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Disease‐Specific, Versus Standard, Nutritional Support for the Treatment of Pressure Ulcers in Institutionalized Older Adults: A Randomized Controlled Trial
Author(s) -
Cereda Emanuele,
Gini Anna,
Pedrolli Carlo,
Vanotti Alfredo
Publication year - 2009
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2009.02351.x
Subject(s) - medicine , calorie , randomized controlled trial , enteral administration , nutritional supplementation , parenteral nutrition , vitamin , surgery , gastroenterology , physical therapy
OBJECTIVES: To investigate whether a disease‐specific nutritional approach is more beneficial than a standard dietary approach to the healing of pressure ulcers (PUs) in institutionalized elderly patients. DESIGN: Twelve‐week follow‐up randomized controlled trial (RCT). SETTING: Four long‐term care facilities in the province of Como, Italy. PARTICIPANTS: Twenty‐eight elderly subjects with Stage II, III, and IV PUs of recent onset (<1‐month history). INTERVENTION: All 28 patients received 30 kcal/kg per day nutritional support; of these, 15 received standard nutrition (hospital diet or standard enteral formula; 16% calories from protein), whereas 13 were administered a disease‐specific nutrition treatment consisting of the standard diet plus a 400‐mL oral supplement or specific enteral formula enriched with protein (20% of the total calories), arginine, zinc, and vitamin C ( P <.001 for all nutrients vs control). MEASUREMENTS: Ulcer healing was evaluated using the Pressure Ulcer Scale for Healing (PUSH; 0=complete healing, 17=greatest severity) tool and area measurement (mm 2 and %). RESULTS: The sampled groups were well matched for age, sex, nutritional status, oral intake, type of feeding, and ulcer severity. After 12 weeks, both groups showed significant improvement ( P <.001). The treatment produced a higher rate of healing, the PUSH score revealing a significant difference at Week 12 (−6.1±2.7 vs −3.3±2.4; P <.05) and the reduction in ulcer surface area significantly higher in the treated patients already by Week 8 (−1,140.9±669.2 mm 2 vs −571.7±391.3 mm 2 ; P <.05 and ∼57% vs ∼33%; P <.02). CONCLUSION: The rate of PU healing appears to accelerate when a nutrition formula enriched with protein, arginine, zinc, and vitamin C is administered, making such a formula preferable to a standardized one, but the present data require further confirmation by high‐quality RCTs conducted on a larger scale.