Older Peoples Essential Nutrition (OPEN) Eastleigh Launch 19 th - - PowerPoint PPT Presentation

Older People’s Essential Nutrition (OPEN) Eastleigh Launch 19th March 2015

Agenda

Topic Speaker Welcome Martin Stephens, CEO, Wessex Academic Introduction to OPEN Dr Dina Foy, Locality Lead, ENTVS Why identifying and caring for malnutrition is important Dr Emma Parsons, Lead Dietitian, Wessex AHSN Why we need joined up care for malnutrition All Eastleigh OPEN Nutritional Care Pathways Dr Emma Parsons, Lead Dietitian, Wessex AHSN OPEN Training Plan Rhiannon Jones, Dietitian, Wessex AHSN Raising awareness of good nutrition for

• lder people in Eastleigh

Jean Roberts Jones, CEO, One Community Questions and Answers All

Why identifying and treating malnutrition is important

Dr Emma Parsons Lead Dietitian, Wessex AHSN

Overview

• Identification and treatment of malnutrition
• Development of the nutritional care pathways

Why focus on

• lder people’s

nutritional care?

• Increasing population of older people

– Expected to rise from 16% to 25% over the next 45 years.

• Nutrition plays an important role in maintaining the

health and independence of older people.

• It is just as important to ensure people remain in

good health, as well as treating those who become nutritionally compromised.

Maintaining independence in older age

• 90% of older people live independently in the UK.
• 10% require care in the community
• The independent sector now accounts for around

96% of council-supported placements. Care Homes Homes Places Residential 13,134 247,824 Nursing 4,672 215,463

Nutritional inadequacies

• Vulnerability to nutritional inadequacies associated with:

– Increasing age, – worsening health conditions – Levels of dependency.

• Definition of malnutrition:

– ‘A state of nutrition in which a deficiency, excess or imbalance

• f energy, protein and other nutrients (e.g. vitamins) causes

measurable adverse effects on tissue/body form and function and clinical outcome’

Elia 2000.

Malnutrition – Does it matter?

COSTLY - Disease related malnutrition in the UK costs in excess of £13billion (Elia 2009). Under-recognised and under-treated across care settings (Elia 2003)

Malnutrition in community

• 93% of malnourished individuals live in the community

– Affects ~3 million people

• Prevalence varies according to setting
• Vulnerable groups are at higher risk

5% GP practices (NICE, 2006) 16% Hospital Outpatients (Rust, 2009) 30-42% Care Homes (BAPEN)

Children Elderly Socially Isolated Chronic Disease

Malnutrition: A common problem

‘Malnutrition’ was found to affect:

• 25% of adults on admission to hospitals
• 41% of adults admitted to care homes in the previous 6 months
• 19% of adults on admission to mental health units in the UK

Most of those affected were in the high risk category.

(171 hospitals, 78 care homes and 67 mental health units)

Causes of malnutrition

• Social isolation
• Adaptation to new

surroundings

• Social networks
• Dining environments
• Drug-nutrient

interactions

• Anxiety
• Depression
• Bereavement
• Chronic disease
• Physical disability
• Loss of senses

(sight, smell etc.)

• Changes in gastric

signalling pathways

• Sarcopenia

Physiological

Psychological

Social Poly- pharmacy This may then result in a reduction of food intake and weight loss, which can lead to a range of clinical and economic consequences.

Outcomes for malnourished

• utpatients
• Risk of malnutrition in general outpatients

was associated with;

– Increased hospital admissions – Increased healthcare use

(Cawood et al, 2011)

• Malnourished outpatients with COPD

– Twice the number of hospital admissions – Three times more likely to die in 6 months

(Collins et al, 2010)

Treatment of malnutrition Maximise nutritional intake Compliance Clinical benefits

Identification of malnutrition with screening

Nutritional care pathway

Opportunity for HCP’s to improve

• utcomes

The need for screening

Many reports since 1992 have specified the need for screening.

