Chronic wounds have traditionally been classified based on their etiology (venous ulcers, diabetic ulcers, pressure ulcers, etc.), reinforcing a reductionist perspective of the problem. However, this fragmented model has undermined understanding of their common pathophysiology and standardizing management approaches. From a medical epistemology standpoint, the evolution of pathological concepts has demonstrated that many syndromes were initially considered heterogeneous disorders until their underlying commonality became evident (e.g., metabolic syndrome, systemic inflammatory response syndrome). This review discusses and supports the proposition that chronic wounds should be conceptualized within a syndromic framework, wherein a shared set of pathophysiological processes underlies their diverse clinical manifestations, prompting a move beyond etiological reductionism. This proposition is supported by three epistemological arguments: biological, clinical, and practical. Through an analysis of fundamental syndromic principles, relevant examples illustrate this novel perspective. Ultimately, this proposition aims to advance a comprehensive and multi-level approach to chronic wound care, emphasizing multidimensional therapies that facilitate optimal, timely, and cost-effective outcomes. Such a conceptual shift would enable the integration of therapeutic strategies, the development of cross-cutting biomarkers, improved prediction of treatment responses, and greater consensus in research.

Population aging is a global health priority due to the dramatic increase in the proportion of older persons worldwide. It is also expected that both global life expectancy and disability-free life expectancy will increase, leading to a significant rise in the proportion of individuals with extreme longevity, such as non-agenarians and centenarians. The inaccuracy of clinical evidence on therapeutic interventions for this demographic could lead to biased decision-making, influenced by age-related beliefs or misperceptions about their therapeutic needs. This represents a potential clinical ageism scenario stemming from gaps in clinical evidence. Such biases can result in 2 significant issues that adversely affect the health status and prognosis of older persons: polypharmacy and therapeutic inertia. To date, documents on polypharmacy in non-agenarians and centenarians account for less than 0.35% of the overall available evidence on polypharmacy. Furthermore, evidence regarding therapeutic inertia is non-existent. The purpose of this letter is to discuss polypharmacy and therapeutic inertia as potential clinical ageism scenarios resulting from the clinical evidence gaps in extreme longevity.

Background: Centenarians are considered the most successful human biological aging model. However, the characteristics and patterns of research among centenarians have not been described or analyzed. Thus, this study aimed to disclose the historical landscape of global research on centenarians. Methods: This bibliometric study investigated historical evidence on centenarian research published in the Scopus database. The bibliometrix package in R was used to perform visual and quantitative analyses of research metrics, trends, and patterns. Results: Of the 2,061 documents included between 1887 and 2023, 84.2% (n=1,736) were published as articles with primary data. We identified international collaboration and annual growth rates of 21.4% and 3.15%, respectively. The United States published the highest number of papers on centenarians (n=786), whereas the publications from Italy had the highest impact (h-index of 90). Based on the frequency of keywords, mortality, genetics, dementia, Alzheimer’s disease, and immunosenescence are a few of the most studied topics among centenarians, with emerging research related to mitochondrial DNA and comparison of results between nonagenarians and centenarians. Italy, the United States, and China lead the global research collaboration network, collaborating most frequently with Japan and European countries. Conclusion Global research on centenarians has grown over the last 20 years, primarily led by Italy, the United States, and China. Latin American and African countries have conducted little or no research on centenarians. The most widely studied topics include mortality, cognition, immunosenescence, and genetics.