Editorial

For many people, the term malnutrition conjures up visions of the emaciated and stunted bodies of children in underdeveloped countries.

The term malnutrition, in nutritional terms, really refers to a state in which there is a deficiency, excess or inadequacy of micronutrients such as vitamins and minerals or of protein or energy, resulting in adverse effects to the sufferer.

Yet in highly developed countries such as the UK malnutrition is rife amongst the elderly, especially those in residential and nursing homes and hospitals.

Obviously illnesses and disorders such as dementia associated with aging exacerbate any nutritional problems in elderly people. Additionally reduced absorption of nutrients as well as poor dentition, arthritis and mobility problems all cause nutritional difficulties of actually cutting up and eating food.

It is quoted that around 16 per cent of elderly people in residential care are malnourished to some extent. In the hospital situation about 40 per cent of adults are considered to have some degree of malnutrition, with the figure rising to 60 per cent of elderly people in hospital.

Malnutrition increases the risk of complications such as sepsis, wound infections and hence delays in healing, urinary tract infections and pneumonia. The muscle weakness that usually accompanies malnutrition means that the person has a reduced ability to cough and thus is more prone to chest infections such as bronchitis and pneumonia. Tasks such as dressing, eating, walking small distances are all made more difficult due to muscle weakness.

Malnutrition obviously increases the length of stay in hospital and is thus quoted to cost the National Health Service over £300 million per year.

Much is going on to try and improve the situation regarding malnutrition. There are initiatives in improving hospital food with the "Better hospital food project", which includes recipes developed by celebrity chefs, more staff to help with feeding patients plus a general better awareness of the situation. Numerous specialist products can be used to boost up intakes as well as specialist feeding techniques.

In the community, attention is also focussing on the problems of malnutrition, with food and nutritional care being expanded in the National Minimum Standards for Care Homes for Older People.

It is vital that people who are at risk of malnutrition or who have some degree of malnutrition are correctly identified and action is taken to enhance their nutritional status.

Various assessment tools have been used to identify those who are at risk of malnutrition. Assessment tools need to be simple and quick to use and not be dependent on blood tests and other invasive measurements.

The Malnutrition Universal Screening Tool (MUST) has been developed and successfully trialled and is about to be launched in the UK. It relies on the Body Mass Index, involuntary weight loss over the preceding three to six months and the presence of acute disease.

Owing to its simplicity, all types of health professionals can obviously use it and it is hoped that it helps to identify and then enable some steps to be taken to alleviate malnutrition in the elderly and indeed in anyone suffering from it.

Mabel Blades