Malnutrition
Article Type: Food facts From: Nutrition & Food Science, Volume 42, Issue 5
BAPEN published its fourth annual Nutritional Screening Week (NSW) report which reveals that malnutrition is not as commonly believed just a problem amongst the older generation but is actually also affecting 26 per cent of those aged between 20 and 29 years admitted to hospital. The report which presents the results of a UK screening survey has highlighted that whilst prevalence of malnutrition is lower than in previous surveys it was still found to affect one in four adults on admission to hospitals, more than one in three adults admitted to care homes in the previous six months, and up to one in five adults on admission to mental health units. Most of those affected were in the high risk category. Whilst the survey looks specifically at those on admission to hospitals, care homes and mental health units, the results seem to provide a clear snapshot of the alarming rates of malnutrition affecting one-fourth of adults of all ages admitted to hospital from their own homes. This highlights the very real need for consistent and integrated strategies to detect, prevent and treat malnutrition to exist within and between all care settings, not just in hospitals.
The high prevalence of malnutrition on admission to hospital and during hospital stay is not a trivial problem that can be ignored and it is not as commonly cited a problem caused by hospital food. It is a major problem that needs multi-disciplinary attention. Appreciation of the magnitude of the problem and its detrimental effects on morbidity and mortality during hospital stay can help establish appropriate policies at a local and national level. Since the Nutrition Screening Week surveys assessed nutritional risk on admission to hospital, its presence indicates that it had largely developed in the community and that there is still a real risk on discharge back into the community. It is therefore essential that strategies to prevent and treat malnutrition before admission to institutions be considered in more detail.
Whilst nutrition screening policies and practice vary, it is encouraging to see that over the past four years the proportion of hospitals screening most of their patients on admission has significantly increased and that BAPEN’s Malnutrition Universal Screening Tool (MUST) is the most commonly used screening tool in all care settings.
Hospital survey
In 2011, 4,868 women and 4,232 men were surveyed. The age range was 18-106 with 56 per cent of the patients aged 65 years and over. As in previous surveys,the 2011 results show that women appear to be at greater risk of malnutrition with 28 per cent affected vs 22 per cent of men. Whilst risk increased with age there was substantial malnutrition risk present at all ages: 22 per cent in patients under 60 years, 23 per cent in those aged 60-79 years and 33 per cent in those aged 80 years and older. The results confirm that malnutrition is common on admission to acute and community hospitals, all types of wards and in all age groups and diagnostic categories. Most patients screened were at high risk of malnutrition (18 per cent) compared to 7 per cent at medium risk. The NSW surveys suggest that there has been some improvement in the establishment of policies on nutritional care over time. In this last survey eight out of ten hospitals reported having a nutritional steering committee, almost all centres had a nutrition screening policy and almost all centres reporting auditing screening practice at least once a year. Hospitals reported using a range of screening tools with 85 per cent hospitals that responded using the MUST either alone or in combination with other tools.
Care home survey
In 2011, 369 women and 206 men were surveyed. The mean age was 80 years with 88 per cent of residents aged 65 years and over. About 26 per cent of those aged less than 70 years, 41 per cent of those aged 70-84 and 52 per cent of those aged 85 years and over were assessed to be at risk of malnutrition. The results of this survey highlight higher prevalence of malnutrition in nursing homes compared to residential homes, for it to increase with age and occur more frequently in women than men. Age was significantly greater in care home residents than in patients admitted to hospital which could contribute to the higher rates of malnutrition. About 94 per cent of centres use a screening tool for patients on admission and of these 92 per cent use MUST.
Mental health unit survey
In 2011, 296 women and 349 men were surveyed. Malnutrition was significantly greater in those aged 65years and over compared to those less than 65 years. About 24 per cent vs 15 per cent, respectively. Prevalence was also significantly greater in women than men, 24 per cent vs 14 per cent who were younger than women. The overall prevalence of malnutrition was found to be 19 per cent which is substantially lower than that found in hospitals (25-34 per cent) and care homes (30-42 per cent) in all four surveys. Policy and practice varied between units and compared to the hospital survey, mental health units reported having a lower proportion of nutrition steering committees (67 per cent vs 84 per cent) a policy for nutritional screening (79 per cent vs 99 per cent)and access to a nutrition support team (39 per cent vs 60 per cent). However,almost all units (93 per cent) said that they audited the practice of nutritional screening mostly once a year) and over nine out of ten units linked the results of screening to a care plan and the majority (76 per cent) always or usually included nutritional information on at risk patients in the discharge letters.
The four screening week surveys have contributed a considerable amount of information on the prevalence of malnutrition and screening practice within the UK, and data from them have been used both nationally and internationally to indicate the magnitude of the problem that we have to deal with. We aim to amalgamate all the data obtained from them to obtain a more robust picture of malnutrition and publish a report towards the end of 2012. Marinos Elia,Professor of Clinical Nutrition & Metabolism, Institute of Human Nutrition,University of Southampton.
2011 recommendations
Patients or residents admitted to all institutional care settings should be screened using a validated screening tool such as MUST and repeat measurements made at intervals according to care settings, using accurate and reliable instruments.
Scales on all wards and in all care settings should be calibrated annually.
Staff involved in nutritional screening should be trained and be competent to undertake screening and implement care plans.
The results of nutritional screening should be linked to care plans, which may vary according to local resources and policies.
Nutritional information relating to subjects identified as malnourished should be included in communications on discharge from hospital and mental health units.
Access to nutrition advice and nutrition support teams should be available in all care settings.
The practice of nutritional screening should be audited regularly.
Consistent strategies to detect, prevent and treat malnutrition should be in place in all care settings, including the community, where most malnutrition riginates.
A copy of the 2011 Nutrition Screening Survey Report can be downloaded from web site: www.bapen.org.uk/pdfs/nsw/nsw-2011-report.pdf
The 2011 survey and audit on nutritional screening was undertaken by BAPEN in collaboration with the British Dietetic Association, The Royal College of Nursing and the Irish Nutrition and Dietetic Institute, and with support from the Welsh Assembly Government, Scottish Government and the Chief Nursing Officer in Northern Ireland, the Department of Health in England and the National Patient Safety Agency.
