An often-overlooked component of wound healing is the psychological impact chronic wounds have on patients. This can be due to many factors that contribute to stress, sleep disruption, social isolation and depression in patients with wounds. However, for older adults, these impacts have greater affect. Not only does this affect their mental health, but research shows that these stressors can have a substantial and clinically relevant impact on wound repair and directly influence their wound healing processes.
Stress
Stress and negative mood can arise in those with non-healing wounds due to several components of their wound healing journey. There are many costs associated with wound healing, especially for those who do not seek early intervention or proper treatment, like hospital stays, lost work hours or amputations. Managing a wound is a highly involved process, requiring constant care, dressing changes and multiple doctor’s appointments that disrupt normal daily routines. Some of the procedures and treatments for wounds can be uncomfortable, or just painful. The physical effects of the wound, such as the way a wound looks, high levels of drainage or unpleasant odor can be distressing and embarrassing.
For older adults, stress brought on by a chronic wound can lead to more severe health problems like heart disease, high blood pressure and diabetes. These chronic conditions further increase their likelihood of developing non-healing wounds. Living in a state of constant stress can also make older adults prone to get a cold or the flu. Evidence shows that an impaired immune response can slow or halt the healing process.10
Sleep Disruption
One study showed that participants with slow-healing wounds or wound infections reported a significantly poorer sleep quality than those without impaired wound healing. This can be due to physical factors, like pain and discomfort, or other psychological factors, like stress. There is also a connection between chronic wounds and daytime fatigue. Sleep disturbances, fatigue and tiredness can also strengthen other psychological impacts and cause further social distance and isolation.
Compared to younger people, older adults often already experience sleep disturbances without the effects of a non-healing wound. Getting enough sleep is important for the general health and well-being of older adults, but it is especially important for those undergoing the healing process. Good sleep quality supports adequate immune function and is key to healing.
Social Isolation
Research shows that those who suffer from non-healing wounds tend to deliberately avoid spending time in public and become more introverted because of their wound. This may also be due to the physical effects, like pain and odor. Those who socially isolate themselves may do so from their close family and friends, as well. Unfortunately, this may include avoiding asking for help in hopes of reducing their perceived burden.
Loneliness and social isolation in older adults are serious health risks. Although hard to measure precisely, the CDC offers strong evidence that social isolation in older adults increases their likelihood to visit the emergency department or become hospitalized. It also increases their chances of developing dementia or heart disease or having a stroke. These are all factors that contribute to the development of chronic, non-healing wounds.5
Depression
Depression is a serious medical illness that negatively affects how a person feels, the way they think and how they act. Stress, negative mood, sleep disruption and social isolation all contribute to depression. Severe stress raises the incidence level of depression. Negative emotions like sadness, anger, grief, anxiety and frustration are common for those with depression. Not only can sleep disruption and deprivation lead to depression, but depression can also lead to sleep disturbances. Evidence links social isolation with depression, and some even note that social withdrawal is one of the most common signs of depression.
Depression and anxiety in older adults have several harmful effects. It can affect their immune system function, hormone regulation, pain signal regulation, inflammation levels and cell function. Depression can also disrupt the eating habits of older adults who may already experience nutritional problems. Healthy eating habits and a proper diet are key to successful healing.1
Managing Psychological Impacts
For all patients with non-healing wounds, it is important to manage these psychological impacts in order to optimize healing:
- Maintain strong relationships with family, friends and peers to combat loneliness, stress, anxiety and depression. Developing relationships with nurses and other healthcare providers can also provide support.
- Keep a positive mindset. Replacing discouraging, negative thoughts and maintaining focus and passion can help throughout your wound healing journey.
- Use controlled breathing exercises or meditate. These techniques can help you gain a new perspective on stressful situations, focus on the present and reduce negative emotions.
- Eat a healthy diet. A balanced diet can help keep the immune system healthy and strong, which improves wound healing.
- Seek prompt, proper care. Specialized wound care services address the physical complications that lead to psychological impacts. In addition, a wound center like the [WOUND CENTER NAME] can offer a comprehensive approach to healing, coordinating traditional and advanced therapies that aid and accelerate the healing process.
The Wound Care Clinic at KCHS is open 8:00 a.m. to 4:00 p.m. each Tuesday. For more information about wound care or to schedule an appointment, call 308-832-6535. No referral is required.
REFERENCES
2https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9412748/
3https://www.webmd.com/depression/features/stress-depression
4https://onlinelibrary.wiley.com/doi/10.1111/wrr.12193
5https://www.cdc.gov/aging/publications/features/lonely-older-adults.html
6https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052954/
7https://pubmed.ncbi.nlm.nih.gov/33314686/
8https://www.webmd.com/depression/features/depression-traps-and-pitfalls
9https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689397/
10https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341916/
11https://www.psychiatry.org/patients-families/depression/what-is-depression