Presentation on theme: "Malnutrition in later life - the Challenge Dr Mike Stroud Consultant Gastroenterologist, Southampton Co Chair Malnutrition Task Force Chair NICE Guidance."— Presentation transcript:
Malnutrition in later life - the Challenge Dr Mike Stroud Consultant Gastroenterologist, Southampton Co Chair Malnutrition Task Force Chair NICE Guidance Group ON Nutrition Support President Elect BAPEN
B A P E N Malnutrition Matters British Association for Parenteral and Enteral Nutrition A multi-disciplinary charity committed to raising awareness of malnutrition and the options for nutritional treatment, along with the impact on health outcomes, resource utilization, and health & social care budgets.
PHYSICAL Disease related malnutrition Feeding Swallowing Low activity Decreased organ reserve Specific disease Multiple drugs (taste) SOCIAL Isolation Poverty PSYCHOLOGICAL Depression/bereavement Dementia Alcohol Mobility Malnutrition in the UK Vulnerability
Potential causes of malnutrition in older people Access: being able to get to food or can food get to you (i.e. home delivery of shopping/cooked food). Physical mobility and transport to get shops etc? Availability: do shops offer healthy affordable food? Are they close by? Ability: is older person Physically able to cook & have facilities to do so, do they have cooking skills? Can they open the packaging’, ‘can you eat yourself (or have the help to eat)’? Affordability: income and poverty - 1 in 5 older people are in poverty in the UK, most of it preventable Awareness: do they have interest in food and what may or may not be appropriate, awareness of reasons which have reduced appetite or understanding of the risks of not eating,? The messages and myths around healthy eating for older persons. Aspiration: the desire, motivation and will to do something about it Assessment: of malnutrition risk when suffering from disease or illness. Are the symptoms or risk recognised? Assumption: that its normal to get thinner as you get older or with illness and disease. Appetite: The desire to eat and drink
Inadequate food intake is common in hospital European Nutrition Day survey* found that of patients aged >75 years only 1 : – 46% ate all of breakfast – 34% ate all of lunch – 35% ate all of dinner Older inpatients in a hospital elderly care unit in the UK were judged to be eating inadequately at only 67% of assessments 2 * 748 units in 25 countries, total n=16455, aged >75 years n= Schindler KE, Schuetz E, Schlaffer R, Schuh C, Mouhieddine M, Hiesmayr M. NutritionDay in European hospitals: risk factors for malnutrition in patients older than 75 years. Clin Nutr 2007; 2:10. 2.Patel MD, Martin FC. Why don’t elderly hospital inpatients eat adequately? J Nutr Health Aging 2008; 12(4):
Inadequate food intake in nursing homes NutritionDay survey of Austrian and German nursing homes* showed 1 in 3 residents ate ≤ 50% of their lunch on the assessment day 1 Eating difficulties found to be common (56%) in special accommodation residents i.e. nursing home-type care in Sweden 2 * n= Valentini L, Schindler K, Schlaffer R, Bucher H, Mouhieddine M, Steininger K et al. The first nutritionDay in nursing homes: participation may improve malnutrition awareness. Clin Nutr 2009; 28(2): Westergren A, Lindholm C, Axelsson C, Ulander K. Prevalence of eating difficulties and malnutrition among persons within hospital care and special accommodations. J Nutr Health Aging 2008; 12(1):39-43.
Prevalence of malnutrition HospitalsCare HomesMental Health Units Centres (n=) Patients (n=) Centres (n=) Resident s (n=) Centres (n=) Patients (n=) 2007 Autumn Summer Winter Spring Prevalence 25-34%30-42%18-20%
Malnutrition in the Community Incidence of low body weight (BMI < 20) – >5% of the ‘healthy’ UK adult population over 65 yrs – >10% of the chronically sick (higher for those suffering from cancer, lung disease, GI problems, neurological and psychiatric illness.
Communities - little or no contact with services Communities in contact with services Care Homes Hospital 93% 5% 2% 3 million malnourished Individuals at risk of malnutrition
FORM AND FUNCTION Genes Nutritional Intake (past & present) Age Activity Disease & Injury Good nutrition = health and resistance to disease Poor nutrition = ill health and susceptibility You are what you eat!
Poor breathing and cough from loss of muscle strength Psychology – depression & apathy depression & apathy Poor Immunity and infections Decreased Cardiac output Hypothermia – decline in all functions Renal function – limited ability to excrete salt and water and water Loss of muscle and bone strength - falls and fractures Loss of muscle and bone strength - falls and fractures Impaired gut integrity and integrity and immunity immunity Impaired wound healing and susceptibility to pressure ulcers Liver fatty change, functional decline necrosis, fibrosis Consequences of Malnutrition (within days)
The Malnutrition Carousel HOSPITAL NURSING HOME CARE HOME Malnutrition PRIMARY CARE dependency GP visits prescription costs hospital admissions SECONDARY CARE complications length of stay readmissions mortality
Nutritional Treatment should: Improve general status Immunity and resistance to infections Wound healing Breathing and coughing Mobility and falls Psychology
Nutrition support in adults 2006 February 2006
The effectiveness of Nutrition Support 30 RCT, n = 3258 RR 0.59 (CI 0.48 to 0.72) 10 RCT, n = 494; RR 0.29 (CI 0.18 to 0.47) Complications % Mortality % Controls Treatment
NICE ONS and length of stay
Nutritional Care & Quality Safety Effectiveness Equality Patient experience
The Cost of Malnutrition Public expenditure associated with <3 million individuals in UK who are malnourished or at risk of malnutrition >£7.3 billion p.a >£13 billion p.a ?? >£15 billion p.a. NICE Cost Saving Guidance places effective treatment of malnutrition as 3 rd in ranking of potential biggest cost savers to the NHS
BAPEN Chair Nutrition in a Cold Climate Easy Targets: Social Services Meals on Wheels Catering Budgets Dietetic Departments ONS prescriptions Nutrition Nurse specialists
We know what excellent nutritional care looks like
Reliable systems of nutritional care IDENTIFY Design systems to screen all patients using a validated screening tool Use local CQUINs TREAT Develop personal nutritional care plans EDUCATION & TRAINING STRUCTURES AND PATHWAYS Continuity across boundaries Senior Leadership PREVENT Work with Public Health, Local Government and Social Services Good nutritional care for every individual, in every setting, on every day
Making it happen ‘’This guide is easy to use since we have defined the top three priority actions for each level of the care system. Simply go to the part that relates to your organisation and take action’’