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Are we Getting any Closer to Improving our Management of Malnutrition?
Malnutrition is common in all types of care homes and hospitals, all types of wards and diagnostic categories. Nearly three million people in the UK at any one time are estimated either to live with malnutrition, or to be at risk because they do not eat enough. Surveys suggest that more than 1 in 3 adults admitted to care homes in the previous six months, and up to 1 in 5 adults on admission to Mental Health Units in the UK are at medium to high risk of malnutrition. And people with a learning disability can be considerably more at risk of being underweight than the general population.
These figures show that malnutrition touches every layer of health and social care services. Despite its prevalence, the issue has perhaps failed to attract the attention it deserves. Some health and social care professionals, along with politicians, automatically think of obesity when nutrition is on the agenda, but malnutrition is also an important public health issue in the UK.
Are things changing?
The Francis report into the tragedy at Mid Staffs Hospital revealed that patients had not been able to eat or drink properly, and that nutrition and hydration had not been regarded as a priority. In response, and in recognition that malnutrition is a problem that extends to other sectors of care beyond the hospital setting, the Department of Health has funded The Malnutrition Prevention Project that is being overseen by the Malnutrition Task Force, an independent group of experts across Health, Social Care and Local government united to address the problem of avoidable and preventable malnutrition in older people.
Malnutrition Prevention Pilot Project
The Malnutrition Prevention Programme scheme seeks to help the one million older people in England who are suffering from or are at risk of malnutrition i.e. those who have a low Body Mass Index (BMI), or are losing weight without trying to. One of the Programme’s aims is to encourage whole communities - including local NHS trusts, hospitals, GP practices, care homes and community groups - to come together and tackle malnutrition. This will include enabling health and care staff to prevent or identify and treat malnutrition early, raising awareness with community groups, and bringing together clinicians and carers. Local Age UK groups that are involved in the project will also mobilise a team of volunteers to provide extra support for older people.
This project is currently being piloted in five different areas across England: South London, Salford, Gateshead, Dorset and Kent, with the learning and results to be disseminated nationally. The hope is to significantly reduce the number of people aged 65 and over in these areas who are malnourished.
What is happening with nutritional screening in care homes?
The South London Pilot has just reported preliminary results at a Care and Nursing Homes Network event. They reported on an audit conducted as part of the project on compliance with national nutritional care guidelines. This states that people in care homes should be screened on admission and re-screened monthly or when there is clinical concern. The audit was undertaken in 19 out of 23 South London care homes (63% residential, 16% nursing and 21% dual registered) where the majority of service users were elderly. They concluded after auditing 762 care records that:
- Nutritional screening tests were routinely included in residents care records in care homes but were rarely fully and accurately completed.
- More than 90% of residents had a nutrition care plan in place, but the care plans rarely related to the nutritional screening test score and rarely included nutritional goals.
- As a result, around half of those at medium or high risk of malnutrition in care homes failed to receive the nutritional care they required.
- Training should be focussed on translating nutrition screening to appropriate actions.
Raising the profile of nutrition in care homes
At the same event, a presentation was given by a care home group who have raised the profile of nutrition in their care homes. They have introduced
- Nutrition champions.
- Quarterly regional nutrition meetings attended by the champions and head chefs.
- Monthly nutrition meetings where the nutrition profiles of residents are discussed.
- Daily discussion of the nutritional status of at risk residents.
- ‘Resident of the day’ visits from the chef.
What about GPs?
In terms of progress with increasing GP awareness of malnutrition, the Royal College of General Practitioners (RCGP) has launched an online nutrition learning programme designed to help GPs and other primary care professionals identify malnutrition in the community. The programme has been developed to help them follow the pathway for managing adult malnutrition in the community which has the backing of doctors, dietitians, pharmacists, nurses and Bapen, the charity devoted to raising awareness about malnutrition and improved nutritional care. The pathway is a good starting point for GPs who traditionally do not see malnutrition as part of their remit
However, the feeling still seems to be that while progress has been acknowledged on the hospital side, there is still some difficulty in trying to get GPs to recognise the fact that malnutrition is an issue for them as well as for hospitals.
In addition Mencap, who previously highlighted the tragedy of Martin, a 43 year old with learning difficulties who was left without food for 26 days following a stroke, wants to see more easy-to-read material about the risks of malnutrition produced for adults with a learning disability to support them and to highlight that malnutrition can be a lifelong problem.
Whose responsibility is malnutrition?
It is often said of malnutrition that because it is everybody's business, by default it becomes nobody's responsibility. But whether you are a GP, working in elderly care or with people with learning difficulties, adequate nutrition can make a difference both clinically and to quality of life. So whoever we are, let’s make it our responsibility to see an improvement in the nutritional care of our service users.
Ayela Spiro, British Nutrition Foundation – QCS Expert Nutrition Contributor