1. A Community based Approach to the Assessment & Management of Malnutrition in the Elderly Presenter Renae Hamilton Dietitian Singleton Community Health Centre Project Partner David Sanders Rural Procedural General Practitioner Singleton

2. Singleton LGA Located within the Lower Hunter Local Health District; in the centre of the Hunter Valley Region, NSW Population 23,822 (1) Population >65yrs = 2139 (9.2% of total pop) (1) 8 Surgeries 27 General Practitioners (GPs) 1 Community Dietitian Singleton LGA 1.Australian Bureau of Statistics (2009) National Regional Profile – Singleton (A), viewed 31 Oct 2011, www.abs.gov.au www.abs.gov.au

3. Background Information Protein Energy Malnutrition contributes to health care expense (2) Malnutrition impacts on a person’s QOL Malnutrition in the community is actually estimated to be at a rate of 10-30% (3) If an older adult loses >4.5kg in 6 months the likelihood of institutionalisation increases 1.7 times (4) 2.Sullivan DH, Johnson LE, Bopp MM, Roberson PK. Prognostic significance of monthly weight fluctuations among older nursing home residents. J Gerontol A Biol Sci Med Sci. 2004;59:M633-9. [PMID: 15215284] 3.Stratton RJ et al. Disease-related malnutrition : an evidence-based approach to treatment. Walling ford: CABI Publishing, 2003 4.Payette, H et al. 2000. Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population. J. Clin. Epidemiol. 53: 579-587.

4. Problem Identified Low Referral rate for Malnutrition to Singleton Community Health Centre Dietetic Clinic 2009 It was determined that the elderly malnourished may not be being identified and thus treated appropriately Project was established as part of the NSW Rural & Remote Clinical Team Leadership Program 2009 NSW Rural & Remote Clinical Team Leadership Program

5. To ascertain a community based validated malnutrition screening tool which can be successfully integrated into current General Practice (GP) software programs, for the screening of patients aged >75yrs who access GP surgeries within the Singleton LGA Aim

6. Step1: Malnutrition Screening Tool A Cohort of Dietitians established appropriate malnutrition screening tool 6 Questions Takes <5 minutes to complete Appropriate in the Community Setting

7. Step 2: Develop Flow Chart

8. Step 3: Develop Nutrition Resources

9. Step 4: Re-Program into Software Re-program screening tool, flow chart and resources into current software programs used by General Practitioners (GPs) Needs to be simple to use at a click of a button 75 + health check screens for nutritional status, but currently no formal screening method Introduce a validated malnutrition screening tool into the 75+ health check

10. Results: Malnutrition Screening in Medical Director New Nutrition Assessment Link

11. Results: Medical Director – MNA-SF® Currently set up for GP to complete –? If this can be autocompleted? Clicking onto continue will move onto the MNA-SF

12. Results: Medical Director – MNA Result & Prompts Links to handouts to give to patients Automatically comes up with a screening score with a process for the GP to follow –This patient had a score of 0-7points

13. Result: Printed Nutrition Resources

14. Results: Other useful information The current integrated program calculates the number of: –Patients screened with the MNA-SF –Patients identified as malnourished or at risk of malnutrition –Ensures that patients are reviewed when they are required

15. Outcomes Provided GPs with an easy to use, validated malnutrition assessment tool Allowed for assessment of incidence of malnutrition within GPs patient list Currently only being trialled within one surgery –80% Local GPs indicated they would integrate a “user-friendly” screening tool: Closer Communication with GPs

16. Strategies for Future The assessment tool could become part of the routine Health Assessment done by General Practices on all the patients over 75 This innovation will help General Practice with RACGP Standards of health care: –1.3.1 – Health promotion and preventative care –1.4.1 – Evidence based practice –1.5.1 – Continuity of comprehensive care –1.6.1 – Engage with other services

17. Acknowledgements Clinical Team Leadership Program –Jan Dent –NSW Institute of Rural Clinical Services and Teaching Fairholme Medical Practice –Dr David Sanders –Reception Staff –Practice Nurse staff Software Design/Consultant –Stewart Sanders Lower Hunter Local Health District Dietitians –Cassandra Knight –Alison Hopkins –April Donohue –Sharon Lawrence Nutrition & Dietetics Area Profession Director & Line Manager –Helen Jackson