An estimated 3.8 million adults in the UK were living with at least one wound in 2017-2018, with NHS wound care costs reaching £8.3 billion in this period (Guest et al, 2020). Gray et al (2018) highlighted the global economic burden of wounds, attributing rising costs to variations in care and the underuse of evidence-based interventions. Hard-to-heal, non-healing or chronic wounds are defined as those that do not follow an expected healing trajectory (Ferris and Harding, 2020; Mitchell, 2020; Wounds UK, 2022; Sharpe et al, 2023). and are of particular concern.

These wounds pose complex wound management challenges: they can adversely impact health and wellbeing and lead to significant resource implications for health care providers. Hard-to-heal wounds are also associated with increased morbidity (Ferris and Harding, 2020; Alam et al, 2021), with the majority often linked to conditions more prevalent among older people or those living with frailty, such as vascular disease, venous insufficiency, unrelieved pressure and diabetes (Gould et al, 2015).

Frailty, marked by reduced physiological reserves and heightened vulnerability to stressors, worsens these issues. Together, ageing and frailty increase the risk of tissue breakdown, infection rates, prolonged healing times and rising healthcare costs.

This article examines the relationship between ageing, frailty, increased risk of wounds and wound healing, drawing on recent research to highlight key challenges. It also provides evidence-based recommendations for practice, highlighting the importance of preventive strategies and holistic wound assessment. The findings emphasise the importance of a proactive approach to improve clinical outcomes in older, frail populations while ensuring efficient use of healthcare resources.

While wound management is predominantly a nurse-led discipline, we found minimal clinical involvement of tissue viability nurses and other specialist nurses in direct patient management. We also noted that the percentage of patients accessing different resources increased over the five years along with the absolute amount of resource use. For example, between 2012/13 and 2017/18, there was >10,000% increase in the number of healthcare assistant visits, a 399% increase in the number of district/community nurse visits and a 51% increase in the number of practice nurse visits. Conversely, there was a 2% decrease in the number of specialist nurse visits. Additionally, dressing and bandage types were continually switched at successive wound dressing changes for the majority of patients, suggesting confusion and conflict within the treatment plan.

• It was not possible to infer from the patients’ records which professional groups were the decision makers for changing dressing type and what the goal of treatment changes were.