Nutrition and Wound Healing in the Elderly Treated with Supplements and Dietary Regimen
Talk about a double-edged sword: as adults grow older, they’re more susceptible to wounds, and at the same time, aging slows down the healing process. And that’s not all—many elderly patients are low in the nutrients needed to help the body heal. While doctors can offer all sorts of treatment options, age-related roadblocks sometimes hinder their efforts. Pharmacists have the important job of counseling elderly patients about essential nutrients and making appropriate supplement recommendations to support wound healing.
Chronic Wounds and Delayed Healing in the Elderly
Chronic wounds in the elderly are frequently associated with age-related health conditions. Vascular disease, diabetes and venous insufficiency are three of the top causes, but unrelieved pressure and surgery also contribute to the overall incidence. Based on these underlying causes, it’s no surprise that diabetic foot ulcers, venous leg ulcers and pressure sores are three common chronic wounds found in the elderly population.
- Venous ulcers: Account for 70 percent of all lower extremity ulcers—recurrence rate is 90 percent.1
- Diabetic ulcers: About 30 percent of diabetics suffer from lower extremity disease—diabetic foot ulcers are associated with mortality rates of 16.7 percent at 12 months and 50 percent at five years.2
- Pressure ulcers: Estimated to occur in 9 to 38 percent of hospitalized patients and 2 to 28 percent of those in long-term care—few studies have explored prevalence in the community.
Wound healing involves a complex process of overlapping phases: inflammation, proliferation, angiogenesis, epidermal restoration and wound remodeling. Every phase is affected by aging. Put simply, older skin is slower to respond, which leads to blunted wound healing and increased inflammation.3 Many physiological functions are involved: less oxygen is present and cells react slowly, so macrophage infiltration, angiogenesis and epithelization are all diminished. Sometimes macrophages fail to remove dead cells. In the elderly, skin mitochondria are increasingly dysfunctional, which severely impacts wound healing. Some of the most fundamental changes in aging skin—reduced elasticity, thin skin and loss of the fat layer—impair the rate of healing.
Nutritional Support Is Essential for Wound Healing
Patients tend to focus on the obvious treatment of bandages and antibacterial creams. Doctors choose from a wide variety of wound dressing materials and topical agents to ensure optimal healing. Of course, any underlying health conditions must be properly diagnosed and treated. But nutritional support is as essential, if not more critical, in elderly patients who may be malnourished or deficient in critical nutrients. Following a complete nutritional assessment by a registered dietitian, patients may need medical products or OTC supplements. With background knowledge of the key nutrients, pharmacists can target nutritional needs:
- Calories: Patients with chronic wounds require more calories than normal. The National Pressure Ulcer Advisory Panel recommends 30 to 35 calories per kilogram of body weight daily, although caloric requirements also depend on overall health, ability to move and age.4
- Protein: Insufficient protein causes the body to break down lean muscle mass, which in turn impedes wound healing. To get the recommended 1.25 to 1.5 grams of protein per kilogram of body weight, many elderly patients need to boost dietary protein or take supplements. Be sure to ask your patients about chronic kidney disease, as they may not be able to tolerate extra protein.
- L-arginine: Conditionally essential amino acids such as L-arginine are depleted during times of illness, increased stress and extreme physical activity, so supplementation may help wound healing. L-arginine participates in protein synthesis and collagen deposition.
- Vitamin A: Through its role regulating cell growth and differentiation, vitamin A stimulates overall More specifically, it impacts chemotaxis, adhesion and tissue repair. Supplemental and preformed vitamin A can become toxic. While the tolerable upper intake level is 3,000 micrograms of retinol activity equivalents daily, elderly patients may reach toxic levels at lower doses.
- Vitamin C: This antioxidant supports the production and function of white blood cells, but its immune support isn’t its major role in wound healing. Angiogenesis, collagen synthesis and matrix crosslinking all depend on the presence of vitamin C.5
- Zinc and iron: Zinc supports cell proliferation and synthesis of protein and collagen, while iron delivers oxygen and also helps synthesize collagen. A deficiency of either mineral can impair healing and weaken the strength of the wound. However, supplemental iron may inhibit zinc absorption, so they should not be taken together.
- Vitamin E: While it’s known to modulate cell signaling, gene expression and wound healing, a review published in the June 2016 issue of the Internal Wound Journal reported that there isn’t enough evidence to support its role.6
Tips for Pharmacist Outreach
As a pharmacist, you may be more comfortable counseling patients about pharmaceutical products than nutritional supplements. But as a community pharmacist, your role is more important than you realize. Some of your elderly patients may self-treat, going to the doctor only when their wound becomes intolerable. Even those who are under a doctor’s care may not get nutritional advice unless they see a wound care specialist. Consider proactive outreach that includes:
- Patient education: It’s a sure bet that few, if any, of your elderly patients know about the role of nutrients in wound healing. Talk with them and recommend supplements.
- Medication review: Make sure that your patients with chronic wounds aren’t taking medications that cause nutritional deficiencies.
- Coordinate and collaborate with health care providers – Call geriatric specialists in your area to discuss how you can help their patients. Reach out to all the physicians treating your patients to be sure everyone knows about nutritional recommendations.
- Carry a reputable line of nutritional products – In addition to individual supplements and multi-vitamins, consider adding a line of protein powders, protein bars or ready-made drinks, if you don’t already carry them. These products provide protein and extra calories—some also contain vitamins and minerals.
Protect Elderly Patients with Pharmacist Intervention
It’s important for patients to know that getting nutrients from a healthy diet is always an ideal first intervention. But elderly individuals face all sorts of dietary roadblocks, from health issues to loss of appetite or even lack of transportation to purchase food. Supplements offer a valid way to fill nutritional gaps and they may make a significant difference in patients with chronic wounds. Pharmacists can be a bridge of communication to let patients know about options, while ensuring physicians address patient needs.
Pharmaceutica North America provides high-quality APIs, prescription products such as diclofenac sodium gel and a variety of OTC dietary supplements. Call us today to talk about how we can support the pharmaceutical needs of your patients.
- “Wound Care,” March 2016, http://emedicine.medscape.com/article/194018-overview ↩
- “Diabetic Foot Ulcer: An Evidence-Based Treatment Update,” 2014, http://www.medscape.com/viewarticle/828552 ↩
- “Chronic Wound Repair and Healing in Older Adults: Current Status and Future Research,” March 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582412/ ↩
- “Nutrition and Wound Healing in the Older Adult: Considerations for Wound Clinics,” November 2013, http://www.todayswoundclinic.com/articles/nutrition-wound-healing-older-adult-considerations-wound-clinics ↩
- “Nutrition and Wound Healing,” accessed July 2016, http://worldofwounds.com/wp-content/uploads/2015/04/Nestle-Nutrition-Wound-Healing-book.pdf ↩
- “Vitamin E and Wound Healing: An Evidence-Based Review,” June 2016, http://www.ncbi.nlm.nih.gov/pubmed/25124164 ↩