Wound care

Chronic wounds have an association with malnutrition and impaired wound healing. Wounds can happen at any age and worsen due to malnutrition. Assessing a patient with malnutrition will help determine the nutrition needed to improve the wound healing process. However, it can be difficult to determine nutritional assessment in geriatric population because the typical signs for malnutrition may be normal elderly people due to normal aging process. There are many types of assessments used to determine if someone is at risk for malnutrition and the risk of developing pressure ulcers. Which means, many facilities are using different tools to assess this which can lead to different treatment. To determine the malnutrition/nutrition status associated with the development of wounds, mobility/activity status, skin status, moisture exposure, weight loss, or appetite can all be evaluated. Pressure ulcers can develop in any individual but especially in the geriatric population due to immobility and unable to shift pressure off the boney prominence or devices attached to their body.

Wounds can worsen due to inadequate protein intake which can lead to edema in the peripheral vasculature and cause acute and chronic inflammation. Lack of adequate nutrition can impair wound collagen accumulation and impair wound healing and promote the wound worsening. In order to promote collagen synthesis, there is a need of energy, amino acids, oxygen, trace minerals and vitamins. A range of 30-35 kcal/kg body weight and 1.2-1.5 g protein/kg is recommended as a baseline for someone with wounds and pressure ulcers.  The essential amino acid to synthesize connect tissue proteins is arginine. Studies have shown that a supplementation of 30 grams of arginine will significantly increase wound collagen. Vitamin A can enhance would healing even in nondeficient states by reversing the anti-inflammatory effects of corticosteroids. However, vitamin C supplementation when there is a nondeficient state has not shown to benefit wound healing. Another micronutrient needed for wound healing is copper, zinc, and iron. All three are extremely beneficial to promote faster wound healing, but like Vitamin C, zinc supplementation has not been shown to improve wound healing when there is not a deficiency of zinc. Honey is the last supplementation that may be beneficial but is still unknown of the true effects.  Honey is high in sugar, water, proteins, B complex vitamins, minerals, antioxidants, and enzymes that may be beneficial as a topical treatment for wounds. Honey has a low pH inhibiting growth of microorganisms and has low free water activity preventing bacterial growth too. There is still controversy over whether it is beneficial or not, but more research needs to be done. Overall, nutrition is an important part of caring for wounds and pressure ulcers and dietitian should always be on the care team to help improve the process of wound healing.

LS

Haughey, L., & Barbul A. (2017). Nutrition and lower extremity ulcers: causality and/or treatment. The International Journal of Lower Extremity Wounds. 16(4), 238-243.