[Managing refractory wounds in the elderly with the concept of chronic critical illness]

The skin structure undergoes alterations in the elderly, making the skin soft tissue more susceptible to injury and thereby increasing the risk of developing refractory wounds. Elderly patients exhibit unique pathophysiological characteristics, often accompanied by severe and complex comorbidities (such as organ diseases, psychiatric and psychological issues, geriatric syndromes, etc.) and polypharmacy. Some patients may already be in a state of chronic critical illness for an extended period. Advanced age, refractory wounds, and critical illness often interact clinically, creating a vicious cycle. The management of refractory wounds in elderly patients should be regarded as an essential component of the overall management of geriatric comorbidities. To this end, the author proposes incorporating the concept of chronic critical illness into the management of refractory wounds in the elderly, focusing on the interplay between comorbidities and polypharmacy through multidisciplinary, dynamic, and stratified approaches. While focusing on the diagnosis and treatment of refractory wounds in the elderly, it also takes into account the diagnosis and treatment of geriatric organ diseases, functional maintenance, and actual needs.