NICE 2006

– Screening should take place on initial registration at general practice surgeries and when there is clinical concern (1.2.5)

Nutrition Action Plan DH 2007

– Five key priorities for action – Point 3 of the plan encourages nutritional screening for all people using health and social care services

Care Quality Commission – Essential standards of quality and safety

(2010)

– ‘Nutritional screening is carried out to identify where they are at risk of poor nutrition and hydration when they first begin to use the service and at regular intervals’

“MUST”- Malnutrition Universal Screening Tool

‘MUST’: Use in all settings Acute

Emergency admission Routine admission Monitoring and review

Primary care

Routine assessment Health checks New patient checks

Care home

On admission Monthly monitoring

Home visits

New assessment Monitoring

NICE QS24: Nutrition Support

1.

• People in care settings are screened for the risk of malnutrition using a

validated screening tool.

2.

• People who are malnourished or at risk of malnutrition have a

management care plan that aims to meet their nutritional requirements.

3.

• All people who are screened for the risk of malnutrition have their

screening results and nutrition support goals (if applicable) documented and communicated in writing within and between settings.

4.

• People managing their own artificial nutrition support and/or their carers

are trained to manage their nutrition delivery system and monitor their wellbeing.

5.

• People receiving nutrition support are offered a review of the indications,

route, risks, benefits and goals of nutrition support at planned intervals.

Nutritional care in the community

• Currently there is a lack of:

– Screening for malnutrition – Documentation of nutritional status – Use of appropriate equipment and care plans – Monitoring and review – Implementation of nutrition support

Cawood et al 2008, 2009; Parsons et al 2009, 2010

Barriers to identifying malnutrition

• Awareness of the need to identify and treat

malnutrition

• Staff require training in nutritional screening
• Access to people at risk of malnutrition may vary

– Those accessing community services may be identified and monitored more easily than those not accessing services

(e.g. outpatients, GP surgeries, district nurses)

• Funding for nutritional screening within community

services

• Support for people unable to feed themselves (e.g. modified

feeding aids)

• Dietary advice from a Dietitian
• Altered meal patterns
• Fortified food with protein, carbohydrate, fat,

vitamins, minerals

• Oral nutritional supplements (ONS)
• (NICE 2006)

Oral nutrition support strategies

Oral Nutritional Supplements

• Palatable drinks containing calories, protein, vitamins

and minerals

• Available as milkshakes, juices, puddings and soups
• Over the counter:

– Build Up, Complan, Boots Recovery

• Via prescription:

– Fortisip, Ensure, Fresubin

• May be used in association with dietary advice

NICE review of the evidence for ONS use

• Proprietary oral nutritional supplements:
• Significantly reduce mortality
• Significantly reduce complications
• Significantly improve weight
• Functional benefits
• Better energy and protein intakes in supplemented
• patients in all trials
• Acceptable to patients

Evidence base for dietary advice in the community

• A Cochrane review (35 trials, n 2468, Baldwin et al 2007)
• Dietary advice vs. no advice

– insufficient studies in the community for meta-analysis

• Supplemented patients had significantly greater weight gain

(or less loss) and significantly greater energy intakes than patients given dietary advice, over 3 months

• ‘lack of evidence for the provision of dietary advice in

managing illness-related malnutrition’

Summary

• Malnutrition is common and costly.
• Screening for malnutrition and monitoring should

take place at regular intervals.

• Peoples nutritional needs and preferences should be

identified.

• Nutrition care plans should be implemented and

reviewed.

• ALL staff should receive training on nutritional care.

Eastleigh Nutritional Care Pathways

Dr Emma Parsons Lead Dietitian, Wessex AHSN

Wessex AHSN Nutrition programme

Aims to:

• Develop and implement an approach(es) for reducing malnutrition

in older people.

• Develop and test a toolkit that develops capability to improve

nutritional care in the elderly.

• Facilitate and lead learning workshops across Wessex to encourage

the adoption of the evidence based approaches to reducing malnutrition in the elderly.

• Develop and apply an evaluation framework.
• Develop and co-ordinate communication through appropriate

channels to facilitate the sharing of good practice

OPEN Older People’s Essential Nutrition

• To reduce the number of older people who are

malnourished and the associated health and social care use.

