Annals of Long Term Care

Supplemental zinc and vitamin C are routinely prescribed for the prevention and treatment of pressure ulcers. The authors sought to determine whether there is sufficient evidence-based medical research to support the use of these supplements. Both zinc and vitamin C have been shown in animals to be necessary for effective wound healing. Since malnutrition in institutionalized older patients may contribute to their risk of developing pressure ulcers and may interfere with the treatment of these lesions, it has been proposed that improving nutrition through supplementation of vitamin C and zinc may assist in the prevention and treatment of pressure ulcers. However, the authors’ review of the literature found that there is insufficient evidence to support the routine use of supplemental zinc and/or vitamin C in individuals with adequate nutrition. Furthermore, supplemental zinc may produce a number of adverse effects. (Annals of Long-Term Care: Clinical Care and Aging 2010;18[3]:28-32)

Introduction
There are several types of skin ulcers that affect older patients: venous or stasis ulcers, arterial insufficiency ulcers, diabetic neuropathic ulcers, and pressure ulcers. In this article, we will focus on whether zinc and vitamin supplementation assist in wound healing, with the focus on pressure ulcers, also referred to as decubitus ulcers, pressure sores, and bedsores.

Epidemiology
Before discussing the incidence and prevalence of pressure ulcers, it is important to point out that there are few good nationwide studies. Pressure ulcers are estimated to affect 1.3-3 million people in the United States.¹ Older people account for 70% of all pressure ulcers. ² The highest incidence of pressure ulcers has been reported in hospitalized vulnerable elderly persons undergoing orthopedic procedures (9-19%) and quadriplegics (33-60%).^3-5 In response to a challenge from the National Pressure Ulcer Advisory Panel (NPUAP), a survey was conducted from 1989 to 2005. The survey included 148 U.S. health facilities. The range of pressure ulcer prevalence prior to 1999 was from 9.2% to 11.1%. Over the next six-year period, from 1999-2005 the prevalence of pressure ulcers remained at 15%.⁶ Similarly, the European Pressure Ulcer Advisory Panel (EPUAP) has reported prevalence rates ranging from 8-23%.^7,8 Studies conducted in the Netherlands have shown the prevalence of pressure ulcers to range from 12.8-20.3% in one study and 23.1% in another.^9,10

The incidence of these lesions in intensive care units (ICUs) is reported to range from 14% in short-stay units to as high as 41% in long-stay units.¹¹ In a cross-sectional point study done in Dutch ICUs, the national prevalence rate was as high as 28.7%.¹² A survey of four European countries has reported a prevalence of 4% in Denmark and as high as 49% in Germany.^13,14 In East Carolina, the prevalence rate prior to implementation of a prevention program in two ICUs was 11.7%.¹⁵ Another study done in an ICU in a midwestern U.S.