1. YOUR LOGO Identifying malnutrition and providing care, support and treatment from a clinical perspective Ailsa Brotherton

2. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Identifying and treating malnutrition.... in 10 minutes  How to identify individuals at risk of malnutrition  Localities with a high prevalence of malnutrition.  What care, support and treatment do older people need Page  2

3. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Identifying Malnutrition: Screening and Assessment Page  3 Screening using a validated tool (‘MUST’) Nutritional assessment and care planning

4. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Localities with a high prevalence We know where it is but do little to prevent it SECONDARY CARE   complications   length of stay   readmissions   mortality CARE HOMES 30-42% of recently admitted residents HOSPITAL 29% of admissions (range 24-30%) England highest PRIMARY CARE   hospital   dependency   GP visits   prescription costs SHELTERED HOUSING 10-14% of tenants HOME General population (adults) BMI <20kg/m 2 : 5% BMI <18.5kg/m 2 : 1.8% Elderly: 14% Prevalence of malnutrition in the UK Data from the Nutrition Screening Weeks 661 hospital centres and data on 34,699 patients

5. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Change in screening practice on admission in hospitals Key finding: Majority subjects at risk admitted to hospital are from home and could be identified earlier Data kindly supplied by Christine Russell, Chair of NSW

6. Geben Sie hier Ihre Fußzeile ein YOUR LOGO We have described the problem, measured the prevalence and made clear recommendations for action Page  6 HospitalsCare HomesMental Health Units Centres (n=) Patients (n=) Centres (n=) Residents (n=) Centres (n=) Patients (n=) 2007 Autumn 1759336173161022332 2008 Summer 13050897561417185 2010 Winter 185966814885720146 2011 Spring 17175417852367543 Prevalence 25-34%30-42%18-20% Data kindly supplied by Christine Russell, Chair of NSW

7. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Seasonal Trends  The overall prevalence of ‘malnutrition’ on admission to hospitals varied significantly between seasons: 28% in autumn and summer, 34% in winter, and 25% in spring.  The higher prevalence in winter can be related to a number of factors: Greater social isolation which may result in reluctance of people to go out shopping or visit GP More severe accidents on icy surfaces; More severe hypothermia More prolonged and severe chest infections.  The well-known effects of malnutrition causing weakness, lethargy, impaired temperature regulation and immunosuppression could predispose to such problems during cold weather. Page  7

8. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Variation across the UK Page  8 SCOTLAND Significant improvements in awareness of ‘malnutrition nutritional screening practice and in the organisation of nutrition support services. Implementation and inspections: NHS QIS Standards on Food, Fluid and Nutritional Care. Some improvements in awareness nutritional screening and in the operational infrastructure of nutrition support services No significant improvement in the inclusion of nutritional information in discharge communication Some improvements

9. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Age related Data  Overall the prevalence of ‘malnutrition’ was about 33% higher in those aged 65 years or older than those less than 65 years old. Gender  Higher prevalence of ‘malnutrition’ in women than men by 3-6%.  The difference was more marked in those aged 65 years or older than those less than 65 years old Source of Admission  In all the surveys, the majority of patients were admitted from their own homes and at least 1 in 4 were at risk of ‘malnutrition’ on admission.  Overall, half of the patients admitted from care homes were also at risk but these accounted for the smallest proportion of admissions. Page  9

10. Geben Sie hier Ihre Fußzeile ein YOUR LOGO What care, support and treatment do older people need? A nutritional assessment should consider the main causes of malnutrition and the support and treatment be tailored to meet an Individual’s needs (including oral nutritional supplements where indicated)

11. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Resources and pathways for use in the community Page  11

12. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Ailsa Brotherton, Nicola Simmonds and Mike Stroud on behalf of the BAPEN Quality Group

13. Geben Sie hier Ihre Fußzeile ein YOUR LOGO “The starting point for improvement is to recognise the need” The first step to improvement is to recognise the need

14. Geben Sie hier Ihre Fußzeile ein YOUR LOGO...we have everything we need to design highly reliable systems of care Page  14