Why wounds in older adults heal more slowly
Age by itself does not stop a wound from healing, but several things that come with age stack up. Skin becomes thinner and loses the padding underneath it, so it tears and bruises more easily and has less to rebuild with. Circulation to the legs and feet is often reduced, which means less oxygen and fewer nutrients reach the wound. Diabetes, common in older adults, slows every stage of healing and dulls the pain signal that would otherwise prompt someone to look at a sore. Nutrition is frequently the quiet problem: an older person who is eating less, or eating mostly carbohydrates, does not have the protein a wound needs. And medications such as blood thinners, steroids and some chemotherapy drugs interfere with clotting and tissue repair.
None of this means a wound in an older adult cannot heal. It means the plan has to account for all of it at once, which is why wound care for seniors works best when it is tied to primary care rather than treated as a separate problem. Our guides on why some wounds heal slowly and skin tears in older adults go deeper.
Common wounds in seniors
The wounds families most often call about in older adults are:
- Bed sores and pressure injuries. Damage over the tailbone, hips, heels, elbows or back from sitting or lying in one position. They can develop in days and are the most common wound in bed-bound and chair-bound seniors.
- Skin tears. A flap of thin skin pulled away by a bump, a transfer or tape removal. Minor at first, but easily infected and slow to close in fragile skin.
- Diabetic foot ulcers. Open sores on the sole, toes or heel in a person with diabetes, often painless because of nerve damage and therefore found late.
- Venous leg ulcers. Shallow, weeping wounds on the lower leg related to swelling and poor vein function, usually with discolored skin around them.
- Wounds after a fall or surgery. Incisions that open or drain, lacerations from a fall, and wounds around a fracture repair or joint replacement.
Each of these has its own plan, and more than one can be present at the same time. The treating clinician decides what the wound needs. Gateway makes sure the plan actually happens where the patient lives.
Care at home, in assisted living, memory care and skilled nursing
Where a senior lives changes how wound care has to work, so Gateway arranges it differently in each setting.
At home. A physician, podiatrist (DPM) or nurse practitioner visits the house or apartment. The clinician sets the plan, Gateway coordinates supplies and follow-up, and the family or a home health nurse handles dressing changes between visits. This is the service described on our mobile wound care and wound care for homebound patients pages.
In assisted living. Assisted living staff can help with daily needs but usually cannot provide skilled wound treatment. Gateway arranges clinician visits to the community, keeps the community's nursing staff informed and makes sure orders and supplies arrive. See wound care in assisted living.
In memory care. Residents with dementia may not report pain, may pick at dressings and may not tolerate a trip to a clinic. Visits in the familiar setting, with staff who know the resident, work better. See wound care in memory care.
In skilled nursing. Skilled nursing facilities have nurses who can do daily wound care, but many need a visiting wound specialist to assess, debride and direct the plan. Gateway arranges regular facility wound rounds for that purpose.
For adult children, including from out of town
Many of the calls we take come from a son or daughter who lives in another city and just learned that a parent in St. Louis has a wound. The questions are the same every time: how bad is it, who is looking at it, who is changing the dressing, and is anyone actually in charge of this?
Gateway is built to be the answer to that last question. We take the call from the family, gather records with the parent's permission, arrange the visit, and then keep the family informed after each visit so no one has to piece together what happened from a facility voicemail. If you are managing from a distance, start with our guide to helping a parent with a wound from far away. If you are nearby and doing the hands-on care yourself, caring for a parent at home in St. Louis and our page for families and caregivers cover what to watch for and how to ask for help.
How wound care connects with primary care and follow-up after a hospital stay
A wound in an older adult is rarely the only thing going on. Blood sugar, swelling, heart failure, nutrition, mobility and a long medication list all affect whether it heals. That is why Gateway offers wound care and primary care together, often through the same visiting clinicians. Read how primary care and wound care work together, and how diabetes care at home supports foot and leg wounds.
The weeks after a hospital or rehab discharge are the riskiest time. Instructions get lost, supplies do not arrive, the follow-up appointment is three weeks out and the wound changes in the meantime. Gateway's transitional care after discharge is designed for exactly that window, and house calls for seniors covers the broader primary care visits that keep an older adult out of the hospital in the first place.
Warning signs to report now
Call the treating clinician's office, or Gateway, the same day if you notice any of these in an older adult's wound:
- Redness, warmth or swelling spreading outward from the wound
- New or increasing pain, or pain in a wound that used to be painless
- Drainage that is thicker, darker, greener or has a bad smell
- Fever, chills, confusion or a sudden change in alertness
- Black or dark brown tissue that is growing
- Bleeding that soaks through a dressing
- A wound that is larger or deeper than it was a week ago
In older adults, confusion or a sudden decline is often the first sign of infection, before the wound itself looks worse. Our guide to the signs of wound infection explains what each one means. For a medical emergency, call 911.
To ask about wound care for a senior in Greater St. Louis or the Metro East, call 314-325-0126 or request care online. Start with wound care in St. Louis for the full picture of how Gateway arranges care.
Common questions
Can a wound specialist see my parent at home or in their senior living community?
Yes. Gateway arranges visits by a physician, a podiatrist (DPM) or a nurse practitioner at private homes, assisted living, memory care and skilled nursing facilities across Greater St. Louis and the Metro East.
Who changes the dressing between visits?
It depends on where the patient lives and who is already involved. At home it may be a family member, a home health nurse or a private duty caregiver. In a facility it is usually the facility's nursing staff. The visiting clinician writes the instructions, and Gateway makes sure whoever is doing the changes has them.
How does Medicare handle wound care for seniors at home?
It depends on the plan and on the patient's situation. Original Medicare and Medicare Advantage plans each have their own rules for clinician visits at home, for supplies and for home health, and only the plan can say what it will pay. Ask us about your plan before the first visit and we will explain what to check. Our guide on Medicare and wound care at home lists the questions to ask.
My parent has dementia and will not leave the house. Can you still help?
Usually, yes. Visits in a familiar setting are often the only practical option for someone living with dementia, and it is one of the main reasons families call Gateway. Staff or family who know the person can be present during the visit.
How do I get updates if I live out of town?
Tell Gateway, with your parent's permission, that you are the family contact. We will let you know what happened at each visit, what the plan is and what the facility or home caregiver has been asked to do.
What is the difference between a bed sore and a pressure injury?
They are the same thing. Pressure injury is the clinical term; bed sore and pressure ulcer are older names for it. Our page on pressure injuries and bed sores explains the stages and how they are treated.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.