Pressure injury prevalence has been reported at 16-23% in combined hospital and residential aged care populations (1,2).
Chronic leg ulcers affect 1-3% of people aged over 60years, with incidence increasing up to 5-10% in the 80+ age group. (3,4).
Wounds can include pressure ulcers, wounds post-surgery or trauma and wounds or ulcers as a result of Diabetes.
The presence of wounds results in:
- Reduced mobility
- Decreased QOL
- Reduced independence
- Pain and discomfort
- Reduced socialisation
- Increased morbidity and mortality
- Increased health costs
The risk factors for wounds include:
- Increased age
- Comorbidities (DM Type 2, renal failure, peripheral vascular disease)
- Poor immune system
- Poor skin integrity
Research consistently shows that eating problems, weight loss, low body weight, undernutrition and malnutrition are associated with an increased risk for pressure injuries, and inadequate nutrition and low body weight are associated with wounds that are slow to heal or non – healing.
Food and good nutrition are essential for wound healing and maintenance of skin integrity.
Eating a variety of foods from each of the food groups will ensure you are getting all of the nutrients your body needs.
Elderly people have increased requirements for a number of nutrients to ensure wound healing.
Kilojoules – Energy
Required for producing collagen and maintaining normal body function. Increased energy sources are vital for wound healing
Sources: oils/fats, cereals, tofu, legumes, meats, beans, nuts, seeds, dairy products, chocolates, sweets, avocado
Protein: including arginine and glutamine.
Normal protein requirement is 0.8 – 1.0g/kg/day
Protein requirements with wounds can be up to 2.0g/kg/day
Sources: beef/lamb/chicken/fish, eggs, tofu, legumes, nuts, tofu, soy drink, milk, yoghurt, cheese
Stimulates the inflammatory response, epithelialisation and is a co-factor for collagen synthesis
Sources: egg yolk, dairy, fish, orange and yellow coloured fruit and veg
Promotes collagen and new blood vessel synthesis
Sources: fruit, tomato, capsicum, broccoli
Adds strength to the healing wound and scar during granulation
Sources: organ meats, seafood, wholegrains, legumes, nuts
Promotes collagen production, immune function and is involved in the catalytic activity of ~100 enzymes for tissue regeneration
Sources: red meat, fish, dairy, eggs, wholegrain cereals
Essential for the development of healthy red blood cells
Sources: red meat, chicken, fish, iron- fortified cereals and breads
Dehydrated skin is less elastic and more susceptible to break down. Fluid improves circulation and is important for blood and oxygen supply to the wound
Ensure 1.5 – 2.0 L fluid daily
Nutritional Support and recommendations
The National Aged Care Mandatory Quality Indicator Program makes it compulsory to report about the presence of pressure injuries over a 3-month period for all residents in aged care homes.
All elderly clients, residents should be screened to identify those at nutritional risk. Examples of screening tools include: MST, MNA, MUST.
Those identified as being at risk of malnutrition should cease dietary restrictions, and commence on a High Protein/high energy diet, including fortified foods and HPHE milkshakes.
Screening and treatment with adequate nutrition is essential for the prevention and healing of pressure injuries, wounds.
A referral to a Dietitian should be included as part of treatment.
Martineau J, Bauer JD, Isenring E& Cohen S (2005). Malnutrition determined by the patient-generated subjective global assessment is associated with poor outcomes in acute stroke patients. Clinical Nutrition; 24(6): 1073-1077.
Middleton MH, Nazarenko G, Nivison-Smith I, SmerdleyP (2001). Prevalence of malnutrition and 12 – month incidence of mortality in two Sydney teaching hospitals. Internal Medicine Journal; 31:455-461.
Neumann SA, Miller MD, Daniels L & Crotte M (2005). Nutritional status and clinical outcomes of older patients in rehabilitation. Journal of Human Nutrition and Dietetics; 18: 129-136.
Patterson A, Young A, Powers J, Brown W &Byles J (2002). Relationships between nutrition screening checklists and the health and well-being of older Australian women. Public Health Nutrition; 5:65.