression used in practice. It also considers some of the challenges in achieving international consensus on compression, and highlights clinician skill as a variable that future studies into the effectiveness of compression therapy must address. [ABSTRACT FROM AUTHOR]

The aim of this article is to explore the evidence surrounding the effect of venous leg ulceration (VLU) on patients' quality of life. There is a large amount of evidence about the treatment of VLU in terms of pathophysiology, healing and symptom control. This has been formulated into clear protocols for community nurses to guide wound management. However, guidance for practice in terms of the wider psychological and social implications of supporting patients living with VLU is limited. This article aims to evaluate the literature on the quality of life of patients with VLU and suggests improvements that will make practice more holistic. [ABSTRACT FROM AUTHOR]

The use of sugar in the treatment of wounds dates back to Ancient Egypt. This article begins with a summary of that history and, in the case study that follows, a patient describes his 13-year experience of living with leg ulcers. The patient explains the challenges these ulcers have brought to his day-to-day life and the particular problems he encountered with pain management. He discusses different approaches by doctors and district nurses to manage the ulcers and how, by chance, a newspaper article led to a meeting with a PhD student researching sugar and wound care - a meeting that was to lead to a new lease of life for the patient. [ABSTRACT FROM AUTHOR]

Chronic venous leg ulceration is a long-term condition commonly associated with lower-limb injecting and chronic venous hypertension caused by collapsed veins, incompetent valves, deep vein thrombosis and reflux. It is not usually a medical emergency, but intravenous (IV) drug users with leg ulcers can attend emergency departments (EDs) with a different primary complaint such as pain or because they cannot access local primary care or voluntary services. Leg ulceration might then be identified during history taking, so it is important that ED nurses know how to assess and manage these wounds. This article explains how to assess and manage chronic venous leg ulcers in patients with a history of IV drug use, and highlights the importance of referral to specialist services when required, and to local primary care or voluntary services, before discharge to prevent admission and re-attendance. [ABSTRACT FROM AUTHOR]

Leg ulcer treatment is a substantial aspect of primary care nursing. Approximately 70 per cent of all leg ulcers are venous and research suggests that such ulcers are highly likely to recur unless appropriate aftercare is provided. Kenneth Ripley reviews local practice provision by the nursing intervention team in the light of best-evidence and provides guidance and recommendations for enhancing patient care and outcome. [ABSTRACT FROM AUTHOR]

This article aims to explain the difference between venous and arterial leg ulcers, methods of treatment and prevention for each kind of ulcer, and the social and emotional impact of venous ulcers. [ABSTRACT FROM AUTHOR]

This article discusses the protocol in managing leg ulcer. A leg ulcer is defined as a wound below the knee that has been present for longer than six weeks. The management of leg ulcers is determined by their aetiology. Between about 60 and 70 percent of leg ulcers are caused by chronic venous hypertension and these are usually managed by the application of compression to improve venous insufficiency and blood supply. The most important role for emergency nurses is appropriate referral and follow up.

The article focuses on the specialist wound medicine centre at the Victorial Hopsital in Deal, Kent, England. Topics discussed include the advanced wound nurses and a tissue viability nurse at the centre, the satellite clinics of the centre, and the podiatry and lymphoedema services being provided by the centre.

The author describes how her general practitioner (GP) practice established the Best Foot Forward Leg Club in Dorset, England to engage with lower leg ulcer patients and reduce time spent in treatment rooms so as to spend more time for other nursing needs. She notes that addressing the social isolation linked to lower leg ulceration will help support patients to self-manage their condition. Also noted is her plan to be involved in a research project on improving compliance and wound healing.

What is your job? I am an independent specialist practitioner and visiting fellow at Queensland University of Technology, Australia, and life president of the Lind say Leg Club Foundation. The foundation helps people to take ownership of their care when living with leg ulcers and associated conditions. [ABSTRACT FROM AUTHOR]

The Barnstaple Leg Club has been running for almost two years in north Devon providing treatment and support to older people with leg ulcers on a weekly basis. This article examines the concept of leg clubs and describes how the community nursing team that leads the club offers holistic care to local people. The nurses are able to see more patients than they would by carrying out home visits, healing their wounds and boosting their self-esteem and confidence, while at the same time reducing social isolation. [ABSTRACT FROM AUTHOR]

When asked to set up a dedicated nurse-led leg ulcer clinic, community nurse Linda Harris was full of enthusiasm. She began to doubt she had made the right decision, however, when she realised she had to spend long periods of time kneeling on the floor, and would have to maintain a flexed and twisted body posture while cleansing or dressing patients' legs. Determined to provide continuity of care for these patents, she explored the market and when no suitable equipment could be found, she set about developing a prototype for a height-adjustable trolley and footbath. These are now in production so that other nurses can use them. [ABSTRACT FROM AUTHOR]

This section offers news briefs on research about nursing older people. A study has found that some patients developed post-thrombotic syndrome in the second year and was lowered in patients who used elastic compression stocking for two years. A review and meta-analysis has shown that a high intake of whole grain is associated with a lower risk of coronary heart disease, cardiovascular disease, and total cancer.

The article presents abstracts on topics related to nursing for older people which include the benefits of saturated fat, the benefits offered by dance and exercise after breast operations, and aspirin as the best treatment for leg ulcers.

Abstracts of several articles related to gerontological nursing are presented such as "Consumption of spicy foods and total and cause specific mortality: population based cohort study," by J. Lv and colleagues, "Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment," by J. Pagonabarraga and colleagues, and "Zinc-impregnated and odour-control two-layer compression," by J. Stephen-Haynes and R. Callaghan.

The article reports on the results of a study led by Markos Klonizakis from Sheffield Hallam University in England which aims to investigates whether exercise can improve outcomes for patients with chronic venous leg ulcers.

The article offers Great Britain healthcare industry news briefs as of April 2014. A study conducted to test the clinical effectiveness of two compression stocking treatments on venous leg ulcers. A study to test the clinical and cost effectiveness of dressings used by National Health Service patients for the treatment of venous leg ulcers. A study to examine the level of pain and health and wound healing in patients with chronic leg ulcers.

The article offers information related to several health care industry researches as of February 2014. Research topics include the impact of home-based telecare (TC) on health-related quality of life of older people, effectiveness of nurse-led management of hypertension and comparative research on the effectiveness of compression bandages and hosiery for leg ulcers.

The article features community nurse Linda Harris, who invented the Harris Trolle, which allows nurses to bathe and cleanse leg ulcers at a height that is suitable for patients and nurses.

The article presents research articles from various journals including “Living a life in shades of grey” by Kouwenhoven and colleagues from the Journal of Advanced Nursing. “Spray-applied cell therapy with human allogeneic fibroblasts and keratinocytes for the treatment of chronic venous leg ulcers” by Kirsner and colleagues from the Lancet. “Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis” by Guermazi and colleagues from the British Medical Journal.

The author discusses some of the reasons as to why venous leg ulcers remain the cause of such pain and suffering as well as a major health cost worldwide. He mentions the urgent need for something to be done to tackle this problem owing to the fact that the recovery rate was under 10 percent while the infection rate was nearly 60 percent. He recommends that the best solution would probably be to encourage compliance, or at least admit to failure over ulcers.

The article discusses medical research published in various journals. A study published in the "British Medical Journal" found that ultrasound does not make any difference in hard to heal ulcers. Another study published in the "Health Technology Assessment" concluded that water softeners may benefit children with eczema. Research published in the "Journal of Family Planning and Reproductive Health Care" found that young people want anonymity and confidentiality when it comes to contraceptives.