Aim

• Eastleigh, Hampshire
• Plans to spread wider across Hampshire.

Location

• It is estimated that malnutrition costs for Wessex are at

least £520 million (approx. 4% of total UK costs).

Rationale

Key Stakeholders

Health care Social Care Voluntary sector

GP Practices Community Nursing Older Peoples Mental Health Pharmacy Hampshire County Council Eastleigh Borough Council Social Workers Occupational Therapists Community Independence team One Community Age Concern Hampshire Age Concern Eastleigh

Programme details

• Based on national guidelines, providing guidance on

screening, individualised care plans, co-ordination between relevant workforces and timely care and review

Nutritional Care Pathways

• Sessions developed to raise awareness of the issues of

malnutrition in the general public as well as in the community health and social care workforce

Raised awareness

• to support future commissioning of good nutritional care

both within Eastleigh, and wider in Hampshire.

Evaluation framework

• Piloting of a nutrition package that can be adopted in
• ther localities.
• (e.g. training and awareness materials, evaluation tools,

nutritional care pathways)

Support package

Development of the Eastleigh nutritional care pathways

• No local pathways currently exist to identify and treat

malnutrition

• Need for agreement across health and social care
• Care pathways adapted from those used in Purbeck,

Dorset

• Discussions held with key stakeholders to agree content

and roles.

Treatment of malnutrition Maximise nutritional intake Compliance Clinical benefits

Identification of malnutrition with screening

Nutritional care pathway

Training Plan

Rhiannon Jones, Dietitian, Wessex AHSN

Overview

• Purpose and scope of training
• Brief outline of the training sessions
• Training schedule

Purpose of training sessions

• To raise awareness of malnutrition in the community
• earlier prevention and treatment
• To educate the health and social sector on implementation
• f the care pathways

Scope of Training

Health care Social Care Voluntary sector

GP Practices Community Nursing Older Peoples Mental Health Pharmacy Social Workers Occupational Therapists Community Independence team One Community Asian Elders Age Concern Hampshire

Training Schedule

Date Volunteers 11th,17th, 18th February, 22nd April Asian Elders group 25th March Social Workers 25th March Occupational Therapists 25th March Community Independence Team 25th March Community Nurses 15th April Older People’s Mental Health 15th April St Andrew’s GPs 24th April St Andrew’s Practice Nurses Parkside GPs 24th April Parkside Practice Nurses 30th April Boyatt Wood GPs 13th April Boyatt Wood Practice Nurses

Training: Content

GP Nurses Social care teams Duration 30-60 minutes 1 hour Practice Nurses 2 hours Community nurses 2 hours Malnutrition: Evidence, screening and treatment(s) Care Pathway MUST Care Planning Case Studies Resources

Volunteers Training Session

• To provide volunteers with basic skills in identifying the

potential signs of malnutrition, and how to provide support to people at risk.

Volunteer session outline

• Basic awareness of malnutrition
• Malnutrition in relation to their role
• Where to signpost
• Where to refer to first

Who are the volunteers?

Volunteers

1Community staff and CEO Housing / Environment EBC Sitter and Respite Carer Older People’s Forum Leaders Solicitor Dementia Advice Service Pavilion on the Park

Volunteer Session Feedback

“Helpful to cascade the message” “Good pace and level of info” “More confidence to initiate a discussion” “Everyone got a chance to speak” “Well organised and informed”

Support post-training

• Follow-up four to six weeks after training

– Meeting – Observation

• Implementation feedback
• Further training needs
• Hotline number (Wednesday afternoons):

07990 002 102

• Email address: nutrition@wessexahsn.net

• To book a session, contact

– Talk to us today – nutrition@wessexahsn.net – 07990 002 102

• Any questions?

Voluntary and Community Groups

Jean Roberts-Jones Chief Executive One Community

The Voluntary Sector:

Lunch Clubs Social Groups Good Neighbour Schemes Dial A Ride & a lot more.

Engagement – Men’s Shed Purpose – Volunteering Financial Advice Carers Advice Mobility

www.1community.org.uk Telephone: 02380 902400