Benefits of an oral nutritional supplement on pressure ulcer healing in long-term care residents.

OBJECTIVE To investigate the effects of an oral nutritional supplement (ONS) plus standard care on the healing of pressure ulcers in long-term nursing home residents in addition to standard care. The ONS (Cubitan, Nutricia Advanced Medical Nutrition) was high in energy and protein, and enriched with arginine, vitamin C and zinc. METHOD A total of 245 patients with grade II-IV pressure ulcers were enrolled into this open study at 61 long-term-care facilities, which reflect the nursing-home population of Luxembourg and Belgium. Residents received the ONS daily for nine weeks, along with their normal diet or enteral feed and standard pressure care. Pressure ulcer area (mm2) and condition were assessed after three and nine weeks. Data were analysed using ANOVA and expressed as mean +/- SD. RESULTS The patients' age was 82.2 +/- 10.1 years. Sixty-seven patients (27%) had been previously treated with the ONS. The majority of pressure ulcers were located at the sacrum (54%) and heel (32%). The average intake of the 200 ml ONS was 2.3 +/- 0.56 servings daily, which corresponds to 46 g protein, 6.9 g arginine, 575 mg vitamin C, 87 mg vitamin E and 21 mg zinc. After nine weeks' nutritional support, the average pressure ulcer area reduced significantly from 1580 +/- 3743 mm2 to 743 +/- 1809 mm2, which is a reduction of 53% (p<0.0001). Complete wound closure occurred after three and nine weeks in 7% and 20% of the pressure ulcers respectively. The amount of exudation (assessed subjectively) also decreased after specialised nutritional support (p<0.0001). CONCLUSION A high-protein ONS enriched with arginine, vitamin C, vitamin E and zinc, when used with standard pressure ulcer care, significantly reduced the mean pressure ulcer area of long-term nursing home residents.