Purpose: The purpose of this study was to determine the extent to which wound severity, demographics, comorbid conditions, risk factors, and selected therapies influenced wound healing in older adults.

Methods: This retrospective chart review study used a structured data abstraction protocol. Trained research assistants at four sites in the US reviewed the closed records of subjects treated for chronic pressure, diabetic, or venous ulcers. Data were recorded at monthly intervals over a 6 month period.  

Results: A total of 400 subjects were included in our database: 114 pressure, 103 diabetic, and 183 venous. Sample description was: 72.7 years old, 56.5% female, 60.6% white, 34.7% married, and 72.7% Medicare. Severity scores ranged from 0 to 15. Bivariate analysis showed that higher severity scores were associated with not healing, Medicaid insurance, enzymatic and autolytic debridement, and nutritional support. Controlling for wound severity in multivariate logistic regression models, Medicaid, more dressing type changes, higher percent antimicrobial dressings, more frequent sharp debridement, more frequent enzymatic debridement, and more instances of inappropriate debridement management, all decreased the odds of healing. Wound severity, greater use of mechanical debridement, topical antiseptics, and antimicrobial dressings, and more dressing type changes all increased the odds of not healing.

Conclusions: Although wound severity plays a role in chronic wound healing, specific treatment approaches selected by clinicians also affect healing. Improving treatment decisions might improve chronic ulcer healing rates.