Connections Among Biologic Embedding of Childhood Adversity, Adult Chronic Illness, and Wound Care: A Review of the Literature

Adverse childhood experiences (ACEs) biologically embed by altering brain development and influencing epigenetic mechanisms. These experiences may generate health risk factors. PURPOSE: A literature review was conducted to compare ACE-generated health risk factors with risk factors for wound development and aberrant healing, as well as to identify a gap in literature regarding critical connections between ACEs, chronic illness, and wound development/healing, with associated practice implications. METHODOLOGY: A literature search of English-language articles was conducted using the Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and PubMed using the search terms adverse childhood experiences, adults, wounds, chronic disease or illness, and epigenetics. The searches yielded 561 publications regarding ACEs, chronic illness or disease, and adult; 182 for ACEs; and 547 for epigenetics and wounds. Abstracts were reviewed to remove duplicates and studies with participants who were <18 years old. Publications were reviewed for salience; those discussing the biologic plausibility of ACEs contributing to adult illnesses and associated wound development and healing were reviewed for inclusion. RESULTS: Sixty-eight (68) publications were found appropriate for review and included population-based studies; literature reviews; epidemiologic data; meta-analyses; and systematic, cross-sectional, observational, and prospective studies as singular or mixed methods designs. A substantial overlap was found in terms of risk factors generated by ACE exposure and risk factors for wound development/healing, as was a gap in the literature regarding this relationship. Epigenetic mechanisms and altered brain development are implicated in processes through which childhood adversity erodes human health. CONCLUSION: Adult health risks as a result of exposure to ACEs and critical connections with risks for wound development and disrupted wound healing via epigenetic influences are recognized in the literature. Practice implications include considering screening for the risk factor of ACEs exposure in adult patients to identify this additional risk factor and practicing patient-centered, trauma-informed care. Further research into the integrative roles of these factors is warranted.