Faculty Bibliography

OBJECTIVE:To study the characteristics of residents in postacute (PA)/long-term care (LTC) facilities with wounds and prevalence of wound types other than pressure injuries (PIs). METHODS:The authors conducted a retrospective review of all wound care consultations over 1 year at The New Jewish Home, a 514-bed academically affiliated facility in an urban setting. Investigators analyzed residents by age, sex, type of wound, presence of infection, and whether the resident was PA or LTC. Authors designated PIs as facility acquired or present on admission. RESULTS:During the study period, 190 wound care consultations were requested; 74.7% of consults were for those in PA care. The average patient age was 76.3 years, and there were 1.7 wounds per resident receiving consultation. Of studied wounds, 53.2% were PIs, 15.8% surgical, 6.8% arterial, 6.3% soft tissue injury, 5.8% venous, 2.6% malignant wounds, and 2.1% diabetic ulcers; however, 11.6% of residents receiving consults had more than one wound type. In this sample, 13.2% of residents had infected wounds, and 76.2% of PIs were present on admission. CONCLUSIONS:The wide variety of wounds in this sample reflects the medical complexity of this population. The transformation of LTC into a PA environment has altered the epidemiology of chronic wounds and increased demand for wound care expertise. These results challenge traditional perceptions of wound care centered on PIs. Given its importance, a wound care skill set should be required of all PA/LTC providers.

OBJECTIVE:To study the epidemiology and characteristics of wounds related to malignancy in a large, academically affiliated postacute/long-term care (PALTC) facility. DESIGN/METHODS:Retrospective case series of 1 year of wound care consultations. Inclusion criteria included a cancer diagnosis with wounds related to malignancy or complications from cancer-related debility and/or treatment. SETTING/METHODS:Academically affiliated 514-bed PALTC facility. PARTICIPANTS/METHODS:Of 190 consults, 27 residents (14.2%) met the inclusion criteria. Of these, 20 (74.1%) were female, and 7 (25.9%) were male. The average age of residents with a cancer diagnosis and wounds was 69.5 years (range, 48.1-86.7 years), and 25 (92.6%) were on the postacute service. RESULTS:The most common reasons for consultation included pressure injuries (44.4%), surgical wounds (21.4%), and malignant wounds (14.8%). Seventy-six percent of pressure injuries were present on admission. Breast (29.6%), gastrointestinal (25.9%), and gynecologic (11.1%) malignancies were most common. Of the studied residents, 14 (51.9%) had metastases, and 13 (92.9%) had pressure injuries. CONCLUSIONS:These findings begin to fill a gap in understanding the spectrum of wounds in PALTC residents with cancer and reinforce the importance of the wound care skill set, including pressure injury prevention. Quality cancer care for older adults must anticipate severe skin complications not only from the tumor and its treatment, but also from the sequelae of immobility, immune compromise, malnutrition, and skin failure. The close association of metastatic disease with pressure injury raises issues of unavoidability and casts new doubt upon the use of pressure injuries for quality measurement.

Background: Wounds related to malignancy in post-acute/long-term care (PALTC) have not been well studied. An understanding of these conditions is essential for resource allocation to improve outcomes and quality of life for older persons with cancer.
Method(s): We reviewed all patients referred for wound consul-tation over one year in an urban, academically affiliated 514 bed PALTC facility. Inclusion criteria included diagnosis of cancer with wounds related to malignancy or complications from cancer-related debility and/or treatment. Residents were analyzed for age, sex, type of malignancy, presence of metastases, wound type, and infection.
Result(s): Of 190 consults, 27 (14.2%) met our inclusion criteria. 74% were female and average age was 69.5 (range 48.1-86.7). Reason for consult included pressure ulcer (PrU) (44.4%), surgical wound (22.2%), malignant wound (14.8%), and infection (14.8%). Surgical wounds included dehiscence and unhealed graft donor sites. 4 patients (14.8%) had infections that included bacterial, fungus, and zoster. Most common malignancies were breast (29.6%), rectum (14.8%), colon (7.4%), oral (7.4%), lung (7.4%), uterine (7.4%), and lymphoma (7.4%). Other tumors (18.5%) included renal, esophageal, hemangioblastoma, neuroendocrine, and vulvar. 51.9% of all patients had metastases. 92.9% of patients with metastases had PrU.
Conclusion(s): Wounds related to malignancy are common in PALTC. By 2030, 70% of all cancers will be diagnosed in older adults. The increase in cancer and related sequelae will stress our healthcare system in terms of morbidity and cost. Our data suggests a different array of malignancy-related skin issues than previously published. These findings highlight a gap in knowledge of the spectrum of wounds in residents with cancer admitted to PALTC and reinforces the importance of the wound care skill set including PrU prevention. Efforts focused on quality cancer care for older adults must anticipate severe skin complications not only from the tumor but from long-term sequelae of immobility, immune compromise, and nutritional deple-tion. The close association of metastatic disease with PrU raises issues of terminal ulceration and casts doubt on routine use of PrU for quality measurement