While “you are what you eat” may have some limitations, there’s no doubt that what you choose to put into your body has a big impact on your health.
The opposite is also true: what you choose not to put into your body also has health consequences. If you’re missing key nutrients, your body is going to have a harder time staying healthy and healing from any injury or illness.
Pressure injuries are no exception. Good nutrition is key to preventing PIs, says Dr. Sarah Van Gansbeke, a clinical nutrition and pharmacology expert. When the body is in good condition, tissues are less sensitive to pressure, shear or friction. When the body doesn’t have adequate nutrients, however, tissues don’t have the strength to withstand those forces, and injuries are much more likely to develop.
But as important as nutrition may be, it remains an enormous challenge "on the floor" in hospitals and long term care facilities. Some estimate that as much as 60% of older patients in American hospitals suffer from malnutrition.
That figure underscores the importance of monitoring residents' nutritional intake. But keeping patients on the healthy side of the nutrition scale is not simply a matter of serving three square meals each day. It means keeping close track of how people are eating and if they are getting what they need from their foods.
It also means knowing when to supplement their diets with protein-rich drinks that are high in calories, vitamins, and minerals. Supplements, however, as useful as they are, must never replace regular food as the source of nutrition.
Nutrition-Related Risks for PIs
Dr. Van Gansbeke identifies four nutrition-related health factors that increase the risk of pressure injuries.
1. Unwanted weight loss - Losing more than 5% of one's body weight in one month or more than 10% in six months is a nutritional warning sign. In most circumstances, one can’t lose that much weight without compromising tissue health.
2. Low body weight - A Body Mass Index (BMI) of 18.5-25 is normal. People with low body weight increase their susceptibility to pressure injuries.
3. Dehydration - Not consuming enough fluid is the obvious cause of dehydration, but it could also come from drinking too much diuretic or from an illness with frequent vomiting and diarrhea. Signs such as nausea, dizziness, muscular spasms, and weakness could point to the need for more hydration.
4. Malnutrition - Not getting enough nutrition not only increases the risk for developing PIs but also slows the healing process when one occurs. So it makes sense to pay special attention to signs of malnutrition, including a patient who starts to fit poorly in their regular clothes, or starts to show signs of a sunken face. Malnutrition can make people's handshakes feel soft and they might exhibit a noticeable drop in their energy levels. Their attitudes also might become more apathetic. Watch for these signals.
If signs of malnutrition start to appear, the resident needs a nutrition screening. Dr. Van Gansbeke recommends NRS 2002 for general population and MUST or MNA for the geriatric population.
Malnutrition - Causes and Treatments
As people get older, they experience metabolic changes. They start to lose fat and muscle, which they need to resist pressure injuries. Their thirst decreases so they are more vulnerable to dehydration. They may start losing their teeth, so choices of foods could become more limited. Older residents also receive more medication, which can have an effect on nutrition.
Preventing malnutrition starts with effective monitoring. Keeping track of residents' nutritional readings allows health workers to intervene as early as possible, preventing deterioration.
Each patient should have a chart detailing all of the food and liquid consumed as well as their nutritional value, to see if it meets the patient's needs. Frequent follow-up is essential.
To help prevent pressure injuries, residents need to consume a minimum of 30-35 kcal per kilogram of body weight. They also need 1.25-1.5 grams of protein per kilogram each day. Most people get only 0.8 grams on average, but people fighting pressure injuries need higher levels of protein.
They also need 2-2.5 liters of water each day to prevent dehydration. That number goes up when the patients have a fever or when they are vomiting. Too often, patients who are bedridden and need to ask for help to go to the bathroom drink less fluid to avoid going as often. Be watchful to prevent this dangerous cycle.
Using Nutrition Supplements
For patients who are not experiencing malnutrition, studies have shown that nutritional supplements may accelerate healing from pressure injuries and decrease their intensity when they do appear.
The important thing to remember is that supplements do not replace meals. Instead, they come in between meals as snacks. Mealtime is still the best time for stocking up on important vitamins and minerals.
Supplements can come in several forms and should be administered with input from a dietician. The most common are protein-rich drinks that are easy to consume between meals. The can also be powders that should be sprinkled over other foods to increase their nutritional value.
The best ones are loaded with calories and vitamins, even in a small volume of liquid. They can increase intake of Vitamin C for collagen formation and iron to fight anemia, which inhibits the formation of collagen.
While these supplements have proven to be effective in adding nutrients in many cases, they are not free of potential drawbacks. One is that they they’re expensive, so they are far from an efficient solution. Another is that they can make a patient feel full and lower the amount of food consumed at mealtime.
Finally, the jury is still out regarding supplements aimed specifically at fighting pressure injuries. While the chances are good that a positive link will be established one day, there is no clear proof to date.
Making Nutrition a Priority
Good nutrition improves quality of life, promotes healing, and keeps away illness and injury. It is an essential step in any effort to fight pressure injuries and has benefits that reach virtually every aspect of health.
With so much riding on diet and exercise, it is essential to make nutrition the center of any PI prevention program. A new mattress will only be as effective as the strength of the skin tissue it touches.
And all of that starts with nutrition.