Compromised Nutritional Status
Nutrition and hydration play an important role in preserving skin and tissue viability and supporting tissue repair processes for pressure ulcer (PrU) healing. The majority of research investigating the relationship between nutrition and wound prevention and healing has focused on Prus. The 2014 (second) edition of the Pressure Ulcer Prevention and Treatment Clinical Practice Guideline was a collaborative effort between the National Pressure Ulcer Advisory Panel (NPUAP), the European Pressure Ulcer Advisory Panel (EPUAP), and the Pan Pacific Pressure Injury Alliance (PPPIA). The goal of this international alliance was to develop evidence-based recommendations for the prevention and treatment of PrUs that could be used by healthcare professionals globally. The 2009 research was reviewed, confirming that the previous nutrition guidelines were appropriate.
Current research on the impact of malnutrition and the role, of conditionally essential amino acids are included in the 2014 guidelines. The purpose of this white paper is to review the 2014 nutrition guidlelines and discuss nutrition strategies for PrU management. Inadequate dietary intake and poor nutritional status have been identified as key risk factors for both the development of PrUs and protracted wound healing. Several studies, including The National Pressure Ulcer Long-term Care Study, reported that eating problems and weight loss were associated with a higher risk of developing PrUs.
Fry et al also reported that preexisting malnutrition and/or weight loss was a positive predictive variable for all undesirable surgery-related hospital-acquired conditions, including PrUs. lizaka et al’s study of home care patients 65 years or older in Japan noted the rate of malnutrition was higher for those with PrUs (58.7% vs 32.6%,P <.001). Many acute and chronically ill adults, as well as older adults at risk or with PrUs, experience unintended weight loss.
Shahin et al’s 2010 study in German hospitals and nursing homes clearly established the significant relationship between the presence of PrUs and unintended weight loss (5%-10%). A multicenter study conducted in Australian hospitals and residential older adult care facilities also reinforced the relationship between malnutrition and PrUs. Banks et al’s study of Queensland public hospital patients in 2002-2003 found one-third of PrUs were attributable to malnutrition at a mean cost of approximately AU $13 million. The 2014 National Pressure Ulcer Consensus Conference faculty supported the statement that individuals with malnutrition in combination with multiple comorbidities are at increased risk of developing a PrU.
Originally appeared in Advanced Skin & Wound Care.
Mary Ellen Posthauer, RON, LO, CD, FAND – President – MEP Healthcare Dietary Services, Inc
Merrilyn Banks, PhD – Director – Nutrition and Dietetics – Royal Brisbane & Women’s Hospital
Becky Dorner, RON, LO, FAND – President – Becky Dorner & Associates, Inc, and Nutriti, Consulting Services, Inc
Jos M.G. A. Schols, MD, PhD – Professor of Old Age Medicine – Department of Family Medicine and Department of Health Services Research – Maastricht University