From the desk of Dr Nancy Collins, PhD, RDN, LD, NWCC, FAND

Long-term care (LTC) professionals face many challenges in providing adequate nutrition for residents with or at risk of pressure injuries and other types of wounds. One issue is that many residents receiving modified consistencies may already have reduced overall calorie and protein intakes. This means wounds may not have adequate nutritional substrate available to build new tissue for healing. Individuals with dysphagia or swallowing disorders have a higher prevalence of unintended weight loss and pressure injuries.1 Older adults receiving modified consistencies often have a greater dissatisfaction with foods and may find less enjoyment from meals.

Traditionally, modified diets include mechanical soft, dysphagia, and pureed diets often with thickened liquids. The recent global initiative by the International Dysphagia Diet Standardisation Initiative describes and labels dysphagia diets using a modified framework for all ages and cultures for use in any care setting.3 These updated mechanically altered diets provide residents with textures that are more individualized to their chewing and swallowing ability. This may help increase overall nutritional intake, thus preventing malnutrition. However, accomplishing this in LTC facilities is slow because staffing and budget limitations hinder full implementation of the new framework. It is best practice for a speech-language pathologist (SLP) to become involved as soon as a chewing or swallowing problem is identified. To address the problem, the SLP can determine the most appropriate diet texture and liquid consistency.

Many residents would benefit from a wound-specific medical nutritional supplement, but this can pose another problem since many of these popular products are delivered in a powdered form that must be mixed with water. Powders clump, come out of suspension, and it is difficult to blend the precise consistency needed. Additionally, these products typically require two 8-fl-ounce servings each day.

Medtrition offers a different solution called Expedite™ Cup. This product is currently the only available therapeutic nutrition supplement to support wound healing designed with the dysphagia patient in mind. It is a gel-like consistency that is IDDSI Level 4, extremely thick or spoon/pudding thick and served in a 2-ounce daily portion. Expedite Cup requires no preparation and is served by simply removing the foil lid and eating it right out of the plastic cup. Since the serving size is a small 2-ounces/day, it is very easy for patients to adhere to this intervention until their wound is fully healed.

Expedite Cup contains a highly concentrated blend of the collagen dipeptides Prolyl-Hydroxyproline (PO) and Hydroxyprolyl Glycine (OG) plus L-citrulline. These highly active ingredients were carefully selected based on current research to support wound healing. These specific collagen dipeptides stimulate fibroblast activity to help build new tissue3 while L-citrulline is an efficient and more powerful way to stimulate nitric oxide production when compared to supplemental arginine.4

Visit www.expeditehealing.com for more information and to request a free sample kit in the HCP section.

References

1. Cichero JAY. Age-Related Changes to Eating and Swallowing Impact Frailty: Aspiration, Choking Risk, Modified Food Texture and Autonomy of Choice. Geriatrics (Basel). 2018;3(4):69. Published 2018 Oct 12. doi:10.3390/geriatrics3040069.
2. International Dysphagia Diet Standardisation Initiative. A global initiative to improve the lives of over 490 million people worldwide living with dysphagia. Accessed May 15, 2024. https://iddsi.org.
3. Sugihara F, Inoue N, Venkateswarathirukumara S. Ingestion of bioactive collagen hydrolysates enhanced pressure ulcer healing in a randomized double-blind placebo-controlled clinical study. Sci Rep 8, 11403 (2018). doi.org/10.1038/s41598-018-29831-7.
4. Agarwal U, Didelija IC, Yuan Y, Wang X, Marini JC. Supplemental Citrulline Is More Efficient Than Arginine in Increasing Systemic Arginine Availability in Mice. J Nutr. 2017 Apr;147(4):596-602. doi: 10.3945/jn.116.240382. Epub 2017 Feb 8. PMID: 28179487; PMCID: PMC5368575.