healing and nutrition elderly

Patients over the age of 65 are in many cases at greater risk of suffering bone fractures and pressure injuries than younger patients. Their ability to recover from such wounds is often compromised by slower healing rates, which can in turn result in longer hospital stays. Slowness in healing is commonly attributable to poor nutrition, which can be the result of chronic health issues. This problem can often be detected and treated by health professionals, however, improving elderly patients’ ability to avoid such injuries and giving them a better chance of recovering from them more quickly when they do experience them.

The increased risk of pressure injuries in older patients as a result of changes in the skin

A weakening of the skin is a natural part of the aging process, often causing it to appear pale and nearly translucent. The epidermis becomes thinner as time goes on, and as patients enter old age, it becomes more vulnerable to tearing. This is the result of changes in the skin’s connective tissue, which weakens it and makes it less elastic, as well as increased fragility in the blood vessels. Skin is further weakened by loss of elasticity and sweat glands, which slows the epidermis’ ability to repair itself. Coupled with other factors, including physical inactivity and malnutrition, skin wounds in elderly patients often take up to four times longer to heal, leaving them at greater risk of infection.

Elderly patients with health issues commonly require long-term care, and as a result of their weakened epidermises, many of them are at greater risk of developing pressure injuries during treatment. Studies have shown[1] that 80% of such injuries occur within two weeks of admission into a healthcare facility, and 96% within three weeks. Those who are particularly at risk from such injuries include those who suffer from diabetes mellitus, incontinence, malignancy, peripheral vascular disease, or who undergo extended periods of pressure on particular areas of the body. Smoking, a low body mass index (BMI), and simply being older than 65 also put patients at higher risk of suffering pressure injuries, but malnutrition is also one of the leading causes.

The causes of malnutrition in the elderly

Proper nutrition is vital for the recovery of any epidermal patient, and all the more so for the elderly. Those recovering from skin wounds should increase their caloric intake in order to aid cellular regeneration. The additional calories contribute to angiogenesis and collagen deposition while halting protein loss.

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Elderly patients are more likely to be malnourished, however, resulting from a number of factors[2]. These include a decrease in the gastrointestinal tract’s ability to absorb nutrients, as well as oral and dental problems, arthritis, living alone, depression, loss of appetite, poverty, and changes in the sense of taste that often accompany old age and the use of certain medications. All of these can hinder the patient’s ability and desire to eat.

How to detect poor nutrition in elderly patients

All patients over the age of 65 should undergo routine nutritional assessment. Malnutrition can often be detected by observing thinning or brittle hair, fissures or ridges in the nails, enlarged gums that bleed frequently, muscle wasting, glottitis, and/or a loss of more than 5% of total body weight during a 30-day period, or more than 10% within 180 days. Dryness, flaking, and poor turgor in the skin can also indicate malnutrition.

Health professionals treating elderly patients should monitor their values of prealbumin, serum albumin, total protein, transferrin, and total lymphocytes. A deficiency in any of these will show that a patient is malnourished. These should be checked as soon as a patient begins undergoing treatment. If a patient is dehydrated upon arrival, these levels should be checked again 1-2 days later, as dehydration can result in higher than actual measurements.

These values should always be checked even if a patient appears healthy, as symptoms of malnutrition are not always readily apparent.

Greater need for protein in older patients

Patients over 65 require more protein than younger ones. They should receive 1-1.24 grams of protein per kilogram of body weight daily, as opposed to the 0.8 grams per kilogram that younger patients require. Elderly patients undergoing healing require 1.5 grams daily.

Types of nutrition and their relationship to skin health

Adequate intake of arginine, carbohydrates, fluids, lipids, minerals, protein, and vitamins A, C, and K are all crucial for promoting skin health and aiding the epidermal recovery process. These nutrients contribute to the body’s production of enzymes, hormones, and other elements that sustain the epidermis. Patients should be regularly consuming wholesome, nutrient-dense foods to ensure that they receive sufficient amounts of all of these substances.

Nutrition and the treatment of pressure injuries

Several organizations dedicated to combating pressure injuries have offered guidelines on how to deal with them. This includes offering patients who are suffering from or who are at risk of such injuries a specific level of nutritional intake based on their individual needs, taking into consideration their underlying medical conditions and level of physical activity. Such patients should be given a minimum of 30-35 calories per kilogram of body weight to ensure that they are receiving enough nutrition to deal with such problems. In cases where this cannot be provided through a normal diet, high-calorie and high-protein oral nutritional supplements should be offered to compensate.

Protein intake should be maintained at levels that will contribute to a positive nitrogen balance in the patient – usually 1.25-1.5 grams of protein per kilogram of body weight daily, depending on whether or not this is compatible with the overall care the patient is receiving. Sufficient fluid intake must be maintained as well, and vitamin and mineral supplements should be considered if the patient is unable or unwilling to maintain a daily diet that provides adequate amounts of them, or in cases where some other factor, such as a patient’s drug regimen, is causing nutrition depletion.

One simple way to help elderly patients increase their protein intake is to advise them to add protein powders to cereals and beverages. Supplements that are high in calories and protein can also be added as snacks to a malnourished patient’s diet. Patients who exhibit malnutrition should be referred to a nutritionist for more specific guidelines. But in some cases, simply finding ways to promote increased appetite among older patients[3] is sufficient to deal with any nutritional deficiencies.

Promoting proper nutritional intake in patients over 65 is crucial, both for promoting better health as well as dealing with existing medical issues.

Author Bio: Robert Snapp is a freelance healthcare writer and world traveler from San Luis Obispo, California with an educational background in biology and neuroscience. His work covers medical conditions like PTSD, Autism, Depression, and Wound Care among others.

[1] (n.d.). How nutrition and aging affect wound healing – LWW Journals. Retrieved July 29, 2020, from https://journals.lww.com/nursing/fulltext/2003/08000/how_nutrition_and_aging_affect_wound_healing.48.aspx

[2] (2019, February 8). Nutritional Factors for Wound Healing in the Older Adult Patient. Retrieved July 29, 2020, from https://www.todayswoundclinic.com/articles/nutritional-factors-wound-healing-older-adult-patient

[3] (2020, June 5). Good Nutrition is Key to Wound Healing: 10 Ways to Stimulate …. Retrieved July 29, 2020, from https://vohrawoundcare.com/good-nutrition-is-key-to-wound-healing-10-ways-to-stimulate-appetite-in-seniors/

Image by StockSnap from Pixabay

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