Clinical Characteristics and Determinants of Healing in Older Adults with Chronic Lower Extremity Ulcers: A Retrospective Cohort Study

Background/Objectives: Chronic lower extremity ulcers are a major cause of morbidity in older adults. However, real-world data on clinical characteristics, microbiological findings, treatment patterns, and outcomes in older adults remain limited. The objective of this study was to evaluate the clinical characteristics and factors associated with healing in older adult patients with chronic lower extremity ulcers. Methods: This retrospective cohort study included patients aged ≥65 years with chronic lower extremity ulcers treated at a tertiary dermatology center between January 2016 and March 2025. Demographic, clinical, microbiological, treatment, and outcome data were collected from medical records. Factors associated with healing outcomes were evaluated using regression analyses. Results: A total of 191 patients were included. Venous ulcers were the most common ulcer subtype (37.2%), followed by diabetic ulcers (19.4%). Wound cultures were positive in 48.2% of patients, with Staphylococcus aureus being the most frequently isolated organism. Complete healing was achieved in 18.8% of patients, while 29.6% experienced partial healing. Peripheral arterial disease (adjusted OR 0.25, 95% CI 0.09–0.64) and greater ulcer depth (adjusted OR 0.45, 95% CI 0.20–0.91) were independently associated with a lower likelihood of complete healing. Greater ulcer depth and positive wound cultures were independently associated with non-healing. Peripheral arterial disease and greater ulcer depth were also associated with delayed healing. Conclusions: Chronic lower extremity ulcers in older adults are associated with poor healing outcomes. Peripheral arterial disease, ulcer depth, and wound infection emerged as key determinants of healing and may help identify patients requiring closer monitoring and multidisciplinary management.