Body Composition and Wounds

As seen in the Consultant Connection March 2016 Issue
by Susan M Cleveland BSN, RN, WCC, CDP - reprinted from The Director Summer 2015
Sarcopenia, from the Greek meaning “poverty of flesh”, is the degenerative loss of skeletal muscle mass and strength associated with aging. Cachexia, on the other hand, is loss of weight and muscle mass caused by disease. It is a complex metabolic syndrome associated with underlying illness. Starvation typically is thought to result from a lack of access to food whether due to financial constraints or other food availability issues.
Often all weight loss has been lumped into a single category but this is not a complete picture. Wound healing can be helped or hindered by the resident’s nutritional status. Since the cause of poor nutrition in the elderly is multifaceted reflecting physical and psychosocial changes, our assessment must include a thorough knowledge of their poor nutritional status. 
Malnutrition is defined as inadequate intake of protein and / or energy over prolonged periods of time resulting in loss of fat stores and/or muscle wasting. Physical signs of malnutrition include:
  • Thin wasted appearance 
  • Thin to normal appearance with peripheral edema, ascites, or anasarca (extreme generalized edema)
  • Severe muscle wasting
  • Edema of lower extremities
  • Sparse, thin, dry hair
  • Dry, thin skin
  • Obvious bony prominences
  • Temporal wasting
  • Lowered body temperature
  • Lowered blood pressure
  • Some muscle wasting with retention of some body fat
  • Lowered heart rate
  • Changes in hair and nail appearance
  • Dyspigmentation of hair and skin
  • Delayed wound healing
 
Malnutrition can be masked by the presence of excess body fat. The scale doesn’t know the difference between a pound of fat and a pound of muscle. At this point it comes down to discovering “body composition” –the different components of the body making up total body weight or relative portions of fat, bone, and muscle mass.
Measurements of body composition can be obtained by different methods. Low-tech methods the one most familiar to general population is skin fold measurements, easy to obtain in any clinical or non-clinical setting. High-tech methods include magnetic resonance imaging (MRI), computed tomography (CT) and multicomponent models that are expensive, limited in availability and tedious limiting them to research and clinical studies.
Body composition is important for different reasons to different portions of the population. Residents with chronic wounds should be concerned with body composition. Humans need a certain amount of essential fat for body function; however, excessive fat has been linked to many diseases. As clinicians, we should be aware; regardless of weight many are losing lean mass. When a resident has a non-healing wound despite optimal care, consider composition issues and the effect lean body mass loss and sarcopenia.
Effective treatments often require more than one approach. Periodic monitoring and trial of different options for weight management should be employed until the right combination is discovered to work for the individual resident.