Nutrition supplementation for faster healing of pressure ulcers in immobile hospitalized elderly patients

Abstract

Overview of topic: The incidence of PUs is on the increase especially in elderly patients who have impaired mobility, are malnourished and this presents a major concern in the health care system. The current standard treatment consist of wound cleansing, change of dressings, wound debridement, use of pressure releasing devices and repositioning of patients every 2 hours. Oral nutritional supplementation (ONS) is not yet an integral part of wound care. Evidence indicates that ONS consisting of high energy, protein, enriched arginine, vitamin C and zinc aid in various processes of wound healing. The Research Question: Is applying a standard diet with ONS more effective than merely a standard diet for faster wound healing of PUs, in immobile hospitalized elderly patients aged 65 years and over? The PICO elements: Population Immobile patients with pressure ulcers aged 65 and over Intervention Applying a standard diet with oral nutritional supplementation Comparison A standard diet Outcome Faster wound healing Inclusion and Exclusion Criteria: The main criteria included papers selected in the English language, dating from year 2000 onwards about PU care. Participants who were not immobile elderly patients, aged 65years and over with PUs were excluded. The Search: The search resulted in six studies consisting of four randomized controlled trials and two non-randomized controlled trials. Methods of Appraisal: These were appraised using the Critical Appraisal Skills Programme checklists. Results of the Study: The intervention group as compared with the control group showed acceleration of PU healing. Main conclusion: ONS has been found to be effective in increasing rate of wound healing, not if only macro nutrients such as proteins are given but if a set of supplements specifically to target wound healing are administered. Implications and Recommendations: Introducing a new product for PU care may be susceptible to various controversies such as an extra expense, its adverse effects and its suitability on the patients. Prior to its implementation ONS can be given for a period of time and health care professionals can evaluate its effects.