Poor nutrition in the elderly can result in a number of complications, including weight and muscle loss, reduced mobility, infections, and poor skin integrity. These complications increase the risk of residents developing pressure injuries and wounds. Nutrition plays an essential role in wound healing, and should be considered as a fundamental part of wound management in aged care. Poor nutrition before or during the wound healing process may delay healing and impair wound strength, making it more prone to breakdown.
When the body sustains a wound, requirements for protein and calories are higher than usual while the body is replacing old injured tissue with new tissue. The effects of a wound can be pronounced, even if the wound is small! If the body is not getting the nutrients it needs during the healing process, it can go into a state of malnutrition. The following nutrients are essential for wound healing in the elderly:
- Protein: essential for the maintenance and repair of body tissue. Depleted protein will slow the wound healing process. Sources: meat, chicken, fish, eggs, dairy products, lentils and legumes, nuts and seeds, tofu
- Energy: requirements increase depending on the size and complexity of the wound. The body’s preferred energy sources are carbohydrates and fats. Sources: carbohydrates – wholegrain bread and cereal, pasta, rice, potato, biscuits. Fats – meat, milk, cheese, butter, cream, yoghurt, oils and margarine
- Zinc: key role in tissue growth and healing. Sources: red meat, fish, milk products, chicken and eggs
- Iron: provides oxygen to the site of the wound to assist healing. Sources: red meat, offal, fish, eggs, dark green leafy vegetables, dried fruit, nuts and yeast extracts (e.g. Vegemite)
- Vitamin C: important for forming new blood vessels, immune health and absorption of iron. Sources: fruit and vegetables (particularly oranges, tomatoes and leafy vegetables)
Hydration is also essential in wound management, as dehydrated skin is less elastic and more susceptible to breakdown. Dehydration also reduces blood flow, impairing the supply of oxygen and other nutrients to the wound. It is vital that residents are encouraged to consume fluids with all meals and snacks.
Arginine is another essential nutrient during wound healing. Arginine is a protein that has been shown to be important in several pathways involved in wound healing. Arginine supplements may be beneficial for residents with a stage two or above pressure injury. Residents who require nutrition support for wound healing or with pressure injuries should be referred for the dietitian for a thorough nutrition assessment to determine whether oral nutritional supplements are required.
In summary, a varied diet containing meat, chicken, fish, eggs, full fat dairy products, wholegrain breads and cereals, and fruit and vegetables, will assist with wound healing. Other tips for helping residents with wounds to meet their nutritional needs include:
- Avoid low fat or low sugar diets
- Encourage nourishing mid meal snacks
- Offer alternative meals or extra desserts if the resident doesn’t complete their main meal
- Provide assistance with set up and meals as required
- Offer larger portions of meals or desserts if the resident is eating well
- Address any barriers to eating, such as dysphagia, confusion, pain, depression, constipation or poor dentition
- Encourage residents to drink their supplements (if prescribed)
For more information regarding nutrition and wound healing or to discuss individual resident needs, please speak with your visiting dietitian from the Eat Well Nutrition team.