Did you know that approximately 3% of older Americans--approximately 1.67 million people--are currently dealing with an open wound? While the body possesses a remarkable ability to recover, wounds that do not heal can substantially affect an individual’s mental, social and physical well-being. Although Wound Healing Awareness Month has ended for 2023, it is always a good time to explore a holistic approach to healing that can enhance healthy aging.

To ensure comprehensive, effective wound care, all aspects of the healing process must be addressed. Good nutrition plays a tremendously significant, but often overlooked, role in healing. Appropriately fueling the body can make a notable difference in healing wounds.

Protocols serve as valuable tools for enhancing the consistency and efficiency of medical care, and they can be especially critical when it comes to nutrition because malnutrition tends to be underdiagnosed and undertreated, highlighting the need for a more proactive approach. To provide the best care possible, protocols are regularly updated to integrate the latest knowledge and discoveries. By staying up-to-date with these protocols, healthcare providers can bridge the gap between what clinicians do and what scientific evidence supports, ultimately promoting optimal healing and well-being for older adults.

A new protocol has been developed specifically to help prevent pressure injuries from developing when a patient is in the hospital. Core steps of the Standardized Pressure Injury Prevention Protocol Checklist (SPIPP-ADULT) 2.0 are:

1. Assess risk factors to guide risk-based prevention.
2. Assess skin/tissue for signs of damage and pressure injury.
3. Implement preventive skin care and manage incontinence.
4. Redistribute pressure.
5. Maintain good nutrition.
   

The National Pressure Injury Advisory Panel defines a pressure injury as localized damage to the skin and underlying soft tissue, often occurring over a bony prominence or due to a medical or other device. It can manifest as intact skin or an open ulcer, and it may bring discomfort.

Vital connection between nutrition and wound healing

Wounds can arise from various causes, including surgery, trauma and pressure injuries. Some wounds don’t respond to initial treatment and fail to heal within the expected timeframe of around 30 days. These chronic nonhealing wounds are typically seen in individuals with complex medical needs and multiple comorbidities, particularly diabetes and obesity.

As an individual gets older, natural physiological changes can make wound healing more difficult. The skin becomes thinner and less elastic, making it more vulnerable to injuries, while the immune system may weaken, further compromising the healing process. For older adults who are experiencing age-related changes and comorbidities that slow wound healing, proper nutrition becomes even more crucial to optimize the healing process and minimize the risk of complications.

Adequate nutrition, especially when it comes to protein, carbohydrates and energy, plays a pivotal role. These nutrients provide the necessary building blocks for cellular regeneration, tissue repair and immune function--all essential processes for optimal wound healing.

Dietary intake alone may not provide enough of the necessary nutrients to impact chronic nonhealing wounds. In such cases, nutritional supplementation may be necessary to provide the specific nutrients needed for wound healing (Table 1).

Table 1. Important nutrients and their function in supporting wound healing

Social and emotional impact of chronic wounds

For chronic wounds, particularly pressure injuries, the social repercussions cannot be overstated. Such wounds can cause discomfort, restrict mobility and emit unpleasant odors. These effects often give rise to self-consciousness and social seclusion, imposing a profound impact on an individual’s social well-being, which affects healthy aging.

Chronic wounds can also exact an emotional toll on older adults, as mental health is more likely to decline when the physical state falters. Chronic wounds can evoke frustration, anxiety and depression, and the added stress compounds the erosion of overall quality of life. Emphasizing the role of nutrition in supporting wound healing can potentially enhance mental as well as physical well-being, empowering older adults to reclaim their regular and active social engagements. Prioritizing wound prevention and care by taking steps such as implementing the Standardized Pressure Injury Prevention Protocol Checklist (SPIPP-Adult) 2.0 in hospitals further upholds the vital social dimensions of care.

Quality care supports wound care

Chronic wounds can impact hospital readmissions, and Medicare expenditures for chronic wound care are significant. Thus, it is not surprising that many of the value-based programs and quality measures of the Centers for Medicare & Medicaid Services (CMS) are related to wound care. And a new pressure injury quality measure has been proposed for CMS FY 2024 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long‑Term Care Hospital (LTCH) Prospective Payment System (PPS). This system governs reimbursement for acute-care hospitals and long-term facilities.

The American Board of Wound Management (ABWM) Foundation named June as Wound Healing Awareness Month to highlight the challenges of chronic wounds. By looking at the whole person and incorporating proper nutrition into wound care, healthcare providers can promote healthy aging by improving wound-healing outcomes. Let’s prioritize nutrition as an essential component of wound care as we strive for optimal healing and healthy aging.

Resources for nutrition and wound care

National Pressure Injury Advisory Panel: SPIPP checklist

Journal on Active Aging article: Nutrition to aid wound healing in the aging adult

ICAA report: Taking the next step forward

Abbott Nutrition Health Institute (ANHI) webinar: Nutrition and wound care: Why it matters for value-based healthcare

ANHI video: Good nutrition for wound healing

Laura Borth, MS, RDN, CD, is a registered dietitian nutritionist and policy analyst at Defeat Malnutrition Today in Washington, DC.