Malnutrition Resources

One of the most prevalent challenges associated with tackling malnutrition is the misunderstanding that surrounds it leading to this condition going unrecognised and untreated. Malnutrition can commonly be incorrectly understood as an inevitable
result of the aging process, or a problem only faced by those living in the most extreme poverty. However, it is acutely important to understand that malnutrition caused by disease
and illness is a widespread problem in the UK, and nurses can and do play an important role in identifying and managing malnutrition in their patients, clients or service users.

The ‘Managing Adult Malnutrition in the Community’ multidisciplinary panel is celebrating the 10th anniversary of the launch of the guidance. The guidance document was developed to assist non-nutrition experts in the identification, treatment and
prevention of disease-related malnutrition in the community.

Malnutrition affects at least three million people in the UK, with 93% of these living in the community (BAPEN, 2018). Conversely, managing malnutrition can result in improvements in patients’ physical function, such as strength, quality of life and clinical outcomes, and reductions in healthcare use (such as hospital stays and admissions) (Stratton et al, 2018). Identifying and managing malnutrition can therefore improve lives and save money (Stratton et al, 2018).

In 2006, the National Institute for Health and Care Excellence (NICE) released the landmark guidance on nutrition, ‘Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition’ (NICE, 2006). At the heart of NICE guidance and quality standards is the aim to integrate research into practice and reduce gaps between recommended and actual practice. However, successful implementation is dependent on national and local action. To facilitate the implementation of the NICE clinical guidance (CG32), a national multidisciplinary expert panel was convened to explore and develop strategies that would overcome barriers to implementation of the NICE guidance, facilitate access to practical tools, and enhance knowledge to improve the management of disease-related malnutrition in the community. The collaborative work undertaken by the panel, in conjunction with major stakeholders, led to the development of the ‘Managing Adult Malnutrition in the Community’ materials. This article reviews the work of both the initial panel in 2012 and subsequent expert panels, that have delivered and continue to develop resources for nurses and the wider multidisciplinary team to assist in tackling malnutrition, which affects up to three million people in the UK at any time (Elia and Russell, 2009), especially that which arises as a consequence of illness and long-term medical conditions having an impact on appetite and the ability to eat and drink.

There is evidence to suggest that the older adult is at risk of malnutrition. A number of factors are associated with this, including those living in care homes, and people with long-term or progressive neurological conditions. With the growing number of people surviving into older age, these risk factors needs to be considered. An additional risk factor is those who have dysphagia. This may restrict the choice of foods available and reduce the pleasure of eating. Assessment and management of dysphagia can help patients enjoy their food intake safely and in a nutritious manner. This article discusses the complexity of managing an adequate nutritional intake for those with dysphagia.

F or those living with swallowing difficulties — otherwise known as dysphagia — it is not just the physical side-effects of the condition that can be debilitating. Eating homeblended texture-modified food that one is not accustomed to can, despite best efforts, often be unappealing and have a negative impact on a person’s quality of life.
Josephine Bailey has dysphagia as a result of oesophageal cancer and did not enjoy the experience of homeblending once discharged from hospital three years ago:

I’d lost a massive amount of weight and didn’t want to be tube fed anymore. Mealtimes were becoming really stressful. I didn’t know what to eat, I was pureeing everything with my hand-held blender, which wasn’t working very well, and everything resembled mush.

Malnutrition (or undernutrition) affects at least three million people in the UK (1.3 million are over the age of 65), with 93% of these living in the community (British Association for Parenteral and Enteral Nutrition [BAPEN], 2018). Malnutrition has an estimated cost of £19.6 billion in England, with older adults (≥65 years) accounting for over 50% of this cost (Stratton et al, 2018). Malnutrition has adverse effects if unidentified and untreated.

The term ‘wound’ can cover everything from relatively minor wounds, such as a small surgical scar, to major wounds, such as chronic leg ulcers. Typically, the cause and type of wound determines how quickly and effectively it heals (Thomas and Bishop, 2007). The presence of complications such as infection can dramatically increase the time it takes for a wound to heal. In a 2015 research study, conducted by gathering data from The Health Improvement Network (THIN) database, the cost burden of wound care in the NHS was estimated. After adjusting for comorbidities, the estimated cost to the NHS was between £4.5 billion and £5 billion. Furthermore, the study found that nutritional deficiency and diabetes were independent risk factors for wounds not healing (Guest et al, 2015). Nutritional factors, such as protein-energy malnutrition, dehydration, and deficiency in certain micronutrients, have all been identified as important for some stages in the process of wound healing. Being able to identify those who are malnourished or at risk of becoming so, and those who have micronutrient deficiencies, is key to successful wound healing outcomes.

Claire Campbell, chair of the National Nurses Nutrition Group (NNNG) and nutrition support nurse specialist, Frimley Health NHS Foundation Trust, looks at how community nurses can help to tackle malnutrition and identify those most at risk.

Dysphagia is a term used to describe difficulty or discomfort in swallowing food, fluids and even saliva. It is usually caused by another health condition, such as stroke, head injury or dementia, and can affect people of all ages. Nurses play a key role in identifying and managing dysphagia and screening for malnutrition. A multidisciplinary approach is required to guide appropriate interventions and achieve the best outcomes. This article discusses the prevalence of dysphagia, as well as the signs and risk factors, before taking a closer look at management strategies to help ensure good nutritional status.