title: The Potential Role of Zinc Supplementation on Pressure Injury Healing in Older Adults: A Review of the Literature.
abstract: BACKGROUND
  Compromised nutritional status is common among older adults (aged ≥ 65 years) and is a risk factor for pressure injuries (PIs), which may lead to poor clinical outcomes. The aim of this review was to determine whether or not poor PI healing in older adults is a result of suboptimal zinc status.
  
  
  METHODS
  A literature search was performed in PubMed from 2001 to 2016 using the key words: "zinc status," "pressure ulcer," "pressure ulcers in older adults," "wound healing," and "zinc sulfate." Inclusion criteria consisted of adequate sample size, nonacute setting, clinical trial or observational study, sound methodology, and generalizable findings for primary and secondary outcomes, which included food intake, oral nutritional supplement (ONS) consumption, risk for malnutrition, nutrient loss from wound exudate, and lab values.
  
  
  RESULTS
  Of 41 total studies, 10 satisfied the inclusion criteria and investigated PI in older adults versus nutritional intake. Both standard and specialty ONS interventions, which contain additional fortification, improve outcomes, though findings are inconsistent regarding formulations preferable for the treatment of older adults. Monitoring for nutritional deficiencies, including Zn, is essential for optimal patient outcomes.
  
  
  CONCLUSIONS
  Recently, Zn in combination with ONS containing additional kilocalories, protein, and other trace elements, has been investigated for PIs. Although both standard and specialty ONS interventions improve outcomes, findings are inconsistent regarding preferable formulations for the treatment of older adults. Monitoring for nutritional deficiencies, including Zn, is essential for optimal patient outcomes. Unreliability of biomarkers for frank Zn deficiency make diagnosis uncommon, and oral Zn sulfate administration has not shown significant effects on PI outcomes in the past.
  
  
  CONCLUSIONS
  This population benefits from the clinical application of supplementation with preparations containing Zn, added calories, protein, and other trace elements. This improves outcomes, decreases healing time, and mitigates comorbidities.
authors.affiliation: Central Michigan University, Mt. Pleasant, MI.
authors.forename: Melissa
authors.initials: M
authors.lastname: Heintschel
authors.affiliation: Central Michigan University, Mt. Pleasant, MI.
authors.forename: Roschelle
authors.initials: R
authors.lastname: Heuberger
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology; D019587:Dietary Supplements; D006801:Humans; D044342:Malnutrition / Q000150:complications*; D009751:Nutritional Requirements; D003668:Pressure Ulcer / Q000178:diet therapy* / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control*; D014131:Trace Elements / Q000494:pharmacology / Q000627:therapeutic use; D014945:Wound Healing / Q000187:drug effects* / Q000502:physiology; D015032:Zinc / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D014131:Trace Elements; D015032:Zinc