Detection and Treatment of Malnutrition in Care Homes Fiona McKenna, Community Dietitian Sutton and Merton Community Services
Topics to be covered The importance of nutrition Malnutrition: causes and consequences Nutritional screening and assessment Nutritional supplements including tasting
What can good nutrition do Prevent malnutrition Improve health & ability to recover from illness Reduce infections, complications and mortality Improve mood and well being Prevent pressure sores Prevent dehydration
What is malnutrition An inadequate intake of dietary energy (calories) and protein can result in depletion of fat stores loss of muscle loss of body weight
Overview Malnutrition is under recognised and under treated It costs the NHS an estimated 7.3 billion Nutritional screening Malnutrition Universal Screening Tool
Symptoms Loss of appetite Tiredness, loss of energy Reduced ability to perform normal tasks Reduced physical performance Altered mood Poor concentration
Consequences Impaired immune response Reduced muscle strength Impaired wound healing Apathy, depression and self neglect Increased risk of admission to hospital and length of stay Increased mortality
Warning Signs of Weight Loss: Recent weight loss Self reported weight loss Reduced appetite Fatigue, apathy, reduced activity Anthropometric indices muscle wasting, fat loss Loose clothes/jewellery
Monitoring nutritional status Nutrition Risk Assessment Tool Record weight weekly Maintain Food Record Chart Check Nutritional Care Plan All the above constitute an important part of your role
Introducing MUST Malnutrition Universal Screening Tool
The 5 steps of MUST Steps 1-3: Take 3 measurements and score them against the scale provided Body Mass Index (BMI) Weight loss Acute disease effect Step 4: Add scores together to identify overall risk of malnutrition Step 5: Form appropriate care plan in line with local policy
1. MUST and BMI Score BMI range (kg/m 2 ) Weight Category Significance 2 <18.5 Underweight Poor protein energy status probable 1 18.5-20 Underweight Poor protein energy status possible 0 20-25 Desirable weight Poor protein energy status unlikely 0 25-30 Overweight Increased risk of complications associated with chronic overweight 0 (obese) >30 Very overweight (obesity) Moderate (30-35 kg/m 2 ), high (35-40 kg/m 2 ) and very high risk (>40 kg/m 2 ) of obesity-related complications
2. MUST and weight loss Unintentional weight loss over a period of 3-6 months is an indicator of acute or recent-onset malnutrition If previous weight is unavailable, subjective criteria include: Clothes and/or jewellery having become loose History of reduced food intake, reduced appetite, and swallowing problems Over 3 6+ months, underlying disease of psychosocial or physical disability weight loss
2. MUST and weight loss Score Unplanned weight loss in past 3-6 months (% body weight) Significance 2 >10 Clinically significant 1 5-10 More than normal intraindividual variation early indicator of increased risk of undernutrition 0 <5 Within normal intraindividual variation
3. MUST and acute disease effect Most likely to apply to patients in hospital Should also include patients with Grade 3 or 4 pressure sore Applies to patients who have had or are likely to have no nutritional intake for more than five days MUST Score: Add 2 if acute disease effect applies
4. MUST and overall risk of malnutrition Total of scores from steps 1, 2 and 3 Document score Total scores 0 1 2 BMI + weight loss + adverse disease effect Low risk Medium risk High risk
Food Fortification For use in patients who: are at risk as per MUST healthy eating guidelines are no longer appropriate Should be tried in the first instance Fortification is achieved by adding ingredients to food to make it more nutrient dense
Food Fortification Fortified milk - add skimmed milk powder to full fat milk / add full cream milk powder Added butter and margarine Use of double cream and evaporated milk Add sugar, honey, jam and syrup Increase the use of fried foods and add cheese, mayonnaise or salad cream to sandwich fillings and other foods
When to prescribe nutritional supplements? High risk according to MUST and weight continues to decline, despite trying the dietary interventions Use first line products Review monthly: weight, MUST, compliance
Summary Malnutrition is a significant issue in the community Some high risk groups, many different causative factors Nutritional assessment essentials Screening tool & assessment tool Food record charts Regular weights
Any Questions