New Tools to Identify Malnutrition Annemarie Aburrow RD Consultant - - PowerPoint PPT Presentation

Annemarie Aburrow RD

Consultant Dietitian for Wessex AHSN

New Tools to Identify Malnutrition

Tonight’s webinar will cover:

• Wessex AHSN: Who we are and what we do
• The Nutrition in Older People Programme (2014-18): key achievements
• Wessex AHSN Healthy Ageing Programme
• The problem of malnutrition in the community and the need for new tools
• Need for new validated approaches in the community to help identify risk of

malnutrition, provide signposting & advice, that can be used by the wider workforce and volunteers

Wessex Academic Health Science Network (AHSN): Who we are & what we do

• Wessex AHSN is one of 15 AHSNs in England
• Hampshire, Dorset, the Isle of Wight and

South Wiltshire

• Speed innovation across the region’s health

system to create a healthier population and thriving economy

• Programmes drive research into practice to

address local health and social care priorities through partnership, collaboration, investment and support e.g. Healthy Ageing, Nutrition in Older People Programme, Medicines Optimisation, Mental Health

Nutrition in Older People Programme: 2014 – 2018

• 1. Nutritional screening and care planning

by integrated teams (health and social care) in the community

A focus on improving screening and care of those most at most at risk and causing the greatest cost – i.e. people living in the community receiving community health & social care

• 2. Innovative approaches for increasing

awareness & identification of people at risk

• f malnutrition by volunteers and carers

To help identify people as risk in the community leading to appropriate signposting, advice, or triage those who need formal screening

• 3. Resource development

To improve awareness and training around malnutrition To provide resources for wider spread, to minimise duplication of effort

Screening, signposting & care planning

Developed simple tools to identify

malnutrition and enable signposting / advice - Nutrition Checklist & Wheel

Research to show the Nutrition Checklist picks up

those ‘at risk’ according to ‘MUST’ (clinical screening tool)

Innovative approaches Resource development

Key achievements of the Programme

https://wessexahsn.org.uk/img/pr

• grammes/NutritionReportExecuti

veSummary.pdf

Purpose:

• Add value to the Frailty agenda and activities in Wessex
• Retain focus on innovation and spread

Three streams of work:

Hydration and Nutrition Evaluation / evidence Spread

• Nutrition Checklist
• Nutrition Wheel
• OPEN Toolkit
• Hydration in Care Homes
• Hydration in Domiciliary

Care

• Red Bags
• Wessex Acute Frailty

Audit

• Healthy Ageing

Timeline

• ESCAPE Pain
• Community of Practice

Healthy Ageing Programme: 2018 - 2023

The problem of malnutrition in the community

• The majority of people with or at risk of malnutrition are living in the

community: 1 in 10 older people and ageing population

• Malnutrition still remains under-detected and under-treated, despite NICE

guidance and quality standards recommending nutritional screening using validated tools such as ‘MUST’

• Malnutrition results from disease-related, physical and social factors – social

risk factors are an important consideration in the community

• £££ - Malnutrition in the UK costs > £19 billion (BAPEN/NIHR 2015)
• Need for new validated approaches in the community to help identify risk of

malnutrition, provide signposting & advice, that can be used by the wider workforce and volunteers

Original checklist developed & piloted by The Patients Association Adaptation of the checklist by Wessex AHSN for use in domiciliary care Adaptation of the checklist by Wessex AHSN for use with Fire Service & Age UK Research to validate the questions on the Checklist Dec 2018: Finalisation and launch of the Nutrition Checklist and toolkit Future plans: evaluation of tool ? App development

Tools to identify malnutrition

Development of the Patients Association Nutrition Checklist

Patients Association Nutrition Checklist

https://www.patients-association.org.uk/blog/patients- association-nutrition-checklist Launched December 2018

• A simple tool designed to identify potential malnutrition risk
• Involves asking an older person 4 key questions to focus

discussions around weight loss and nutrition, to identify potential risk of malnutrition (Section A)

• For those likely to be an increased risk, guidance on the provision
• f basic advice and signposting is provided (Section B)
• Initial testing has been carried out in domiciliary care, Hampshire

Fire & Rescue Service, Age UK Southampton

What is the Patients Association Nutrition Checklist?

