Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 431

A nutritional concern especially relevant for older adults in long‐term care facilities and frail older adults being cared for at home is pressure ulcer prevention and treatment. The prevalence of pressure ulcers is not well known but has been reported to be as high as 30% in long‐term care and 19% in home‐care patients³⁸; and while derived from a varied aetiology, the condition is well known to have a strong malnutrition component. Factors such as repositioning, mattress selection, and wound care also represent key aspects of treatment, but there is no question that a shortage of protein, calories, or/other nutrients required for wound healing would hamper recovery from pressure injury.³⁸

The current state of science on pressure ulcer treatment is equivocal on specifics, but it is widely accepted in clinical practice that nutritional repletion with an oral nutrition supplement (ONS) can benefit malnourished patients with pressure injuries.^38,39 ONSs contain nearly all essential nutrients, including vitamins and minerals. A 2014 Cochrane Review⁴⁰ examined the results of 14 RCTs evaluating the effects of enteral or parenteral nutrition on the prevention and treatment of pressure ulcers. The trials were heterogeneous with regard to participants, interventions, nutrients used in the interventions, comparisons, and outcomes, and the review found no clear evidence of an improvement in pressure ulcer healing from the nutritional supplements.

A more recent review by Heintschel and Heuberger³⁸ considered 10 studies of ONS, including both standard and speciality formulas. The review focused specifically on zinc, based on the role of this essential mineral in a number of anabolic processes including DNA repair and protein metabolism as well as several aspects of immunocompetence. Zinc intakes tend to be low in older adults, but there is a lack of reliable biomarkers of zinc status. While the authors concluded that both standard and speciality ONS improved outcomes, it was not possible to distinguish a preferable formulation. The authors also noted the unreliability of zinc biomarkers and the lack of a significant response of pressure injury to zinc sulfate administration as factors that furthered hampered understanding of the potential impact of zinc status. Thus, while the role of ONS in the prevention and treatment of pressure ulcers was confirmed, the precise role of micronutrients such as zinc await confirmation through further studies in higher quality and more consistent RCTs.