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Malnutrition in community-dwelling older people: lessons learnt using a new procedure

02 April 2020
Volume 25 · Issue 4

Abstract

This article reports the implementation of a new procedure for screening and treatment of malnutrition in a community NHS trust in England. The barriers and facilitators to implementation were assessed with staff from Integrated Community and Older People's Mental Health teams. Data from interviews and surveys were collected at baseline, 2 months after initial training and 16 months after initial training as well as following deployment of a nutrition lead to embed new developments for nutritional care. The adoption of the procedure made screening and treatment of malnutrition simpler and more likely to be actioned. The benefit of a nutrition lead and local nutrition champions to support and empower staff (avoiding reliance on training alone) was shown to drive change for nutritional care across the community. Prioritisation and commitment of leadership at the organisational level are needed to embed and sustain malnutrition screening and treatment in routine practice.

In the UK, it is estimated that approximately 3 million people are at risk of malnutrition (or undernutrition), and nearly half of these individuals are aged 65 years or over, with most (93%) residing in the community (Elia and Russell, 2009). Malnutrition and unintentional weight loss are costly (Elia et al, 2015) and have a significant impact on quality of life due to increased susceptibility to disease and mortality (Soderstrom et al, 2017). Moreover, malnutrition poses a strain on healthcare resources, as it leads to delayed recovery from illness, increased need for healthcare provision at home, more frequent visits by nurses and a greater number of hospital admissions (Guest et al, 2011). Malnutrition is largely preventable through appropriate screening using a validated tool, such as the Malnutrition Universal Screening Tool (‘MUST’) (Elia, 2003). National policy guidance (National Institute for Health and Care Excellence (NICE), 2012; 2017) recommends screening for malnutrition, which leads to substantial cost savings from early identification and treatment largely from reducing healthcare resources (Edington et al, 2004). Screening should be undertaken by trained care providers and integrated into existing pathways of care. After screening, appropriate action should be taken to manage those patients identified to be malnourished or at risk of malnutrition. Malnutrition in the community is optimally treated by providing first-line dietary advice—the ‘food-first’ approach—followed by possible combination with oral nutritional supplements (ONSs) when necessary (Dera and Woodham, 2016; Holdoway et al, 2017).

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