Patients Association Nutrition Checklist

Research Project Aim: A cross-sectional study to investigate the

concurrent validity of the Patients Association Nutrition Checklist to identify the risk of malnutrition in older people living in the community against ‘MUST’

Local organisations offering lunch, social and activity clubs across Hampshire and Dorset were attended by a dietitian and researcher between January and May 2018 All participants were aged 65 and over and were recruited on the day and gave informed written consent Participants asked the questions from Section A of the Patients Association Nutrition Checklist and were then screened using ‘MUST’ (Elia, 2003) Agreement and chance-corrected agreement (ĸ) between ‘MUST’ and the Patients Association Nutrition Checklist were assessed (Landis & Koch, 1977)

Methods

• 312 older people were recruited from 21 lunch and

activity clubs across Dorset (n=140) and Hampshire (n=172)

• Mean age was 79.6 years (SD 8.3)
• Mean BMI was 27.8 kg/m2 (SD 5.6)
• 197 older people (63%) were living alone

Results: Participants

% at risk % at medium risk % at high risk 9.9% (n=31) 6.7% (n=21) 3.2% (n=10)

Results: Risk of malnutrition according to ‘MUST’

• No. participants answering

‘yes’ or ‘don’t know’ to each question (denoting risk)

Q1 “are you or your family concerned you may be underweight or need nutritional advice?” n=23 (34%) Q2 “Have you lost a lot of weight unintentionally in the past 3-6 months?” n=30 (44%) Q4 “Have you noticed that your clothes or rings have become loose recently?” n=37 (54%) Q4 “Have you recently found that you have lost your appetite and/or interest in eating?” n=38 (56%)

Total ‘at risk’ 21.8% (n=68)

Results: Risk of malnutrition according to the Checklist

• Moderate level of agreement between the two tools (sensitivity

85.4%, specificity 87.1%; ĸ= 0.47 (SE = 0.064), 95% CI [0.349, 0.599], P < 0.001)

• There were 4 people at risk according to ‘MUST’ but not identified by

the Patients Association Nutrition Checklist – these participants reported no change in weight and that they had always been slim

• The Patients Association Nutrition Checklist identified more people at

risk than ‘MUST’ – as it included people in the earlier stages of weight loss and with appetite changes

Results: Agreement between the tools

The Patients Association Nutrition Checklist has: ✓ Acceptable sensitivity and specificity when compared with ‘MUST’ ✓ Potential for early identification of malnutrition risk and includes signposting to basic dietary advice and appropriate health and social care support

Conclusions

Tools to identify malnutrition:

Development of the Nutrition Wheel

• 1. Results of a project we ran with Age Concern Hampshire in

2016 piloting the use of the PaperWeight Nutrition Armbands highlighted the need for an interactive tool to act as a conversation starter that includes the importance of asking questions to determine unintentional weight loss

• 2. In 2017, a group of 7 students from BU agreed to develop the

questions and signposting / advice from the checklist into an initial prototype as part of their ‘Service Improvement Project’

• 3. The students obtained some initial feedback from 7 volunteers

in lunch clubs and 12 service users

Prototype developed by students

Tools to identify malnutrition:

Development of the Nutrition Wheel

• 4. The students obtained some initial feedback from 7 volunteers

in lunch clubs and 12 service users – feedback included: Design easy to understand and straightforward to use – with

• r without volunteer

Provision of national helpline numbers helpful A ‘friendly’ way to have the conversation Liked the signposting advice on the information sheet

• 5. The Nutrition Wheel was further amended and 100 were

printed for piloting purposes. A tear-off information/advice sheet produced

Tools to identify malnutrition:

Development of the Nutrition Wheel

6. Ethics approval for research project to pilot the Nutrition Wheel

• piloted by 17 volunteers

All volunteers felt the Wheel was an excellent conversation starter Changes were required to address repetition in questions and make wording less ‘clinical’; also to simplify the advice sheet Design changes required to add in question numbering, use alternative colours

Tools to identify malnutrition:

Development of the Nutrition Wheel

7. Nutrition Wheel has been amended into its final version. A toolkit has also been developed, which includes:

Nutrition Wheel Advice sheet General nutrition FAQ Explanatory guide Explanatory guide for volunteers OPEN undernutrition leaflet

• 8. We are now awaiting delivery of 50 final versions from the

printers – and then plan to speak to the volunteers again to

• btain final feedback

When should different tools be used in the community?

• Final testing of the Nutrition Wheel – 50 Wheels printed to testing

with volunteers prior to launch. Also filming a short promo video

• Launch of the Nutrition Wheel – being adopted & disseminated by

the Malnutrition Task Force – June 2019

• Call to action to review the ‘Managing Adult Malnutrition in the

Community’ pathway to include the Nutrition Checklist and Wheel as ways of identifying ‘clinical concern’ leading to ‘MUST’ screening

• Evaluation of both tools - to understand how they could be effectively

used by other stakeholders (volunteers, community workers and home care staff)

• Explore the potential of app version of the tool(s)

Next steps

Thank you for listening Any Questions?