Supporting Patients with Malnutrition

Maia Fergus-O’Grady, registered dietitian with Wiltshire Farm Foods, explores the importance of being able to recognise the signs of malnutrition

Malnutrition is a common problem that is likely to affect a significant number of patients on a healthcare professional’s caseload. Despite its prevalence, it is commonly overlooked and undertreated. Older adults (aged 65+) are more likely to develop nutritional deficiencies, with over one in 10 individuals in this age group being at risk of malnourishment. This year, Malnutrition Awareness Week runs from the 10 - 17 October; it being a time to highlight the preventability of the condition and recognise the importance of correct management. As OTs, it’s useful to understand the signs of malnutrition, as well as being able to signpost individuals to helpful resources. This could help to manage malnourishment early and minimise the need for more intensive interventions. Not only will this potentially help you, through improving the patient’s ability to carry out tasks as they move throughout the day, but also reduce the financial pressure that malnutrition puts on the NHS and other patient services.

Malnutrition is a complex condition, and can present itself in many ways. Aside from a clear drop in weight, other signs of malnutrition include: 1 Jewellery becoming looser or slipping off 2 Looser, ill-fitting dentures 3 Catching bugs and colds more frequently, developing infections more regularly 4 Clear change in the ability to complete everyday tasks 5 Having to tighten belts with extra notches, clothes becoming looser 6 Difficulties chewing and swallowing 7 Empty cupboards, food rotting in fridge 8 Changes in mood, lethargy, feeling down more regularly There are certain patient groups that might need more support in maintaining or improving their dietary intake. Below, three of these groups have been highlighted, with further advice provided and several useful organisations signposted.

On occasion, the advice given to those with malnutrition can be conflicting to those living with diabetes; for example, adding jam or honey to porridge, or incorporating more desserts into their diet. There is a fine balance between managing their diabetes correctly, and ensuring the individual stays nourished and at a healthy weight. As an OT, it may be helpful to know the local meal delivery services available to service users, particularly those using ‘Traffic Light’ labelling, which enables the customer to easily identify which meal options are low, medium, or high in fat, saturated fat, salt and sugar. It may also prove beneficial to have an awareness of where service users can find more information on managing their dietary intake if they’re not yet at the point of needing a dietetic referral: Diabetes UK is the leading charity providing information to those with diabetes; one of their many useful resources includes a guide called ‘Older people and diabetes’. Several journals, such as Practical Diabetes, provide more in-depth advice on ‘Nutrition in older adults living with diabetes’.

There are several reasons why someone may follow a plant-based diet; it may link to ethics or sustainability, but it can also be associated with cost and health implications. Often, the advice given to those needing to increase their dietary intake is to fortify meals with dairy products such as butter, cream, or cheese. They may also be advised to further improve their intake by consuming high energy snacks such as sausage rolls, quiches, and yoghurts, as well as being encouraged to make up nourishing milk-based drinks. Whilst there are now more plant-based options than ever before, for many, suitable options available to them may be limited, thereby increasing their malnutrition risk. As OTs, you do not need to have an in-depth understanding of ways to boost the nutritional content of meals, but it may be useful to have an idea of resources you can point people to, which include: Vegetarian for Life is a charity working alongside older adults who follow a plant-based diet, and they have a publication called ‘Nutrition for older vegetarians and vegans’. The British Dietetic Association (BDA) have also produced a food fact sheet called ‘Plant-based diets’.

Dysphagia (swallowing difficulties) can occur for a variety of reasons, and means that individuals can no longer move their food from the mouth to their stomach in a safe, effective way. Texture-modified meals are key in its management, however, research indicates that those with dysphagia are more likely to be at risk of malnutrition than the general population. Many go undiagnosed, particularly in a community setting. Whilst some service users may choose to blend their meals at home from scratch, for others, this may not be a feasible, or safe solution and they may instead require that texture-modified meals are delivered to their home. For OTs, understanding the common signs and symptoms of dysphagia would be valuable, as well as how the management of dysphagia can impact the practical aspects of day-to-day life, with useful resources including: Malnutrition Pathway is an organisation that helps to manage adult nutrition, providing several useful resources, one of which is named, ‘Dysphagia: a healthcare professional fact sheet’. Marie Curie has a web page dedicated to providing information on those who have difficulty swallowing.

With OTs working together with their multidisciplinary team and being able to signpost individuals to useful resources in the early stages of malnutrition, it can not only improve the quality of life of the service user, but also potentially reduce pressure on fellow healthcare professionals and the NHS.

The latest episode from Wiltshire Farm Foods’ Dietitian Diaries podcast focuses on sustainable eating. To listen, download from wherever you source your podcasts from.

Vincent is a 79-year-old widower who has a diagnosis of Parkinson’s disease. He has recently moved home to be closer to his son and daughter-in-law who are helping with his care, and now lives in a detached bungalow on his own. The OT Service recently conducted an occupational therapy assessment and within this assessment they trialed the Rollz Motion Rhythm rollator as a measure to help with Vincent’s mobility. The case study noted that Vincent was presenting with symptoms of Parkinson’s disease, including; a stooped posture, masked expression, slow motor coordination. In addition, Vincent was also presenting with a shuffling gait and freezing while mobilising, particularly at threshes where there were changes in colour or texture under foot. A trial of the Rollz Motion Rhythm was recommended through the OT assessment as a method of increasing confidence and consequently engagement of meaningful activities. The rollator has been designed specifically to support the symptoms of Parkinson’s disease, particularly for gait freezing by using sensory feedback through a laser line, vibration and tones promoting continuous placing of steps.

As hoped, the three key elements of the Rollz Motion Rhythm had a dramatic impact on Vincent’s mobility due to its unique features:

The line projected onto the floor surface provided a visual prompt to support longer stride length and reduced feedback from the thresh.

The metronomic beep appeared to regulate step frequency, which created a rhythmical, uninterrupted stride pattern.

The pace of the vibration delivered through the handles, appeared to reinforce the rhythm created by sound, but delivered through an alternative sensory experience. Vincent also stated that he would prefer the vibration when in public, as only he would know it was happening. As well as the impact on gait and balance, Vincent’s posture immediately became more upright, further impacting on step length increase and stepping became more fluent. Vincent’s son stated that he had not seen his dad “stand like that for about 10 years” and mobilised throughout his property without any need for supervision or support, which his son had needed to provide since the most recent fall. Both Vincent and his son felt that it was “life-changing”, as the use of the new walking aid has facilitated a more independent and active lifestyle. Use of Rollz’s Parkinson’s rollator has broken the fall cycle, which occurs from anxiety, leading to inactivity and increased risk, due to the psychological and physical reassurance it provided. This increase in activity and confidence has had a profound impact on Vincent’s overall health, wellbeing, and projected outcomes. You can find out more about the OT Service’s case study by scanning the QR code below. For info about Rollz’s Parkinson’s rollator you can email info@rollz.com.