Hertfordshire Independent Living Service (HILS) Measurable improvements in people s health through nutrition and wellbeing

Transcription

1 Hertfordshire Independent Living Service (HILS) Measurable improvements in people s health through nutrition and wellbeing

2 HILS - who are we? Charitable, not-for-profit social enterprise providing meals on wheels to people across Hertfordshire Provide a range of support services to help people stay independent, healthy and happy in their homes

3 Who do we serve? HILS acts as agent for HCC for the delivery of breakfast, lunch, and tea meals Our clients are: Elderly and frail Disabled Isolated Limited/no support network Vulnerable Moral and statutory responsibility to ensure clients are properly nourished and hydrated

4 Malnutrition in vulnerable people Definition of malnutrition: The National Institute for Health and Care Excellence (NICE) defines a person as being malnourished if they have: a body mass index (BMI) of less than 18.5 kg/m2 unintentional weight loss greater than 10% within the past 3 6 months a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the past 3 6 months Estimates suggest 1.3 million people over 65 suffer from malnutrition, and the vast majority (93%) live in the community Nutrition Support for Adults, Section 1.3, NICE guidelines, Feb 2006, Introduction to Malnutrition, BAPEN, accessed Nov 2014,

5 Malnutrition prevalence in later life One third (32%) of people aged 65 years or over are at risk of malnutrition on admission to hospital 2010 winter hospital screening found the risk of malnutrition was 32% in those aged years and 44% in those % of people admitted to hospital from care homes were at risk of malnutrition Of hospitalised patients needing help to eat meals, 17% said they got insufficient help from staff and 19% got enough help only sometimes Of residents recently admitted to care homes and screened, 35% were at risk of malnutrition 22% (3 million people) of people 60+ GB (2009) skipped meals to cut back on food costs 42% of people 60+ (5.8 million; GB 2009) agreed they struggle to afford essential items such as food, gas, electricity

6 Consequences of malnutrition Increased use of health services Malnourished people: saw their GP twice as often, had 3 times the number of hospital admissions, and stayed in hospital more than 3 days longer than those who were well nourished. Guest, J. F., Panca, M., Baeyens, J.P., de Man, F., Ljungqvist, O., Pichard, C.,Wait, S & Wilson, L. (2011) Health economic impact of managing patients following a community-based diagnosis of malnutrition in the UK, Clinical Nutrition, Volume 30, Issue 4, Pages , August 2011 Impact on carers Carers UK found that 60% of carers worry about the nutrition of the person they care for. One is six carers is looking after someone at real risk of malnutrition but do not have nutritional support of any kind. Malnutrition and Caring: The Hidden Cost for Families, Carers UK, 2012, accessed Nov 2014,

7 Our response Hertfordshire dietetics services under pressure from health/social care challenges Established a HILS Nutrition & Wellbeing Service in 2015 Our aims: Raise awareness Identify and address nutrition and health issues Improve best practice How have we achieved this? Training and education Menu development Bespoke nutrition & wellbeing check Free food-first nutrition boosts Offer dietetic advice Partnership working Student support/research

8 Focus - key nutritional and health issues Key nutritional and health issues Osteoporosis Diabetes Incontinence Dementia Loneliness Dehydration Malnutrition Dysphagia Are these big issues? About a third of people aged over 65 fall each year, 10-25% ambulance call outs related to falls Incontinence affects about 1 in 3 older women Over 12% of over 65s suffer from loneliness & isolation Malnutrition affects 1.3 million people in the UK (93% in the community) Hospital admissions related to malnutrition costs 19 billion each year

9 Nutrition & Wellbeing check Use of national tools e.g. MUST Consider swallow issues and texture needs Eating patterns Mental health issues Finance concerns Loneliness and isolation Memory concerns Support Mobility and falls Hearing and eyesight Hydration Continence concerns

10 Nutrition & Wellbeing check Social At the very core is a person s wellbeing Psychological Health We aim to address the root cause of issues affecting wellbeing

11 Case study Ensure Johnny is having a texture that meets his nutritional needs Tailor a meal service to encourage higher energy meal choices Johnny* Retired Living alone Puree diet Weight loss reported Assess for malnutrition using nationally recognised tool MUST Consider oral nutritional supplements? *Name changed

12 Case study Is this service and intervention enough? Does our intervention address nutritional needs? YES Does it promote wellbeing? Healthy body and healthy mind, being happy and living well NO?

13 Meeting needs In house services Partnership working Monitor and review

14 Johnny Retired Living alone Puree diet Weight loss reported Addressing the root cause: Referral to CMHT for home visit and support Case study Our screening revealed: High risk of malnutrition There was no swallow issue Johnny was choosing puree meals as this was the only food he could tolerate Johnny was suffering from untreated mental health issues with no support and was suffering agoraphobia Practical Support: Higher energy meals Respect wish to have softer meals Food fortification advice

15 Case Study Johnny Retired Living alone Puree diet Weight loss reported Our bespoke approach We don t just fix the problem We look at the cause of it We work out how to prevent this from happening again We review and we adjust 6 months later: Medication to treat mental health issues and support now reduced Walking short distances outside every day Moving towards normalised eating Low risk of malnutrition

16 Early Results At the initial point of contact: Context - 74% of all clients screened were found to be frail 36% of clients were at risk (medium or high) of malnutrition using MUST, with 60% of those at risk, being high risk and 40% medium risk 15% were being prescribed Oral Nutritional Supplements At the 3 month review point: We saw positive outcomes in ~90% of our clients at risk of malnutrition where MUST scores remained stable or improved ~10% of clients had a worsened MUST score due to hospitalisation or advancing dementia (Based on 287 clients screened)

17 We should: Challenge traditional assumptions about how health and wellbeing support should be delivered and by whom Identify and address the root causes of health and wellbeing problems to achieve long term solutions for people Work across functional areas / organisations / sectors to provide the support which meets people s needs Routinely monitor, measure, and review to ensure that services are adapted and improved in response to our learning and changing needs Wider learning

18 Any questions? Contact us on: Website: