Are clinicians limited to palliative care options when elderly patients with comorbidities have diabetic foot ulcers (DFUs)?
Not necessarily. In a recently published study involving over 1,000 patients 75 years of age or older with a DFU and extensive comorbidities, 84 percent of surviving patients healed without major amputation and primary healing of the DFU occurred in 54 percent of patients without any amputation at all.1
The authors of this retrospective study attributed these outcomes to multidisciplinary care in close collaboration with primary care and home nursing.1 According to the study, the multidisciplinary team consisted of a diabetologist, an orthopedic surgeon, an orthotist, a podiatrist and a registered nurse educated in diabetes. Other members of the team included an infectious diseases specialist and a vascular surgeon.
“I think the findings are pleasantly surprising and better than what I would expect in this high- risk cohort,” notes Adam Isaac, DPM, FACFAS, the Director of Research at Foot and Ankle Specialists of the Mid-Atlantic. “In my opinion, the key is really in the high-level care the patients received at each stage of healing. Multidisciplinary care has been proven as the gold standard for limb preservation around the world but the work done by primary care in terms of prevention and home health care/nursing in wound care are often underappreciated. It really takes a village, so to speak, to keep these folks ulcer- and amputation-free, and it seems as though the study results confirm that.”
The study researchers also noted that 56 percent of patients living in institutions or dependent on home nursing care healed without amputation in comparison to 44 percent who healed without amputation despite no support from social services or home nursing.1 While physical exams were conducted regularly by the multidisciplinary team, the study authors cited collaboration with primary care home nursing services for outpatient care as well as daytime telephone service for ongoing patient support.
“This study lends further evidence to the need to continue to push care from the hospital to the home and the role of team care,” maintains David G. Armstrong, DPM, MD, PhD, the President of the American Limb Preservation Society (ALPS).
In another intriguing aspect of the study, researchers noted that nearly one-third of the oldest study patients (ages 88-96) healed without amputation.1 Could this finding and other results from this study change perspectives on how clinicians approach the treatment of DFUs in senior and elderly populations? Dr. Isaac says the study results are “extremely encouraging” in this regard.
“We must not be influenced by age in developing a limb preservation plan,” says Dr. Isaac, a Diplomate of the American Board of Foot and Ankle Surgery. “I think it is only natural for providers to, in some cases, take a more cautious or conservative approach in older patients who may have comorbidities, but the study shows that these patients should be treated in the same way as other age groups.”
- Gershater MA, Apelqvist J. Elderly individuals with diabetes and foot ulcer have a probability for healing despite extensive comorbidity and dependency. Expert Rev Pharmacoecon Outcomes Res. 2021;21(2):277-284.