Malnutrition in older frailadults

The Kings Fund

March 2016

Nigel Barrett

Community Services Manager

1

2

• Age UK South Staffordshire

• Eat Well Staffordshire

• Volunteer process

• Outcomes

• Implications

3

Age UK South Staffordshire

• Lead Partner in Eat Well Staffordshire

• Key provider of services to older people to sustain them to stay in their own homes, with independence.

• Committed to supporting the frail elderly and their carers.

• Free information and advice lines and accessible volunteer based community services

• Has around 350 volunteers in different areas of the organisation – opportunities for everyone.

4

Opportunities for Everyone

• Eat Well Mentor

• Social Support/befriender

• Cook and Eat demonstrator and one to one cooking

• Eat Well Ambassador

5

6

Learning Outcomes

• Eat Well Staffordshire project

overview

• What is malnutrition?

• Prevalence, causes and

consequences of malnutrition

• Signs and symptoms of

malnutrition

• Nutritional screening with the

‘Malnutrition Universal

Screening Tool’ (MUST)

• Intervention and management

according to level of risk of

malnutrition

• Approach to nutritional

screening in practice

• Client Information Sheet

• Personal Safety and policies

• Assessment

• Volunteer follow-up

• Review of visit

What is Malnutrition?

Malnutrition : a serious condition that occurs when a person’s diet

does not contain the right amount of nutrients (energy, protein and

other nutrients).

It means "poor nutrition" and can refer to:

Undernutrition - when a person doesn't get enough nutrients

Overnutrition - when a person gets more nutrients than they need

This project focuses on undernutrition – however we are able to assist

people who are overweight with social support and signpost to other

organisations, such as Waistlines.

www.nhs.uk7

Why Malnutrition?

• It is estimated that more than 3 million people in the UK are either

malnourished or at risk of malnutrition

• A majority of these (approximately 93%) are living in the community,

with a further 5% in care homes and 2% in hospitals

• It is estimated that 1 in 10 people over 65 are malnourished or at risk

• Around 1 in 3 people who are admitted to hospital or

Care homes in the UK are found to be malnourished

or at risk of malnutrition

8

Consequences of malnutrition Impaired immunity

Increased risk of infection

Poor wound healing

Skin breakdown with

ulceration

Increased risk of falls

Memory loss and confusion

Fatigue

Decreased muscle function

Breathing and heart

difficulties

• Increased ill health

• Increased hospital admissions

• Longer recovery time from surgery and illness

• Increased risk of mortality

9

Signs and symptoms

Most common sign of

undernutrition is unplanned

weight loss (losing more than 5-

10% of body weight within 3-6

months)

Sometimes weight loss is not

obvious, as it occurs slowly over

time: may be noticeable that

clothes, belts, jewellery and

dentures gradually feel looser.

http://www.derbyshire.gov.uk/images/eat-well_6pp_DL_HR_tcm44-209499.pdf

10

11

What can we do?

Eat Well Staffordshire looks to:

Raise awareness, signs and symptoms,

Identify malnutrition through nutritional

screening

Provide social support and help with

cooking

Provide advice and signpost

people to healthcare services

12

Referral into Eat Well Staffordshire project for nutritional screening

Eat Well Staffordshire

Hospital discharge

teams Carers (CASS)

Care staff in the home

GPs/District nursing teams

Providers of food

delivered in the home

Fire, police, ambulance

Hairdresser /other

professionalLet’s Work Together

team

Other voluntary agencies

Befriending agencies

Social work teams

Family/

friends

Eat Well team or partner

directly

Self-referral

13

Achievements with volunteers

- 287 People supported over 3 years

- 78% stabilised or improved, 44% reduced MUST scores

- Dame Barbara Clayton Award 2016

- Age UK Volunteering Project of the Year 2015

- Staffordshire Make Every Mouthful Matter Care Pathway

- 59% aged 80+, 22%over 90

- 4000 people attended community events

- 96 1:1 cooking tutorials

- 90 assessments completed monthly,

14

Implications

Volunteers can sustain frail elderly people in the community where they

live regardless of initial wellbeing status

Complex processes can be managed and supported in the community

Frail elderly adults can be supported to do more themselves, and

motivated to commit to goals

Care Navigation with specialist support within the delivery model can

succeed

The NHS alone is not enough, the third sector has a key role to play

15

References

• For further information on the ‘ MUST’ see the BAPEN website www.bapen.org.uk

• The British Dietetic Association (BDA) campaign ‘Mind the gap’

http://www.mindthehungergap.com/about/background.html

• NHS Choices – Malnutrition, http://www.nhs.uk/conditions/malnutrition/Pages/Introduction.aspx

• Focus on Undernutrition, http://www.focusonundernutrition.co.uk/home

• Food First, http://www.bapen.org.uk/tackling-malnutrition/nutritional-advice-and-information/treating-

malnutrition/food-first-project

• Malnutrition Taskforce, http://www.malnutritiontaskforce.org.uk/

• Managing Adult Malnutrition in the Community, www.malnutritionpathway.co.uk

• South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Guidelines for the Safe

Nutrition & Hydration of Service Users, October 2011,

http://www.southstaffsandshropshealthcareft.nhs.uk/getattachment/6df61965-429f-40c8-8966-

7cb1dd52fac8/C-YEL-cm-B-(1).aspx

• NICE Guidance 32 Nutrition Support in Adults 2012

16