Undernutrition in an Elderly Woman with a Pressure Ulcer

Q: An 85-year-old woman was admitted to my nursing home after a hip fracture. She developed a Stage 4 sacral pressure ulcer in the hospital. She lost a lot of weight since her fall, and the nurses report that she is eating about 75% of her diet. Is there any specific vitamin or nutritional supplement that I should be using to help heal her pressure ulcer?

A: Despite having reasonably good nutrition status prior to hospitalization, weight loss and a deterioration of nutritional status often occurs in the hospital.1 Almost 90% of subjects admitted to a subacute rehabilitation facility were either at risk or had undernutrition.2

The approach to nutritional treatment is directed to whole-body nutrition. In persons who are not taking in an adequate diet, the use of nutritional supplements may increase protein and energy intake. It is important that supplements are given between meals, since delivery of supplements with meals does not increase nutrient intake.3

Provision of between 1.2 and 1.5 g/kg of body weight of protein has been associated with higher rates of wound healing. The target for adequate provision of energy should be around 30 to 35 kcal/kg of body weight. In persons who have an inadequate intake of protein and calories, a general multivitamin should be considered. However, subjects who consume a commercial nutritional supplement fortified with added vitamins and trace elements do not need additional multivitamins.4

There is no specific nutritional intervention that has been shown to increase the rate of healing for pressure ulcers. Vitamin C and zinc in supratherapeutic doses have not been shown to accelerate wound healing. No other specific nutritional product has been shown to accelerate healing in pressure ulcers.5