Biobehavioral Mechanisms Underlying Symptoms and Healing Outcomes in Older Individuals with Chronic Venous Leg Ulcers

Background: Venous leg ulcers account for 70–90% of ulcers found in the lower leg, affect 2 million persons annually, including nearly 4% of people over age 65 years, and create a high symptom burden of wound-related symptoms and symptoms of pain, depression, anxiety, fatigue and cognitive dysfunction, collectively labeled as “psychoneurologic symptoms” (PNS).

Purpose: Study’s specific aims are to: (1) Characterize the strength of the associations at baseline among patient-host factors, systemic inflammation, and wound microenvironment with wound area and symptoms (PNS and wound-related); and, (2) Test associations and models over time for: (a) Patient-host factors and systemic inflammation with wound microenvironment; (b) Patient-host factors and wound microenvironment with systemic inflammation; (c) Patient-host factors, systemic inflammation, and wound microenvironment with wound healing; (d) Patient-host factors, systemic inflammation, and wound microenvironment with symptoms (PNS and wound-related) and (e) Patient-host factors, systemic inflammation, wound microenvironment and wound healing with symptoms (PNS and wound-related).

Methods: To achieve the aims, we will longitudinally examine 200 older adults (age >60) who receive standardized wound treatment biweekly across eight weeks’ time. We will characterize patient-host characteristics (age, comorbidities, sex, race/ethnicity, BMI, nutritional status, lifestyle habits, and wound treatment [pressure therapy, debridement, antibiotics]); systemic inflammatory activation (C-reactive protein and cytokines); wound microenvironment factors (local inflammation [Matrix metalloproteinase (MMP) enzymes C-reactive protein, cytokines], biofilm, and micro RNAs); symptoms (PNS [cognitive dysfunction, pain, fatigue, and depressive/anxiety symptoms] and wound-related); and wound characteristics and healing trajectory at the five time points.

Results: "research in progress" 

Conclusions: "research in progress"