Pressure ulcers are common, costly, and adversely affect quality of life. Nutritional status is one risk factor that predisposes individuals to the development of a pressure ulcer. The impact of nutritional supplementation is reflected in the reduced incidence of pressure ulcers; however, the evidence is limited. The precise role of nutritional supplementation in pressure ulcer healing is less clear, yet a trend towards healing has been suggested. Patients should have their nutritional status monitored carefully. If difficulties arise, these should be detected early, and if it is not possible to increase the intake of normal food and fluids, then advice should be sought from the dietitian.
Key words: pressure ulcers, risk, prevention, treatment, nutrition.
Introduction
Pressure ulcers are localized areas of tissue damage caused by excess pressure, shearing, friction, or a combination of all three1 and may be largely preventable. Despite the advances in technology and preventative aids, they remain a common and debilitating problem.2
Search Strategy
Using the databases Medline, CINAHL, and the Cochrane Database, a search on relevant terms was performed to retrieve data related to the role of nutrition in preventing and managing pressure ulcers. Search terms were set to limit retrieved items to research articles published in English subsequent to 1988. The search strategy utilized yielded a number of potentially useful articles, and these form the basis of this article.
Scope of the Problem
Incidence figures have been estimated to range from 2.2-66% per year in the U.K., and 0-65.6% in the U.S. and Canada overall.3 Furthermore, a review of data from a 6-year national incidence study in the U.S. found that the incidence of pressure ulcers in 1999 was 8% and in 2004 was 7%, demonstrating little change in overall figures.4
The presence of a pressure ulcer affects morbidity and may affect mortality.5 Pressure ulcers can be painful and malodorous.6 They are often heavily nursing time intensive.7 One study identified that the risk of dying for older patients with a pressure ulcer was three times greater than for those without a pressure ulcer.5 Other research supports this argument, with two studies demonstrating an odds ratio of 3.64 (p<0.001)8 and 4.19 (p<0.001)9 respectively of death in acute geriatric patients with a pressure ulcer.
Pressure ulcers are a significant financial burden to health care systems. In the Netherlands, pressure ulcers have been found to be the third most expensive disease.7 The length of hospital stay for those with a pressure ulcer is suggested to be 2-3 times greater (30.4 days compared to 12.8 days) than a typical case without pressure ulcers.10
Pressure ulcers are more common in older patient groups; furthermore, the majority of people with chronic wounds are nursed in the community or long-stay setting.11 Changing demographics and an aging populace suggest that the number of individuals with pressure ulcers is set to increase.
Risk Assessment
Risk assessment is one component of the assessment process that is used to identify individuals who are at risk of pressure ulcer development. Risk factors for pressure ulcer development include being bed- or chair-bound, unable to reposition without assistance, difficulty with ambulation, history of stroke, fecal incontinence (which is strongly correlated with immobility), low body weight, lymphopenia, difficulty with independent feeding, impaired nutritional intake,