It is estimated that there are more than three million people in the UK at risk of disease-related malnutrition at any one time and that the vast majority of these (93%) live in the community.1 'At risk' groups include those with chronic disease such as cancer, individuals suffering from dementia, patients with an acute illness and those recently discharged from hospital.1, 2 The recent All-Party Parliamentary Group (APPG) on Hunger report focusing on 'Hidden Hunger and Malnutrition in the Elderly'3 highlighted the need to screen patients in all levels of care in order to address the growing burden malnutrition is placing on the NHS and social care.
In order to address the issue of malnutrition (undernutrition) in the community an expert multi-disciplinary panel first came together in 2012 to produce a practical guide to assist community healthcare professionals in identifying and managing malnutrition and an updated version of the document is now available. The panel has liaised closely with key stakeholders involved in the care of patients with malnutrition in the community to ensure the documents are relevant to all healthcare professionals working in the community. Patient representatives were also consulted to develop the content of the patient and carer resources produced.
The guide 'Managing Adult Malnutrition in the Community' has been developed by a multi-professional team of expert practitioners and is endorsed by key organisations, including the Royal College of General Practitioners (RCGP), the Royal College of Nursing (RCN) and the British Dietetic Association (BDA).4 The document is based on clinical experience and evidence alongside accepted best practice and includes a pathway to assist in the appropriate use of oral nutritional supplements. Healthcare professionals managing patients who have had a recent stay in hospital should find it particularly useful.
The document has received the following National Institute for Health and Care Excellence (NICE) endorsement statement:
Managing Adult Malnutrition in the Community: This booklet supports the implementation of recommendations in the NICE guideline on nutrition support for adults (www.nice.org.uk/guidance/cg32). It also supports statements 1, 2 and 5 in the NICE quality standard for nutrition support in adults (www.nice.org.uk/guidance/qs24). (NICE, December 2017)
The document includes:
- An overview of malnutrition including its clinical consequences, cost implications, details on the prevalence across healthcare settings and information on key patient groups at risk.
- Information on the identification and management of malnutrition according to risk category using 'MUST'
- Guidance on optimising nutritional intake including dietary advice and the appropriate use of oral nutritional supplements
- A practical pathway on the appropriate use of oral nutritional supplements in the management of malnutrition
A number of updated supporting documents are also available:
- 3 leaflets for patients and carers (copies can be downloaded from www.malnutritionpathway.co.uk/leaflets-patients-and-carers )
- Nutrition Drinks (known as Oral Nutritional Supplements) – red leaflet for those at high risk of malnutrition. This leaflet outlines to patients why they have been prescribed oral nutritional supplements and offers them general advice on getting the most from their supplements, for example advice on cooking with supplements and storage
- Your Guide to Making the Most of Your Food – yellow leaflet for those at medium risk of malnutrition. This leaflet provides some simple ideas for patients on how they can get the most nutrition from the food they are eating
- Eating Well – green leaflet for those at low risk of malnutrition. This leaflet gives patients advice on how to eat well and keep as healthy as possible
- Managing Malnutrition with Oral Nutritional Supplements (ONS) – advice for healthcare professionals – an A4 two-sided printable leaflet which gives healthcare professionals an overview of malnutrition and provides a quick guide to the different types of ONS available and patient suitability as well as styles, flavours and formats available. Download a copy from: www.malnutritionpathway.co.uk/health-resources
"The Managing Adult Malnutrition in the Community document, pathways and supporting materials have been instrumental in helping to raise awareness of malnutrition in the community," says Anne Holdoway, Consultant Dietitian and Chair of the Managing Adult Malnutrition in the Community panel. "However, the consequences of disease-related malnutrition and failing to prevent or treat it as early as possible continues to place a considerable financial burden on health and social care budgets. A malnourished patient will cost the NHS in the region of £5,000 more per annum than a nourished individual. Investing time and resources in screening, assessment and appropriate nutritional care is crucial if we are to reduce the financial burden to health and social care and improve health outcomes for patients. I would encourage all professionals to read the materials and identify ways that they can integrate nutritional screening and nutritional care into practice particularly when dealing with those at high risk such as the frail elderly, those with chronic disease, progressive neurological disease, debility, undergoing rehabilitation or social issues."
"Identifying and treating malnutrition will assist in optimising the recovery, reducing the risk of frailty and falls and improving strength and mobility of patients," says Louise Nash, Dietitian, Frail Elderly Pathway Team, Airedale NHS Foundation Trust and a member of the Managing Adult Malnutrition in the Community panel. "The cost of not treating patients in terms of both their overall quality of life and the financial burden of the greater healthcare needs that come about as a result of malnutrition is far greater than the cost of identifying and treating them. Dietitians are key in ensuring best nutritional care in the community and can make a real difference to the care of this patient group."
"Nurses are ideally placed to identify patients at risk of malnutrition," says Liz Anderson, Nutrition Nurse Specialist, Chair of the National Nurses Nutrition Group and a member of the panel. "In the community they will often see patients discharged from hospital on oral nutritional supplements with very little information to assist in the decision making regarding on-going use and management, this guide aims to assist them in the appropriate management of individuals to enable appropriate monitoring, escalation or cessation of the intervention. I hope they will find the documents useful in assisting in their day to day management of patients and that the patient materials will prove a useful resource to nurses see patients on a regular basis."
References: 1. Elia M and Russell CA. Combating Malnutrition: Recommendations for Action. Report from the advisory group on malnutrition, led by BAPEN. 2009; 2. Stratton RJ et al. Disease-related malnutrition: an evidence-based approach to treatment. Oxford: CABI publishing; 2003.; 3. All Party Parliamentary Group on Hunger. Hidden Hunger and Malnutrition in the Elderly. January 2018; www.frankfield.co.uk/upload/docs/Hidden%20hunger%20and%20malnutrition%20in%20the%20elderly.pdf.; 4. The document and supporting patient materials have been endorsed by the following associations: British Association for Parenteral and Enteral Nutrition (BAPEN); British Dietetic Association (BDA); British Pharmaceutical Nutrition Group (BPNG); National Nurses Nutrition Group (NNNG); Primary Care Pharmacists Association (PCPA); Primary Care Society for Gastroenterology (PCSG); Royal College of General Practitioners (RCGP); Royal College of Nursing (RCN); Royal Pharmaceutical Society (RPS); The Patients Association