Most of us take healing for granted. You catch your shin on the corner of the coffee table, you stick a plaster on it, and a week later you have forgotten it ever happened. Then one day, somewhere in your fifties or sixties, that same graze is still there a month later. It weeps a little. The skin around it looks angry.
Slower healing is one of the least discussed changes that comes with age, and one of the most consequential. Left unmanaged, a wound that will not close can lead to infection, hospital admission and months of restricted living. The good news is that most of these wounds are highly treatable, the care is largely free through the HSE, and much of the risk is preventable.
TL;DR
- Skin becomes thinner, drier and slower to repair with age, so wounds that once healed in days can take weeks or months after 50.
- Any wound on the lower leg or foot that has not healed in two weeks should be assessed by your GP or public health nurse, not left to sort itself out.
- Venous leg ulcers are the most common non-healing wound in older adults in Ireland, and graduated compression is the single most effective treatment.
- An ankle brachial pressure index (ABPI) test must be done before compression is applied, because compression is unsafe if the arteries are narrowed.
- Public health nurses provide free community wound care, and the HSE National Wound Management Guidelines set the standard of care you are entitled to expect.
- Spreading redness, heat, swelling, fever or a sudden increase in pain suggest cellulitis and need same-day medical attention.
Why healing slows down after 50
Several things change at once. The outer layer of skin thins and the junction between the layers flattens, making skin easier to tear and slower to knit back together. Collagen production drops. The small blood vessels supplying a wound bed become less efficient, and immune cells arrive more slowly, a process researchers call immunosenescence.
On top of that biology sit conditions that become more common with age: diabetes, peripheral artery disease, venous insufficiency, reduced mobility, and the medications that accompany them. Steroids and long-term anti-inflammatories slow repair, as does smoking, which constricts the very vessels a wound depends on.
The four wounds worth knowing about
Venous leg ulcers are the most common. They usually appear on the inner ankle or lower calf, often after years of swelling, varicose veins or a previous clot, and the surrounding skin may be brown-stained, itchy or hardened. They happen when valves in the leg veins fail, so blood pools rather than returning efficiently to the heart.
Arterial ulcers are less common but more urgent. They tend to appear on the toes, heels or outer ankle, look punched out, and are often painful at night or when the leg is raised. They signal poor arterial supply and need vascular assessment.
Diabetic foot ulcers can develop with very little pain, because nerve damage blunts sensation, and that is precisely what makes them dangerous. If you live with diabetes, the annual foot check through the HSE Chronic Disease Management Programme is not a box-ticking exercise, it is the main line of defence.
Pressure ulcers develop where sustained pressure cuts off blood flow, typically over the heels, hips, base of the spine or shoulder blades. They matter most for anyone spending long periods in a chair or bed. The HSE uses the SSKIN framework for prevention: Surface, Skin inspection, Keep moving, Incontinence management, Nutrition.
The two-week rule
Here is the single most useful thing to take from this article. Any break in the skin on the lower leg or foot that has not clearly improved within two weeks needs professional assessment. Not another fortnight of hoping. Two weeks, then get it looked at.
Go sooner if you notice redness spreading outwards, warmth, increasing pain, a change in the smell or amount of discharge, or if you feel generally unwell or feverish. Those are signs of cellulitis, a bacterial skin infection that responds well to prompt antibiotics and poorly to delay.
How wound care works in Ireland
Your GP is usually the entry point, and for many people ongoing care then sits with the public health nurse (PHN) service. PHNs provide wound dressing and assessment in the home or at local health centres, free of charge regardless of medical card status. Ask your GP for a referral, or contact your local health centre directly.
For complex or stubborn wounds, the HSE has tissue viability nurses, specialists who advise on dressing selection, debridement and underlying causes, and some areas run dedicated leg ulcer clinics. If your wound has been dressed weekly for months with no meaningful progress, it is entirely reasonable to ask whether a tissue viability referral is appropriate. The HSE National Wound Management Guidelines are clear that every leg ulcer should have its cause investigated rather than simply being covered up.
On cost: dressings prescribed by a GP are covered under the medical card, people with diabetes can access certain supplies through the Long Term Illness Scheme, and others may claim through the Drugs Payment Scheme.
Compression, and why the ABPI test matters
For venous leg ulcers, graduated compression bandaging is the treatment that actually works. It supports the failing veins, reduces swelling and dramatically improves healing rates. But it must never be applied blind. A clinician first measures your ankle brachial pressure index, comparing blood pressure at the ankle with that at the arm, to confirm the arteries can tolerate compression. Applying compression to a leg with poor arterial supply can cause serious damage.
Once an ulcer heals, the work is not finished. Recurrence is common, and wearing compression hosiery long term is what keeps it away. Modern stockings come with application aids that make them far easier to manage than they once were.
What you can do at home
- Moisturise daily. Dry, cracked skin is the entry point for most lower leg infections. A simple emollient after washing does more than people expect.
- Eat for repair. Healing is metabolically expensive. Protein at every meal, vitamin C from fruit and vegetables, and adequate fluids all help. If appetite is poor, ask your GP about a dietitian referral.
- Keep moving. Calf muscle contraction is what pumps blood back up the leg. Regular walking and ankle circles while seated genuinely help.
- Elevate. Resting legs above hip level during the day reduces the swelling that stalls healing.
- Check your feet. Daily if you have diabetes or reduced sensation. Use a mirror, or ask someone to help with the soles.
- Stop smoking. Of all the modifiable factors, this one moves the needle furthest. HSE Quitline is 1800 201 203.
The part nobody mentions
Living with a wound that will not heal is wearing. Dressing changes structure your week. Some ulcers ache. Some have an odour that makes people withdraw from company at exactly the point they most need it. Research consistently finds meaningful rates of low mood and social isolation among people managing chronic leg ulcers, yet it rarely comes up in the consultation.
If that is where you are, say it out loud to your nurse or GP. It is relevant clinical information, not a complaint, and it is far easier to stick with months of treatment when you are not doing it alone.
At Críonna Health, we believe ageing well means knowing which changes to accept and which to act on. Slower healing is normal. A wound that will not close is not. Two weeks, then get it seen.
This article is for general information and does not replace individual medical advice. If you are concerned about a wound, contact your GP or local health centre.
📷 Photo by Judy Beth Morris on Unsplash
