Why Food Matters for Older People Rhonda Smith Minerva Health & - - PowerPoint PPT Presentation

Why Food Matters for Older People

Rhonda Smith

Minerva Health & Care Communications Ltd

Why Food Matters for Older People

• Food as ‘glue’ - vital for society, for all
• Food & drink

– Preventative: access, services, support – Supports well-being/activities of daily living – Essential part of care – Improves health outcomes

• Perfect focus for ‘joining up’ community, care, housing & health
• Variable awareness, policy, practice & resources across the UK
• Some progress in policy, professions and wider public
• However ….. malnutrition is common in the older population

Malnutrition: under-nutrition

there’s a lot of it across the UK

3 million in the community at any one time*

Incidence of low body weight (BMI < 20)

>5% of the ‘healthy’ UK adult population over 65 yrs

>10% of the ‘unwell’ higher for those suffering from cancer, lung disease, GI problems, neurological and psychiatric illness

* The ‘MUST’ Report, BAPEN 2003

Malnutrition: under-nutrition

there’s a lot of it across the UK

3 million in the community at any one time*

Incidence of low body weight (BMI < 20)

>5% of the ‘healthy’ UK adult population over 65 yrs

>10% of the ‘unwell’ higher for those suffering from cancer, lung disease, GI problems, neurological and psychiatric illness

Malnutrition in hospital and care – tip of the under-nutrition iceberg!

* The ‘MUST’ Report, BAPEN 2003

Hospitals – malnutrition on admission Proportion at risk of malnutrition

28% 6% medium risk; 22% high risk (2008)

Data on individual patients across the UK

• 9722 individual patients
• 9460 with ‘MUST’ scores
• 9338 with ‘MUST’ scores in patients 18 y and over

Number of Hospitals

• 175

BAPEN Nutrition Screening Week Report 2008

Care Homes – malnutrition on admission Proportion at risk of malnutrition ~30% 10% medium risk; 20% high risk (2008)

Data on individual residents across the UK

• 1610 individual residents
• 1610 with ‘MUST’ scores
• 1610 with ‘MUST’ scores in residents 18 y & over

Number of Care Homes

• 173

BAPEN Nutrition Screening Week Report 2008

• More people live in sheltered housing

than in care homes (~750,000)

• More individuals with malnutrition in

sheltered housing than in hospitals Sheltered Housing (England) Proportion at risk of malnutrition 10-15% half/half medium/high

Screening for Malnutrition in Sheltered Housing BAPEN 2009

* If height, weight or weight loss cannot be established, use documented or recalled values (if considered reliable). When measured or recalled height cannot be

• btained, use knee height as surrogate measure.

If neither can be calculated, obtain an overall impression of malnutrition risk (low, medium, high) using the following: (i)Clinical impression (very thin, thin, average, overweight) (ii)aClothes and/or jewellery have become loose fitting (ii)bHistory of decreased food intake, loss of appetite or dysphagia up to 3-6 months (iii)cDisease (underlying cause) and psychosocial/physical disabilities likely to cause weight loss † Involves treatment of underlying condition, and help with food choice and eating when necessary (also applies to other categories).

OVERALL RISK OF UNDERNUTRITION *

(i) BMI (kg/m2) 0 = >20.0 1 = 18.5-20.0 2 = <18.5 (ii) Weight loss in 3-6 months 0 = <5% 1 = 5-10% 2 = >10% (iii) Acute disease effect Add a score of 2 if there has been or is likely to be no or very little nutritional intake for >5 days LOW ROUTINE CLINICAL CARE†

Repeat screening Hospital – every week Care homes – every month Community – every year for special groups, e.g. those >75y

1 MEDIUM OBSERVE

Hospital - document dietary and fluid intake for 3 days Care homes (as for hospital) Community - Repeat screening, e.g. from <1mo to >6 mo (with dietary advice if necessary)

2 or more HIGH TREAT

Hospital – refer to dietitian or implement local policies. Generally food first followed by food fortification and supplements Care homes (as for hospital) Community (as for hospital)

Add scores

The Malnutrition Universal Screening Tool ‘MUST’

Malnutrition: under-nutrition

Multiple adverse effects on the individual

Immunity - low WBCs, CMI, globulin & SIR Hypothermia Impaired gut integrity and immunity Renal function - loss of ability to excrete Na & H2O Decreased Cardiac output Ventilation - loss of muscle & hypoxic responses Psychology – depression & apathy Anorexia Micronutrient deficiency Loss of strength Liver fatty change, functional decline necrosis, fibrosis Impaired wound healing Slide courtesy of Dr Mike Stroud, Chair, BAPEN

