We appreciate the comments expressed by Dr Finucane. A paucity of studies exist that demonstrate a direct causal link between nutritional status and pressure ulcer development, when other preventive variables are controlled. However, pressure ulcer experts believe that nutritional assessment and the use of supplements when older adults are nutritionally compromised are very important preventive measures. In our study, we used medical records to profile and evaluate the processes of care for hospitalized Medicare patients who were at risk for pressure ulcer development. Given the retrospective nature of the study, we were unable to capture observational data. Although the medical records did note dietitian assessments and recommendations, we could not determine whether these nutritional recommendations were implemented. The ordering of nutritional supplements does not guarantee that the supplements will be given consistently or that the amount will be ingested with direct observations, which limited our study. We believed that the initiation of a nutritional consultation may have sensitized the medical team to the higher risk of pressure ulcer development. To this end, we could conservatively conclude that when a nutritional consultation was initiated, those older adult patients developed fewer pressure ulcers over time. Additional prospective studies are greatly needed to further understand the role of nutrition in preventing pressure ulcers.
Lyder CH. "Quality," Nutrition, and Pressure Ulcers—Reply. Arch Intern Med. 2002;162(1):100. doi: