The Management of Malnourished Adults in All Community and All Health and Care Settings

01 Jul 2018


Dietitians have the expertise both at an individual patient and strategic level to identify, assess, care plan, treat, monitor and review individuals to achieve patient-centred outcomes, and train others to prevent and treat malnutrition. The BDA believes that high quality nutrition and meeting the nutritional, clinical and personal needs of all, must be a priority for all involved in health and social care. The potential for good nutrition to improve the health of the vulnerable population is huge and well documented. Malnutrition* should not be, but is, a very real and current problem in the UK population with national surveys showing that prevalence of malnutrition is still unacceptably high [1-5].

The recent Global Nutrition Report (2016) [7] highlighted the urgent need to end all forms of malnutrition by 2030, given the significant social and economic burden it brings. From a UK perspective, it is estimated that over 3 million people are malnourished or at risk of malnutrition [8]. National UK surveys [1-5] show that malnutrition is costly with the estimated cost of malnutrition continuing to increase (over 7.3 billion in the UK in 2003, over 13 billion in the UK in 2007 and approximately 19.6 billion in England 2011-2012 equating to approximately 15% of the health and social care budget [9]. Nutritional support in adults was ranked as the third highest cost saving intervention (£71,800 per 100,000 general population), associated with implementation of NICE Clinical Guideline (CG32)/Quality Standard (QS24) [9]. 

There have been significant advances in the status of food in community healthcare settings as nutrition is recognised as key to the health and wellbeing of patients and residents. However as recent high profile enquiries have shown, there is still much to do, including early intervention by building sustainable support in the community.  Menu planning, nutrient density, quality of meals, and access to food and hydration all require a coordinated approach. Data demonstrates over 90% of those either malnourished or at risk of malnutrition live in the community. In care homes, the prevalence of malnutrition was reported to be 36% and 24% in older adults and younger adults, respectively [9]. It is therefore essential to address the whole spectrum of nutritional care through strategies that prevent, detect and treat malnutrition in community healthcare settings. The overall cost of treating a malnourished patient is two to three times more than treating a non-malnourished patient [9], with consequences including reduced wound healing, increased risk of infections and complications, and increased number of hospital stays and GP visits. National guidance stressing the importance of providing good nutritional care locally has been developed across the four home countries [10-14] 

The BDA believes that dietitians are ideally placed to liaise with healthcare services and social care services to ensure that vulnerable individuals living independently have access to nutrition support services. 

The BDA believes that:

  • Everyone should have access to a nutritious, high quality diet that meets their individual nutritional requirements and for those unable to meet their nutritional requirements through food alone to have timely access to nutrition support. Systems must be in place in the community health and social care settings to identify and support those at risk of a sub-optimal diet and hydration. 
  • Dietitians should lead the coordinated and integrated approach to addressing the nutritional care of vulnerable populations in community health and social care settings. Dietetic-led nutrition support services are best placed to develop and initiate the correct evidence-based nutritional care policies and guidelines and ensure that those at risk of malnutrition (social or disease-related) are identified and managed appropriately; including those individuals with psycho-social related malnutrition.
  • Commissioners must recognise the value and potential cost savings of preventing malnutrition and ensure they commission services that ensure all people identified as being at risk of malnutrition to be offered nutrition support interventions that aims to meet personalised nutritional requirements.
  • All public sector catering specifications, including the NHS, and care homes have a requirement to meet nutritional standards suitable for the setting and the population they are serving. This should be supported by appropriate expertise from dietitians, caterers and procurement professionals.

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