A pressure injury (or wound) is when the skin becomes red, bruised or even opens due to a reduced blood flow from the pressure of lying down or sitting for a long time. We also call this a pressure ulcer or bed sore.
The elderly and physically disabled population is particularly at risk due to limited mobility. The main affected regions are the coccyx, the buttocks, the heels or elbows. In more severe cases, the skin can open exposing the bones. The healing then becomes difficult and may lead to several health complications.
It is surprisingly a lot more common than we might think.
Among others, Malnutrition is a risk factor for the development of wounds. It is estimated that about 5-15% of Canadians present with malnutrition at home. Malnutrition can develop due to poor access to nutritious food, loss of appetite or anorexia related to certain health conditions, inability to feed oneself, loss of sense of taste or smell, and much more.
Therefore, it is extremely important to optimize nutrition in order to help with wound prevention and healing.
Other strategies, along with nutrition, can help: changing position every few hours, providing wound care by nurses, using specialized mattresses and cushions.
Which nutrients should we look for?
Some of the key nutrients often discussed in wound healing are: Arginine, Omega-3, Vitamin C, Vitamin A, Copper, Iron and Zinc. However, there is not enough evidence to suggest a specific therapeutic dose for each of those. Often times, the registered dietitian will assess if the patient has deficiencies and might suggest supplementing with a multivitamin or with certain specific vitamins/minerals.
Nutritional supplements are usually enriched with vitamins and minerals, and may provide benefits when added to the diet.
In terms of Calories, Proteins and Hydration, people with pressure injuries have higher needs because they are in an inflammatory state. The body requires large amounts of calories and protein in order to prevent muscle wasting by using its own stocks. Protein and hydration also play an important role in immune function, skin cell and collagen production, as well as delivering key nutrients to cells. Therefore, eating foods that are higher in calories, fats, proteins and drinking plenty of liquids is recommended.
When food alone is insufficient or hard to achieve, Nutritional supplements can help supplement the diet.
Which Oral Nutritional Supplements do healthcare providers recommend?
Ensure Advance: Ensure Advance is a High-Calorie, High-Protein supplement. Its key ingredient is HMB, which seems to enhance muscle strength and support wound healing.
Resource 2.0: Resource 2.0 is also a very High-Calorie, High-Protein supplement. It is often used in healthcare settings as a MEDPASS system.
MEDPASS system: provision of small doses (usually 60ml) three to four times a day, with medication, to improve patient adherence, contributing to better overall health outcomes. This system can easily be done at home as well.
Boost 2.24: Boost 2.24 is one of the most calorically dense supplement available in the market. It is ideal for individuals requiring concentrated nutrition for recovery, contains high quality protein essential for tissue repair and regeneration, and facilitates faster healing of wounds.
Disclaimer: this blog provides general information on pressure wounds. It is always important to consider other health factors such as diabetes and renal disease before supplementing or making changes to the diet. The information listed above does not replace the professional advice of a healthcare provider.
References:
- 2009. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel: Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Washington DC: NPUAP.
- Litchford, M.D (2014). Malnutrition as a precursor of pressure ulcers. Advances in wound care.
- 2019, Pennutrition. The Role of Nutrition for Pressure Injury Prevention and Healing: The 2019 International Clinical Practice Guideline Recommendations. Advances in skin and wound care.
- 2024. Pressure Injuries. Cedars-Sinai. Pressure Injuries | Cedars-Sinai
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