1. Debbie Sutton Project Manager No Needless Malnutrition Patient Safety Federation Diet & Falls

2. Reducing the risk of falls Good nutrition Calcium and Vit D Fluid intake Body Weight Exercise

3. 5 – 2 – 2 - 5

4. Poor intake leads to poor outcome – fact!

5. Factors that decrease food intake Swallowing difficulties eg CVA Chewing difficulties, eg. badly fitting dentures. Poor appetite eg.depression, dementia. Medication side effects eg.dry mouth, taste changes, nausea. Restricted intake, eg. gastrectomy, oesophagectomy.

6. Factors that increase nutritional requirements Infections, raised temperature. Wounds, pressure sores Involuntary movements eg. Parkinsons Metabolic effects eg. Cancer Breathing difficulties eg COPD Malabsorption eg diarrhoea, liver disease.

7. Identifying Malnutrition Common sense. Clinical observation. Nutrition Screening. – MUST tool – Weight loss

8. Signs of Malnutrition Rings and watches that are loose fitting. A belt that has been taken in. Coats and jackets that are too big across the shoulders Difficulty getting up from a sitting position. Hollow temples and flat shoulders

9. Simple responses to malnutrition Glass of milk plus slice of cake. Two oatcakes with cheese. Milky coffee and half a Danish Two water biscuits and dessertspoon houmus.

10. High nutrient density

11. Small portions and plenty of variety

12. Familiar snacks and light meals

13. Dietary Calcium Adequate calcium combined with a bone- friendly diet & lifestyle is essential to minimise bone thinning. Adequate calcium should be provided from a well balanced diet.

14. How much calcium? 2-3 portions a day of calcium rich foods. Glass of milk Pot of yoghurt Cheese in sandwich

15. Non Dairy alternatives? Canned sardines or pilchards. Calcium enriched soya products Tofu Dried apricots Nuts

16. Vitamin D

17. Fluid Falls and dizziness UTI’s Constipation Poor mouth care

18. How much to drink? Offer regular drinks (6-8 per day). Appropriate vessel After meals Appropriate temperature. Food as well as drink, (milk, smoothie, fruit juice) Urine straw colour

19. Body weight & activity Being underweight increases risk of osteoporosis Being underweight also increases the risk of broken bones in a fall Aim to be a healthy body weight Weight bearing activity helps strengthen bones & prevent bone loss e.g. walking, dancing

20. Summary A well-hydrated person is less likely to fall; offer drinks every 2-3 hours. A well-nourished person is less likely to fall; offer meals and snacks every 3-4 hours. A mix of starchy and sugary food will help sustain blood sugar levels, eg. jam sandwich, cereal with sugar. Simple solution may be enough.