DERMATOLOGY AND WOUND CARE (M REDDY, SECTION EDITOR) Management of Venous Stasis Ulcers in the Older Adult Kevin Y. Woo 1 & Kimberly LeBlanc 1 & Matthew Livingston 2 Published online: 7 July 2015 # Springer Science+Business Media New York 2015 Abstract Venous stasis disease is common among older adults due to calf muscle pump failure, immobility, chronic edema, and obesity. Increased venous pressure increases the capillaries’ permeability allowing fluid, proteins, and blood cells to leak into the tissues. Ulceration is precipitated by reduced oxygen diffusion to the skin and microvasculature damages. While most chronic leg ulcers are caused by venous stasis disease, there is a need to rule out other underlying pathologies including arterial, neuropathic, metabolic, hema- tological, infectious, malignant, and inflammatory diseases. Compression therapy with high stiffness index is the mainstay of treatment for venous leg ulcers. Adherence to compression therapy could be a challenge in the older population due to reduced dexterity, muscle strength, range of motion, and flex- ibility. Medications such as pentoxifylline, flavonoids, and zinc have been shown to have a positive role in the manage- ment of venous disease. Keywords Venous stasis . Compression . Leg ulcers . Older adults Introduction Venous stasis disease is a common, but often, underestimated chronic health condition with 5–30 % of the adult population exhibits signs and symptoms, such as edema, sensation of heaviness in the legs, and dilated varicose veins [1]. Leg ulcers of venous origin are associated with a prolonged healing tra- jectory and frequent recurrence, up to 70 % within the 3 months of healing [2]. Chronic leg ulcer can be defined as skin breakdown below the level of knee for over 6 weeks [3]. Leg ulcers affect 1.5–5.0 per 1000 the adult population and 20 per 1000 in people aged over 80 years making this a common geriatric disease [4]. While chronic leg ulcers may involve an array of underlying pathologies including arterial, neuropath- ic, metabolic, hematological, infectious, malignant, and in- flammatory diseases, venous insufficiency is the predominant cause and accounts for 70 % of all cases [5] However, accurate diagnosis and treatment of venous stasis disease in older peo- ple can be challenging because of coexisting and comorbid conditions. The disease burden of leg ulcers on the health care system and individuals is staggering. The cost of treating chronic venous insufficiency was estimated to be US$750 million to US$3 billion per year in the USA [6]. According to an analysis of Medicaid and Medicare data that included over 80,000 clients in the USA, venous leg ulcer patients incurred higher annual incremental medical costs compared to matched non- ulcer patients. Venous ulcer patients reported more days missed from work [7]. Many patients living with chronic leg ulcers experience persistent pain and other disabling symp- toms, psychosocial stress, depression, sleep disturbance, loss of employment, and physical disabilities contributing to di- minished quality of life [8]. Considering the constellation of factors that can affect venous stasis disease and the needs of older people, management of venous leg ulcers should be take This article is part of the Topical Collection on Dermatology and Wound Care * Kevin Y. Woo kevin.woo@queensu.ca Matthew Livingston mlivingston@kirchnergroup.com 1 School of Nursing, Faculty of Health Sciences, Queen’ s University, 92 Barrie Street, Kingston, Ontario K7L 3N6, Canada 2 Scottsdale Healthcare, Scottsdale, AZ, USA Curr Geri Rep (2015) 4:229–236 DOI 10.1007/s13670-015-0138-5