Nutrient intake and the risk of pressure sore development in older patients

Evidence-based review of the effects of nutritional supplementation for pressure ulcer prevention

The objective of this evidence-based review was to explore whether the evidence supports the use of nutritional supplements in pressure ulcer (PU) prevention strategies. Several electronic databases, including Ovid MEDLINE (1946 to May week 32 019), Ovid EMBASE (1947 to May 28, 2019), EBSCO CINAHL (until June 13, 2019), Scopus (until July 9, 2019), and the Web of Science (until June 13, 2019) were searched. No limitation was placed on the year of publication. Studies considered for inclusion were those with adult populations, and only English language texts with available full text were reviewed. AMSTAR (a measurement tool to assess systematic reviews) was used to evaluate the quality of the studies included in the systematic review. The Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 Levels of Evidence was used to assess the level of evidence. Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) was used to assess guideline article, and Appraisal tool for Cross-Sectional Studies (AXIS) was also used for cross-sectional studies. The search identified 1761 studies. After the application of inclusion and exclusion criteria, 24 studies were retained of various designs, including 10 systematic reviews, five clinical reviews, three randomised controlled trials, two observational studies, one quasi-experimental study, one cross-sectional study, one cohort study, and one Clinical Guideline. Two were rated as high-quality reviews, 14 were rated as moderate-quality reviews, five were rated as low-quality reviews, and three were rated as critically low-quality reviews. The majority of the reviewed studies were of low-to-moderate quality because of biases in the study design and incomplete data reporting, which did not fulfil the reporting criteria of the appraisal tools. However, the majority of the studies showed a reduction in PU incidence after nutritional supplement though not significant. Whether the use of pharmacological appraisal tools to assess non-pharmacological studies is appropriate is unclear. Regardless of the low-to-moderate quality of the studies in this review, nutritional supplements appear to play a role in PU prevention.

The benefits of VAC therapy in the management of pressure ulcers

This study investigates whether vacuum-assisted closure (VAC) therapy, alginate or hydrocolloid dressing are most effective in the treatment of pressure ulcers. A total of 281 patients were included in this study. The response of each patient's wound was monitored, satisfactory wound closure was examined and the time taken to attain satisfactory wound closure was also taken into consideration. An original analysis of the published data was carried out. Most of the pressure ulcers showed some response in all of the categories investigated, with pressure ulcers in the VAC therapy group showing a greater response in all aspects than those in the other two groups.

Clinical pictures of malnutrition in ill elderly subjects

Malnutrition in ill elderly subjects is common in hospitals, nursing homes, and home care. Depending on the type and composition of the groups of patients under consideration, the prevalence of malnutrition is cited at up to 60%. With advancing age, the amounts of food consumed daily diminish and become significantly smaller than the amounts consumed by the younger population. The elderly mostly eat food of low nutrient density. Especially at times of high energy requirements such as acute or chronic illness, this results in an energy deficit and general malnutrition. Precise diagnosis of malnutrition can be facilitated by determination of a number of biochemical parameters. Knowledge of these permits individualized nutrition therapy. The most important deficits affecting ill elderly subjects are those relating to proteins, iron, zinc, selenium, and vitamins B12, B1, B6 and D. Malnutrition prolongs hospital stays, imposes enormous costs on health services, and causes considerable mortality. The present, very rapid increase in the size of the elderly population will exacerbate the problem of malnutrition. Therefore more attention should be paid to malnutrition by treating it as a disease in its own right and including it in the training of doctors and nurses.

Malnutrition and pressure ulcers: nutritional assessment tools

Good nutrition is essential throughout life and often patients have a poor understanding of what a balanced diet comprises. Nurses need to have a good comprehension of malnutrition. Where malnutrition is evident it can be resolved by working with the patient to encourage a healthy diet. One way to improve patient nutrition is by a nutrition audit of patient food. Numerous nutritional assessment tools exist which help to identify a patient's nutritional status. No nationally standardized nutritional assessment tool exists and there is a danger of assessment methods becoming as proliferate as pressure ulcer risk assessment tools. A solution to this problem may be to use a pressure ulcer risk assessment tool with a nutritional risk assessment tool such as the Burton Score. Pressure ulcers and malnutrition have been demonstrated to be strongly correlated with each other. Malnutrition is not just present in hospitals but also in nursing homes. A solution to this problem is to use nutritional tools to highlight nutritional deficiency in a patient's diet not only in hospitals but also in the community and in nursing homes.