How Nutrition Benefits Wound Healing

As we observe Wound Healing Awareness Month this June, it's important to not lose focus on the holistic approach to healing and its impact on healthy aging. Chronic wounds are most common in older adults, with 3%, or 1.67 million older Americans, having an open wound at any given time. While wounds heal, they can have a significant impact on our mental, social and physical well-being. It is essential to address all aspects of wound care, and one aspect that often goes unnoticed is the role of nutrition.

Protocols can be an important tool for making care more consistent and efficient and for closing the gap between what clinicians do and what scientific evidence supports. This is especially important in nutrition care, where malnutrition is underdiagnosed and under treated. To support the best care, protocols are often updated, like a new wound care–related protocol developed specifically for pressure injury prevention (Figure 1).

Figure 1: New Standardized Pressure Injury Prevention Protocol Checklist (SPIPP-Adult) 2.0

The Link Between Nutrition and Wound Healing

Wounds can develop in several ways, such as from surgery, trauma or pressure injuries. According to the National Pressure Injury Advisory Panel, “A pressure injury is localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. It can present as intact skin or an open ulcer and may be painful.” Wounds that don’t respond to initial treatment and are not healing in the expected time frame (usually 30 days) are considered chronic nonhealing wounds, which typically occur in individuals with more complex medical needs and those with multiple co-morbidities, particularly diabetes and obesity. As we age, our bodies naturally undergo physiological changes that can impact wound healing. The skin becomes thinner and less elastic, making it more susceptible to injuries. Additionally, the immune system may weaken, further compromising the healing process. For older adults who may have these age-related changes and co-morbidities that slow wound healing, proper nutrition becomes even more crucial to enhance the healing process and minimize the risk of complications.

Adequate nutrition, especially of protein, carbohydrates and calories helps optimize these processes, providing the necessary nutrients for cellular regeneration, tissue repair, and immune function, all of which are essential for optimal wound healing. Many times, diet alone may not be sufficient to impact chronic non-healing wounds, which may require additional nutritional supplementation to provide nutrients important for wound healing (Figure 2).

Figure 2: Important nutrients and their function in supporting wound healing

The Social and Emotional Impact of Chronic Wounds

Wounds, especially pressure injuries, can have a significant social impact. They may cause discomfort, limit mobility, and even emit unpleasant odors. This can lead to feelings of self-consciousness and social isolation, affecting one’s overall well-being. The emotional impact of wounds also should not be overlooked. When we don't feel great physically, it can take a toll on our mental health. Chronic wounds can cause frustration, anxiety and depression, and this added stress can impact overall quality of life.

By focusing on proper nutrition, we can help facilitate wound healing and improve mental well-being, fostering a positive outlook on the healing process and getting older adults back to their regular and active social schedule. Prioritizing wound prevention and care (for example through implementing the SPIPP in hospitals to help prevent pressure injuries) can help maintain social dimensions of care.

Quality Measures to Support Wound Care

Chronic wounds can impact hospital readmissions, and the Medicare expenditures for chronic wound care are significant. Thus, it is not surprising that many of the Centers for Medicare & Medicaid Services (CMS) value-based programs and quality measures are related to wound care. This year, CMS is proposing a new pressure injury quality measure in its 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 centers.

In the proposed rule CMS states, “the risk of developing a pressure injury can be reduced through best practices including risk assessment, assessment of skin and tissue, preventive skin care, and reducing progression through treatment of pressure injuries, including nutrition.” Integrating targeted nutrition into clinical wound care protocols may help improve outcomes for CMS quality programs and measures. The American Board of Wound Management (ABWM) Foundation named June as Wound Healing Awareness Month to help bring attention to the challenges of chronic wounds and provide more information about addressing those challenges. By looking at the whole person and incorporating proper nutrition, we can promote healthy aging and improve wound healing outcomes. Let's prioritize nutrition as an essential component of wound care and strive for optimal healing and healthy aging.

Resources for Nutrition and Wound Care:

• The National Pressure Injury Advisory Panel’s comprehensive SPIPP checklist for healthcare professionals provides guidance on assessing and intervening for risk factors, skin health, tissue condition and nutrition in relation to pressure injuries.

• Nutrition to aid wound healing in the aging adult article provides nutrition tips and sample menus.
• Taking the next step forward report outlines opportunities to improve wound care in older adults (scroll down on the webpage to find the publication).
• Nutrition and Wound care webinar illustrates why proper wound care matters for value-based healthcare.

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