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Volume 9.04 18th April 2019
MALNUTRITION IN THE ELDERLY: CURRENT CHALLENGES AND INTERVENTIONS Undernutrition has serious implications for health, recovery from illness or surgery and hospital costs.1 What’s more, malnutrition is estimated to cost £19.6 billion in England annually (2011-12 figures), which is twice as much as obesity.2 A recent report by the British Association for Parenteral and Enteral Nutrition (BAPEN) established that up-front investment in implementing the current National Institute for Health and Clinical Care Excellent (NICE) quality standards on nutritional support in adults, could result in £200 million in savings to the NHS annually, due to reduced healthcare use.2 In the UK, it is estimated that over three million people are malnourished. Of these people, 93% live in the community and 1.3 million are over the age of 65.3 Despite this, malnutrition remains overlooked within the media, the healthcare system and the political agenda. This article will look at current challenges of and interventions for malnutrition in the elderly, whilst showcasing the work of several dietitians. THE PROBLEM WITH NUTRITION RISK SCREENING TOOLS
Numerous studies have reported a lack of recognition and treatment of malnutrition within hospital settings.4 Whilst screening tools do exist, there are not nationally or internationally accepted cut-off points
and guidelines for most nutrition-related variables.5 Consequently, it is difficult to make comparisons between studies, which is problematic when estimating global and national prevalence rates of malnutrition. Nutritional screening is recommended in NICE clinical guideline 32 recommendation 1.2.6 for all inpatient hospital admissions in the UK.6 However, definitions of undernutrition and nutritional risk and cut-off values for the nutritional variables measured must be agreed to allow for consistent and evidence-based practice. Dietitians anecdotally report that the Malnutrition Universal Screening Tool (‘MUST’) score is often calculated incorrectly. This can lead to inappropriate or missed referrals, which can have serious consequences for patients. We need dietitians to collect data, analyse and publish data on incorrect and inadequate nutrition risk screening to allow for changes and improvements to be made. As an evidence-based profession, we need to justify our worth and show that we can make a difference to patient care.
Catering for a boost in everyday food and drinks
Harriet Smith Registered Dietitian and Health Writer Harriet is Founder of Surrey Dietitian providing private dietetic consultations and consultancy services, offering evidence-based nutritional advice, backed up by the latest research on food, health and disease. Harriet has written for national, consumer and industry media. www.surrey dietitian.co.uk @SurreyDietitian
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