COMMUNITY
Anne Holdoway Registered Dietitian With a 30-year career spanning NHS dietetics, private practice, industry and research, Anne currently combines freelance work with private practice. She is dietetic lead for Dorothy House Hospice where she is undertaking qualitative research in diet in palliative care as part of her Doctorate.
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MANAGING ADULT MALNUTRITION IN THE COMMUNITY: NEW UPDATED MATERIALS LAUNCHED It is estimated that more than three million people in the UK are at risk of disease-related malnutrition at any one time, the vast majority (93%) living in the community.1 With an ageing population2 and increasing numbers of individuals with multimorbidities (factors that increase the risk of malnutrition), then the prevalence of malnutrition is likely to rise unless we dramatically improve the screening, treatment and prevention of this debilitating condition. The consequences of disease-related malnutrition and failing to prevent or treat it as early as possible undoubtedly continues to place a considerable financial burden on health and social care budgets.3 The recent APPG report focusing on ‘Hidden Hunger and Malnutrition in the Elderly’4 called for action to proactively screen patients in all levels of care in order to address the growing burden that malnutrition is placing on the NHS and social care. On an individual basis, a malnourished patient will cost the NHS in the region of £5,000 more per annum to manage than a nourished individual. Investing time and resources in screening, assessment and delivering timely and appropriate nutritional care is crucial if we are to reduce not only the financial burden to health and social care, but also improve health outcomes for patients and their carers. Whilst considerable work, in many cases led by dietitians, has been carried out in recent years to raise awareness of the issue of malnutrition in the community and put in place pathways of care, education and training to tackle malnutrition, there undoubtedly remains much to be done in targeting training and resources to increase the awareness
amongst ‘at risk’ groups, which include those with chronic disease such as cancer, individuals suffering from dementia, patients with an acute illness, the frail elderly and those recently discharged from hospital.1,5 In 2012, to facilitate measures to address the issue of malnutrition in the community, an expert multidisciplinary panel came together to produce a practical guide to assist community healthcare professionals in identifying and managing malnutrition. An updated version of the guide is now available. The panel has involved and liaised closely with stakeholders and representatives from key organisations involved in the care of patients at risk of developing malnutrition in the community to ensure the guide documents are relevant to healthcare professionals working in all care settings in the community. Unique to the update is the involvement of patient representatives who assisted in developing the content of the patient and carer resources produced. As before, the guide Managing Adult Malnutrition in the Community has been developed by a multi-professional team of expert practitioners and is endorsed by key organisations including the Royal College of General Practitioners (RCGP), the Royal College of Nursing (RCN) and the British Dietetic Association (BDA).6 The guide is based on clinical experience and evidence alongside accepted best practice and includes an updated pathway to assist in the appropriate use of oral nutritional supplements (ONS). Healthcare professionals inheriting patients who have had a recent stay in hospital, supporting www.NHDmag.com May 2018 - Issue 134
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COMMUNITY individuals with chronic conditions and those caring for the elderly should find it particularly useful. The updated guide has also received the following NICE endorsement statement: Managing Adult Malnutrition in the Community: ‘This booklet supports the implementation of recommendations in the NICE guideline on nutrition support for adults (www.nice.org. uk/guidance/cg32). It also supports statements 1, 2 and 5 in the NICE quality standard for nutrition support in adults (www.nice.org.uk/ guidance/qs24).’ National Institute for Health and Care Excellence, December 2017. The guide includes: • an overview of malnutrition including its clinical consequences, cost implications, details on the prevalence across healthcare settings and information on key patient groups at risk; • information on the identification and management of malnutrition according to risk category using ‘MUST’; • guidance on optimising nutritional intake, including dietary advice and the appropriate use of ONS; • a practical pathway on the appropriate use of ONS in the management of malnutrition. A number of updated supporting documents are also available: • Three leaflets for patients and carers (copies can be downloaded from www. malnutritionpathway.co.uk/leaflets-patients -and-carers). - Nutrition Drinks (known as Oral Nutritional Supplements) - red leaflet for those at high risk of malnutrition. This leaflet outlines to patients why they have been prescribed ONS and offers them general advice on getting the most from their supplements. - Your Guide to Making the Most of Your Food - yellow leaflet for those at medium risk of malnutrition and for use with those at high risk along with the red leaflet. This leaflet provides some simple ideas for patients on how they can get the most nutrition from the food they are eating. 38
www.NHDmag.com May 2018 - Issue 134
Eating Well - green leaflet for those at low risk of malnutrition. This leaflet gives patients advice on how to eat well and keep as healthy as possible. • Managing Malnutrition with Oral Nutritional Supplements (ONS) - advice for healthcare professionals - an A4 two-sided printable leaflet which gives healthcare professionals an overview of malnutrition and provides a quick guide to the different types of ONS available and patient suitability as well as styles, flavours and formats available. Download a copy from www.malnutritionpathway.co.uk/ health-resources The panel are seeking professionals to review the materials, adopt into practice and identify ways to integrate nutritional screening and nutritional care into pathways of care, particularly when dealing with those at high risk, such as the frail elderly, those with chronic disease, progressive neurological disease, debility, undergoing rehabilitation or those with social issues. The cost of not treating patients in relation to overall quality of life and the financial burden of their greater healthcare needs that result because of malnutrition, continue to far outweigh the cost of identifying and treating them. Dietitians in particular can play a pivotal role in ensuring the best nutritional care is provided in the community for vulnerable groups and should work closely with other community healthcare professionals to ensure nutritional screening and care pathways are in place, particularly in GP surgeries, residential and care homes. The updated version of the Managing Adult Malnutrition in the Community guide and supporting materials are available for free to healthcare professionals, patients and carers via the www.malnutritionpathway.co.uk website. -