Survey shows frustration of leg ulcer patients

Older patients adapted better

Just in case anyone believes that leg ulcers amount to little more than unsightly inconveniences that disrupt daily routines and cause minor discomfort, consider the results of a 1994 study from the Boston University School of Medicine.1

When investigators surveyed patients who suffered leg ulcers of varying origins and sizes, many of the subjects reported severe symptoms - principally pain - and a high proportion said their ulcers or related leg swelling adversely affected mobility. Subjects also reported lost time from work, job loss, and negative financial impact, all attributable in some part to their wounds. Many were angry, resentful, or depressed and had a negative self-image.

According to the researchers, the prevalence of leg ulcers ranges from 0.18 to 1.0% of the U.S. population - numbers that are likely to rise as the population ages. By one estimate, leg ulcers result in 2 million lost work days annually in the United States.

The 73 subjects interviewed for the study ranged in age from 33 to 90 years; 25 were men and 37 were women. The mean duration of their ulcers was almost three years.

Here are some of the study's findings:

· Eighty-one percent of the interviewees said their ulcers adversely affected mobility; 57% said mobility was severely impaired.

· Sixty-five percent reported severe pain, and 40% reported pruritis, discharge, and leg swelling.

· Twenty percent of patients were working at the time of their interviews, two-thirds of whom were in semiskilled or unskilled jobs. Half of the employed subjects had to stand during most of their working hours. All patients, particularly younger ones, said their ulcers limited their capacity to work. Four of ten subjects said their ulcers were a factor in their decisions to stop working.

· More than half of the patients spent up to eight hours a week caring for their wounds; 10% spent more than eight hours. More than half of patients needed help caring for their wounds.

· There was a strong correlation between time spent on ulcer care and feelings of anger and resentment.

· Seventy-six percent of patients said their financial situations were adversely affected by their ulcers. Expenses incurred included time lost from work and the costs of medical care, dressings, and transportation to and from medical facilities.

· About a third of patients spent from $100 to $1,000 out-of-pocket annually. A somewhat smaller percentage spent more than $1,000 per year for additional medical care and related expenses.

· More than two-thirds of patients said their ulcers had a negative emotional impact.

· The majority of patients had severe pain and deemed their leg ulcers their most significant problem despite other important and potentially more threatening medical problems. "This factor," say the study authors, "is probably underestimated by physicians who will often judge a chronic wound as non-life-threatening and therefore less important to the patient than other medical conditions."

· Older patients were more effective in coping with or accepting their limitations and disabilities, suggesting that they adapt to many of the physical, mental, and social changes that occur with aging without loss of self-esteem.

· Surprisingly, the majority of patients expressed optimism with regard to their prognosis, even though their ulcers had lasted so long. "The explanation could lie in the fact that 63% of the patients had had a previous leg ulcer that healed," say the authors.

Reference

1. Phillips T, Stanton B, Provan A, Lew R. A study of the impact of leg ulcers on quality of life: financial, social, and psychologic implications. J Amer Acad Derm 1994; 31:49-53.