PREVENTION & TREATMENT

What’s on their plate? Learn how proper patient nutrition can improve wound healing

A comprehensive nutrition program includes both high-nutrient foods and nutritional supplements to combat malnutrition and help heal wounds

Plate with four corners of food: fruits, vegetables, grains and proteins.

It’s estimated that between 20 and 50 percent of all hospitalized patients are at risk for malnutrition, yet only 7 percent are actually diagnosed with this disorder during their stay.1 This leaves millions of people undiagnosed and at risk for further complications. The numbers are even higher for adults aged 65 and older.

Icon of elderly people walking with canes.

Studies estimate that 65% of adults 65 years and older are malnourished.1

Among the complications of malnutrition is poor wound healing. Studies show that patients’ overall health and wound healing rates are directly linked to their nutritional status. So it’s critical that patients’ nutrition needs are constantly monitored and re-evaluated throughout the course of treatment to ensure they receive the right kinds and levels of nutrients. But to achieve optimal nutrition for your patients, you need to know what you’re looking for and have the proper tools.

What does malnutrition mean?

The World Health Organization defines malnutrition as “deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.”2 It covers two broad groups of conditions. One is “undernutrition,” which includes low height, underweight and micronutrient deficiencies or insufficiencies—a lack of important vitamins and minerals. The other is overweight, obesity and diet-related diseases, such as heart disease, stroke, diabetes and cancer.

Both groups are at risk for compromised wound healing. But what makes this condition more complicated is that visually, you can’t confirm that someone is malnourished, making it a hidden danger.

What also makes malnutrition hard to identify is that there can be a large discrepancy between what patients are actually consuming and the nutrients required to improve overall health and wound healing.

To help assess a patient’s nutritional status, caregivers should ask themselves the following questions.

  • Are my patients finishing their meals?
  • Are they getting enough protein?
  • How is nutrition intake being documented?
  • Is documentation accurate?

When a person continues to eat poorly, the risk for unanticipated complications increases. Adults who are malnourished in the hospital are 54 percent more likely to be readmitted within 30 days after discharge than those who are well nourished.1

Assessment tools

Because observation alone won’t help you accurately identify a malnourished patient, caregivers need tools to help them proactively assess a patient’s nutritional status and determine next steps.

This can be done by investing in and maintaining a quality nutritional program that can positively impact patient outcomes and wound healing rates. Caregivers need to screen their patients with a simple, reliable, economical and validated nutrition assessment tool.

The information gathered from the tool will help caregivers develop more precise, targeted individual care plans with emphasis on nutritious foods.

The importance of protein

Malnutrition and weight loss can be a precursor to pressure injuries and delayed wound healing.3 This is especially true when it comes to lack of protein. Several studies identify protein as a key nutrient for aging adults for maintaining muscle composition, repairing tissue and promoting wound healing.

99.5%

Number of adults who drank at least ¾ of their Active liquid protein; only 70% drank the same amount of a complete oral nutritional drink.5

The problem is that total body protein declines with aging. This means that older adults require more protein per kilogram (g/kg) of body weight than younger adults. When there are inadequate levels of protein, the body struggles with making collagen, a major component for skin health and bone strength. Additionally, high exudate loss can contribute to a loss of as much as 100 grams of protein in one day.4

Oral nutritional supplements

With the potential for significant protein loss in older patients, a nutritional supplement can help boost and maintain adequate protein levels. However, getting patients to actually take their protein can be a challenge. Approximately 58 percent of the RDs surveyed said they struggle to get their patients to increase their protein intake.

85%

Registered dieticians who agree the majority of their patients need
protein supplementation.5

That’s where oral nutritional supplements (ONS) can help. ONS are liquids, semi-solids or powders that help patients ingest macro and micro nutrients more easily than eating solid foods.

Many patients have decreased energy, decreased appetite, dysphagia, an illness with high nutrient demand or other factors influencing their ability to eat. In these cases, taking ONS has shown improved outcomes.

Several studies of patients 65 and older, and who are at risk for malnutrition, showed fewer complications (e.g., pressure injuries, deep vein thrombosis, infections) when taking ONS, versus routine care.6 ONS also help deliver other essential nutrients for wound healing, including amino acids such as arginine and glutamine.

Key takeaways

Malnutrition can be a hidden danger to wound healing. Ensuring your patients are well nourished starts with a comprehensive program including nutrition screening, intervention and overall treatment. For those patients requiring extra protein intake, or when wounds are present, consider introducing oral nutritional supplements. If you know what you’re looking for and have the right tools, you can proactively improve your patient’s nutritional status to support wound healing.

Nourish a better way to wound care. Learn more about how liquid protein helps support wound healing.

Author Amy Roger's profile picture.

Amy Rogers, RN-BSN, is a clinical nurse specialist for the Nutrition & Pharmaceuticals division at Medline Industries, Inc.

References:

  1. Malnutrition Quality Improvement Initiative. http://malnutritionquality.org/why-malnutrition-matters.html
  2. World Health Organization. https://www.who.int/features/qa/malnutrition/en/
  3. Posthauer, Mary Ellen. “The Role of Nutrition for Pressure Ulcer Management: National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance White Paper.” Skin and Wound Care, April 2015-Volume 28 Issue 4-p 175-188. https://journals.lww.com/aswcjournal/Fulltext/2015/04000/The_Role_of_Nutrition_for_Pressure_ Ulcer.7.aspx
  4. The importance of patients’ nutritional status in wound healing. British Journal of Nursing, 2001 Mar; 10(6 Suppl): S42, S44-9. https://www.ncbi.nlm.nih.gov/pubmed/12070399
  5. Medline Industries, Inc. Data on file.
  6. A.C. Milne, J. Potter, A. Vivanti, A. Avenell. Protein and energy supplementation in elderly people at risk from malnutrition Cochrane Database Syst Rev. (2) (2009 Apr 18), p. CD003288

Other sources:

  • Posthauer, Mary Ellen. “What Evidence Is There to Support Arginine for Wound Healing?” Wound Source, 29 July 2016, www.woundsource.com/blog/what-evidence-there-support-arginine-wound-healing
  • Seied Hadi Saghaleini, Kasra Dehghan, Kamran Shadvar, Sarvin Sanaie, et. al. Pressure Ulcer and Nutrition. Indian J Crit Care Med. 2018 Apr; 22(4): 283–289. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5930532/