COMMUNITY
MALNUTRITION IN THE COMMUNITY SETTING: A NEW APPROACH TO TRAINING STAFF Malnutrition is increasing at an alarming rate, yet it is still often unrecognised and often untreated. Dietitian’s play a vital role in screening and treating patients. But can more be done? This article looks at a new concept in nursing home training to increase staff engagement. Current evidence suggests that in the UK at present, malnutrition is 93% in the community setting, 2-3% in patients’ own homes and 5% in care homes.1 Those numbers are no doubt steadily on the increase, with malnutrition, just like obesity, being part of the ‘public health crisis’. We know that the cost of malnutrition in both primary and secondary care is a significant burden on the NHS. Current expenditure is reported to be around 19.6 billion per year and more than 15% of total taxpayers’ money is spent on malnutrition.4 Significant cost implications are focused in the over 65 years category and in the elderly, as these are the most vulnerable groups.5 WHAT CAN WE DO AS DIETITIANS?
Dietitians have a vital role as part of the multidisciplinary team to impart expert evidence-based advice in primary, secondary and social care settings. Dietitians also empower patients and
carers by providing adequate nutritional input and the screening needed, with the aim to reduce malnutrition effectively and to improve the overall dietetic treatment of patients. Effective communication, clear management plans, alongside education strategies, can help to reduce the effects seen in patients who show clear signs of malnutrition. In a care-home setting, it can be difficult with dementia patients and those with other chronic conditions to maximise nutritional advice and, often, due to disease progression, it can be a challenging time for all involved in a patient’s care. Discussions with families and carers need to be had early on to explain the progression of the disease and the concept of rapid decline in oral intake of food and fluids. Aiming to help the nursing home to take as much responsibility as possible, really does show positive outcomes and better nutritional care for patients. This could be through offering
Karen Voas Community Dietitian, Betsi Cadwaladr NHS Trust Karen is a Prescribing Support Dietitian with an interest in nutritional support and enteral feeding. Karen is also involved in the North Wales North west BDA Branch as Events Organiser.
REFERENCES Please visit: https://www. nhdmag.com/ references.html
Table 1: Symptoms and consequences of malnutrition Signs and symptoms of malnutrition
Clinical consequences of malnutrition
• Pressure sores/poor wound healing • Dry, fragile skin • Sunken eyes • Loose fitting dentures • Increase in chest infections/urine infections • Dry mouth • Unplanned weight loss • Muscle wastage • Poor appetite • Altered taste changes
• Increase risk of falls • Impaired recovery from illness and surgery • Increased morbidity and mortality • Impaired immune response • Frailty • Impaired wound healing • Reduced muscle strength
www.NHDmag.com November 2019 - Issue 149
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