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Identifying malnutrition and providing care, support and treatment from a clinical perspective

Ailsa Brotherton

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Identifying and treating malnutrition .... in 10 minutes

How to identify individuals at risk of malnutrition

Localities with a high prevalence of malnutrition.

What care, support and treatment do older people need


Identifying Malnutrition: Screening and Assessment

•Screening using a validated tool (‘MUST’)

•Nutritional assessment and care planning


Localities with a high prevalenceWe know where it is but do little to prevent it

SECONDARY CARE complications length of stay readmissions

mortality

CARE HOMES30-42% of recently admitted residents

HOSPITAL29% of admissions

(range 24-30%) England highest

PRIMARY CARE

hospital dependency GP visits

prescription costs

SHELTERED HOUSING10-14% of tenants

HOMEGeneral population

(adults)BMI <20kg/m2 : 5%

BMI <18.5kg/m2 : 1.8% Elderly: 14%

Prevalence of malnutrition

in the UK

Data from the Nutrition Screening Weeks 661 hospital centres and data on 34,699 patients


Change in screening practice on admission in hospitals

0

10

20

30

40

50

60

70

80

2007 (N=175)

2008 (N=90)

2010 (N=141)

2011 (N= 147 )

%

Centres

0-25% patients26-50% patients51-75% patients76-100% patients

Key finding: Majority subjects at risk admitted to hospital are from home and could be identified earlier

Data kindly supplied by Christine Russell, Chair of NSW


We have described the problem, measured the prevalence and made clear recommendations for action

Hospitals Care Homes Mental Health Units

Centres (n=)

Patients (n=)

Centres (n=)

Residents (n=)

Centres (n=)

Patients (n=)

2007 Autumn

175 9336 173 1610 22 332

2008 Summer

130 5089 75 614 17 185

2010 Winter

185 9668 148 857 20 146

2011 Spring

171 7541 78 523 67 543

Prevalence 25-34% 30-42% 18-20%

Data kindly supplied by Christine Russell, Chair of NSW


Seasonal Trends

The overall prevalence of ‘malnutrition’ on admission to hospitals varied significantly between seasons: 28% in autumn and summer, 34% in winter, and 25% in spring.

The higher prevalence in winter can be related to a number of factors: Greater social isolation which may result in reluctance of people to go out shopping or visit GP More severe accidents on icy surfaces; More severe hypothermia More prolonged and severe chest infections.

The well-known effects of malnutrition causing weakness, lethargy, impaired temperature regulation and immunosuppression could predispose to such problems during cold weather.


Variation across the UK

SCOTLANDSignificant improvements in awareness of ‘malnutrition

nutritional screening practice and in the organisation of nutrition support services.

Implementation and inspections: NHS QIS Standards on Food, Fluid and Nutritional Care.

Some improvements in awarenessnutritional screening

and in the operational infrastructure of nutrition support services

No significant improvement in the inclusion of nutritional information in discharge

communication

Some improvements


Age related Data

Overall the prevalence of ‘malnutrition’ was about 33% higher in those aged 65 years or older than those less than 65 years old.

Gender

Higher prevalence of ‘malnutrition’ in women than men by 3-6%.

The difference was more marked in those aged 65 years or older than those less than 65 years old

Source of Admission

In all the surveys, the majority of patients were admitted from their own homes and at least 1 in 4 were at risk of ‘malnutrition’ on admission.

Overall, half of the patients admitted from care homes were also at risk but these accounted for the smallest proportion of admissions.


What care, support and treatment do older people need?

A nutritional assessment should consider the main causes of malnutrition and the support and treatment be tailored to meet an Individual’s needs (including oral nutritional supplements where indicated)


Resources and pathways for use in the community


Ailsa Brotherton, Nicola Simmondsand Mike Stroudon behalf of the

BAPEN Quality Group


“The starting point for improvement is to recognise the need”

The first step to improvement is to recognise the need


...we have everything we need to design highly reliable systems of care

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