Prevalence & consequences

• f malnutrition in the UK

SECONDARY CARE

  complications   length of stay   readmissions   mortality

CARE HOMES 30-42% of recently admitted residents HOSPITAL 28% of admissions PRIMARY CARE

  hospital   dependency   GP visits   prescription costs

SHELTERED HOUSING 10-14% of tenants HOME General population(adults) BMI <20kg/m2 : 5% BMI <18.5kg/m2 : 1.8% Elderly: 14%

Prevalence of malnutrition

Source: BAPEN Toolkit, 2010

The Malnutrition Carousel

15-60% of patients admitted to hospital are already malnourished Up to 70% of patients discharged from hospital weigh less than on admission

More GP visits

Home Hospital

More hospital admissions Longer stay More support post- discharge

Professor Marinos Elia, Chair, Malnutrition Action Group (MAG), BAPEN

BAPEN – UK Cost of Malnutrition – health & social care

2006 - £7.3 billion 2009 - £13 billion

Obesity 2007 - £4.7 billion

Treating Malnutrition Works – 1

COPD Elderly HIV / AIDS Liver disease Surgery  improved respiratory function  increased hand-grip strength  increased walking distance  reduced number of falls  increased activities of daily living and mobility  improved immune function  increased well being  improved cognitive function  immune function changes  lower incidence

• f severe

infections  improved liver function  greater wound healing  less fatigue  less loss

• f

muscle strength

Treating Malnutrition Works – 2

10 20 30 40 50

5 10 15 20 25 30

30 RCT, n = 3258 RR 0.59 (CI 0.48 to 0.72) 10 RCT, n = 494; RR 0.29 (CI 0.18 to 0.47)

Decreased complications % Decreased mortality %

Controls Controls Treatment Treatment Southampton meta-analysis of oral and enteral feeding in malnourished patients

Slides courtesy of Dr Mike Stroud, BAPEN/Southampton

hospital community

Distribution of under-nutrition in the UK

hospital community

Proportion of illness spent in hospital from onset to complete recovery

Adapted from slides provided by Prof Elia/Dr Stroud, BAPEN

Malnutrition in the Community

• Prevent in first place
• Identify where there is risk or where it

exists already

• Inform/support individuals/families
• Provide resources to implement action
• Ensure information flow between settings

– GP, hospital, sheltered housing, care

• Greatest risk at transition

Progress – Scotland leading the way

• 2003 screening on admission to hospital

mandatory (e.g. BAPEN’s ‘MUST’)

• Training – development & use of e-learning
• NHS Scotland – Nutrition Quality standard
• Nutrition Ambassadors – outreach to care and

community (2 year funding ends)

• Nutrition Clinical Network for Hospital staff

(future?)

• Community meals provision valued – protected?

Progress – across the UK

• NICE: nutrition support for adults: hospital, care &

community - implementation slow

• Nutrition summit – Nutrition Action Plan & Governance

Board – findings ignored

• BAPEN – Nutrition Screening Weeks: size of problem
• Age UK – Hungry to be Heard: public feedback
• RCN – Essence of Care: nutrition/hydration benchmark
• Quality Board – value not simply cost: focus on
• utcomes
• Nutritional care – 4th most cost effective initiative (NICE)
• Chief Nurses – nutrition ‘high impact action’
• Guidance galore: care catering, nutrition standards,

diets, meal planning for care homes

Reaching the ‘Tipping Point’

• NHS England: Care Quality Commission

Hospitals, care homes and all clinics – legal requirement Outcome 5: Food and drink should meet people’s individual dietary requirements

• Health & Well-being Boards: Public Health

responsibility – prevention/promotion – all programmes

• Commissioners – GPs & other clinical stakeholders:

nutrition as cross-cutting theme – across all care and disease pathways

• NICE – nutrition as a Quality Standard

Where does nutrition fit in the quality improvement framework.....

Slide courtesy of DH/Ailsa Brotherton

The Big BAPEN Push

• Westminster All Party Parliamentary

Group – Nutrition & Hydration

• Focused Clinical Guidance
• Partnership working across sectors and

professions – can’t do it alone

• Collaboration across all UK nations
• Europe has woken up to malnutrition

Europe & Malnutrition

• Council of Europe – human rights focus
• Studies across Europe reveal same prevalence rates as

UK in hospital & care

• European Nutrition Day in hospitals – record how much

food is eaten not given

• Annual prize for European country tackling malnutrition

most effectively – won by BAPEN 2008!

• Malnutrition included alongside obesity in health

declarations

• EC - ENVI Committee upcoming debate on screening &

mandatory action

Continuum of Nutritional Care

Prevent – Identify – Treat – Support

from Food to Specialist Feeding Community - Care - Hospital Making the ‘Business Case’ for nutritional care together and working together are the keys to preventing & effectively treating avoidable malnutrition

Thank you for this

• pportunity

www.bapen.org.uk