Multidisciplinary working to improve health and prevent malnutrition in older people
David Gray is a Senior Specialist Dietitian leading on nutrition for older people at Guy’s and St Thomas’ (GSTT) NHS Foundation Trust. He is a strong advocate of the power of audit and service improvements to improve the experience and quality of nutrition and hydration in hospital environments and is engaged in research projects through the trust’s links to Kings College London University.
The dietetic team on the Older Person’s Unit (OPU) at GSTT are firmly established within the multi-disciplinary team to help identify and treat malnutrition in older adults both in hospital and the community. On the wards, each consultant has a named dietitian embedded within their team, attending weekly multidisciplinary team meetings and ensuring that no-one is missed by checking each patient is being weighed and screened for risk of malnutrition.
They make every contact count by sparking conversations about their eating and drinking and taking action early to prevent deterioration in nutritional status regardless of their formal screening result. All patients who are discharged before they can be seen also get a phone call and are offered an appointment. It is a team philosophy that there is no point waiting for someone to actually deteriorate to the point of malnutrition before the dietitian gets involved. For many older people this is already too late.
The majority of those seen as an inpatient will continue to receive follow-up on discharge either at home in the community or in specialist nutrition support clinics in the Older Person’s Assessment Unit.
Here conversations shift from supporting recovery through nutrition support to optimising health through secondary prevention and establishing healthy eating habits for healthy ageing. This specialist clinic has lower referral criteria than standard outpatient clinics allowing GP referrals to be seen more quickly, again encouraging more preventative nutrition to be practiced.
The dietitian here is as likely to be contacting social services to request a care needs assessment or the Red Cross to help someone purchase a mobility scooter as they are to be discussing food choices. Every conversation counts and every patient matters.