Collaboration critical to combating malnutrition

One way in tackling malnutrition encouraged patients to take oral nutritional supplements after meals to help prevent loss of muscle mass and muscle strength. ©iStock/KatarzynaBialasiewicz

The issue of poor or inconsistent standards of nutrition in hospitals and care homes continues to persist, with the elderly especially at risk of severe malnourishment.

Malnutrition is not only restricted to those who do not, or simply cannot, consume enough food or the right nutrients.

Malnourishment can also occur when nutrients are ingested but are not digested or absorbed properly by the body. This is more likely to occur amongst the elderly population.

Treatment guidelines exist, but they are rarely applied in practice. Indeed, The European Nutrition for Health Alliance (ENHA) believes nutrition therapy is neglected within health and social care budgets.

“It is essential that malnutrition and dehydration problems are better recognised and treated,” said Elizabeth Meatyard, leadership associate at The King’s Fund, a health think tank based in the UK.

Best practice case study

As a former nurse, Meatyard shared details of a recent initiative she undertook that aimed to recruit larger number of volunteers to assist vulnerable patients to eat and drink.

She further developed The Kingston Hospital Dining Companion programme offering more specialised training to not only give general assistance and companionship to patients at mealtimes but also more detailed dining companion training led by a clinical team.

“Part of the role of the Dining Companion is also to encourage fluid intake, including the prescribed oral nutritional supplement (ONS) drinks,” she said.

“In addition, both fluid and food intake will be recorded by the Dining Companion where indicated. Timing of the supplements was also a concern as some patients were being given the supplements at the drug round just prior to the meal service.”

Speaking at Food Matters Live, Meatyard explained the clinical rationale for encouraging patients to take ONS immediately after their meals.

“This method helps prevent sarcopenia (loss of muscle mass and muscle strength) and nursing staff are currently being trained on this important part of nutritional care.”

Collaboration is key

She explained that this was an example of how a collaborative approach in combating malnutrition was an effective way forward.

“A hands-on collective collaborative leadership will ultimately bring about the changes that are needed in a modern 21st Century NHS (National Health Service),” she said.

“Accept that we must take small steps and embed the resultant changes with close monitoring. Never simply ‘tick a box’ to demonstrate compliance in an audit of nutritional screening, because there is always much more to do if we are going to deliver the improvements in nutritional care that patients deserve.”

There are signs that healthcare trusts are moving towards a combined approach in tackling malnutrition, assessing and allocating resources to best address this ongoing concern. 

In February of this year the UK's Malnutrition Task Force made available guidance intended for local health commissioners and authorities that advised on effective strategies to combat malnutrition.

The scale of malnutrition

The scale of malnutrition in Western Europe makes for grim reading. According to the ENHA, malnutrition costs €8.8 billion per year in the UK alone.

Up to 15% of older people living in the community and above 50% of care home residents are malnourished.

The issue of inadequate nutrition in care institutions was high on the agenda for Elizabeth Feltoe, health influencing manager at Age UK — the country's largest charity for the elderly.

She revealed that 33% of patients admitted to acute care will be, or at risk of becoming malnourished. In addition, 35% of individuals admitted to care homes will also be affected.

The issue of improving nutrition and avoiding malnutrition in hospitals and care homes is a long-running and multi-faceted one, not helped by the barriers faced in efforts to improve the situation.

Malnutrition as a problem is under-recognised and under-treated. An Age UK survey of more than 1500 health professional found that only 51% believed malnutrition was of significant urgency in their organisations.  

Only 47% felt confident their knowledge and skills were enough to aid those most at risk.

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