The spread and adoption of the Nutrition Wheel across Dorset
The Dorset Innovation Hub team
are supporting the implementation of the Nutrition Wheel in Dorset in the context of a wider review of malnutrition services and how best to identify people at risk of malnutrition as early as possible.
With the continued and rapidly growing problem of malnutrition across Dorset (and nationally), the simple and cost effective Nutrition Wheel tool provides an opportunity to prevent malnutrition in older people by way of intervention at an early stage, saving NHS resource and providing the best outcomes for patients. For more information please visit the Beneficial Change Network Case Study
What is undernutrition?
Undernutrition is a form of ‘malnutrition’, which simply means ‘poor nutrition’. It affects 10-15% of people over 65 years of age. A person can become undernourished when they don’t eat enough of the right foods to keep them healthy. Undernutrition has serious consequences because the body isn’t getting the right nutrition to work properly. Some consequences of undernutrition include reduced ability to fight infections, reduced mobility, increased risk of falls, poor wound healing and more frequent GP visits and hospital admissions. Undernutrition is not well recognised or treated in the community.
In view of this, we have worked in collaboration with the Patients' Association and Bournemouth University to develop the Nutrition Wheel. The Nutrition Wheel is an interactive version of the Patients Association Nutrition Checklist and has been designed to be a conversation starter.
We are delighted that both the Nutrition Wheel and the Patients Association Nutrition Checklist have been endorsed by the British Dietetic Association.
We have created an Evaluation Report (available from the 'resources' section) which tells the journey of the Nutrition Wheel from initial concept to scoping, development, launch and post-launch research.
Nutrition Wheel orders
Please note: the Nutrition Wheel itself is made from durable coated card, and as such, Nutrition Wheels can be used many times. The Nutrition Wheel is a tool to be kept by the volunteer or care worker. It is not a patient resource, and as such is not appropriate to give out to patients or clients.
When you order the Nutrition Wheel, you will sent a Nutrition Wheel, along with a copy of the advice sheet (to be given to anyone the Nutrition Wheel identifies as 'at risk') and an explanatory guide. The following resources form part of the Nutrition Wheel toolkit, and can be downloaded through the 'resources' section:
- Advice sheet
- Explanatory guide
- Nutrition FAQ
- Information for GPs and Practice Nurses
- OPEN leaflet (also available as a double-sided easy-print version can be printed and given to anyone at risk of undernutrition)
- Development of the Nutrition Wheel (the research behind it)
- Nutrition Wheel video
On 24 September 2019, the Wessex AHSN ran a webinar on the Nutrition Wheel for the other AHSNs. The purpose of the webinar was to share the research, development and next steps for the Nutrition Wheel. To view and listen to the webinar, please click here to be taken to our video section.
Why was the Nutrition Wheel developed?
The need for an interactive tool originated from a project we undertook using the PaperWeight Nutrition Armband with Age Concern Hampshire volunteers in 2016. The volunteers reported to like using armbands, as it helped them to start a conversation around nutrition. However the armband measures if someone is already thin, and whilst designed to be used in conjunction with questions to determine recent unintentional weight loss, we found that volunteers were often not always asking these questions and were using the armband in isolation. A PDF copy of our evaluation report for this project can be downloaded from the 'resources' section. The initial prototype of the Nutrition Wheel was developed by a group of Adult Nursing and Midwifery students at Bournemouth University as part of their assignment on service improvement. It has since been modified and developed further by the Wessex AHSN with multidisciplinary support.
What does the Nutrition Wheel do?
In clinical practice, undernutrition should be identified using the ‘Malnutrition Universal Screening Tool’ (‘MUST’). The Nutrition Wheel has been developed primarily for use by non-clinical people who work with older people in the community who may not be accessing traditional health and social care services, such as carers, care workers and volunteers. It provides a framework for having a conversation to explore the factors that could increase someone’s risk of undernutrition in a pro-active way. The Nutrition Wheel aims to identify whether someone is at increased risk of undernutrition by asking 4 simple questions, which are labelled 1-4 around the outer edge of the Nutrition Wheel. The 4 questions are the same questions as those found on Section A of the Patients Association Nutrition Checklist, which have been validated against 'MUST' in a research project. This research was published in the Journal of Human Nutrition and Dietetics in October 2019. For more information on our validation work, please visit our page about the Nutrition in Older People Programme.
For people found to be at increased risk of undernutrition through using the Nutrition Wheel, there are an additional 4 questions to ask the person, which focus the discussion around the reasons the person has become undernourished or at increased risk. The Nutrition Wheel also features an 'advice window', which provides basic advice and signposting to help support the person to improve their nutrition and wellbeing. PLEASE NOTE THAT AT THE CURRENT TIME, MANY LOCAL ORGANISATIONS ARE NOT ABLE TO RUN (E.G. LUNCH CLUBS, DAY CENTRES) DUE TO COVID-19. IT IS RECOMMENDED TO CHECK WITH LOCAL ORGANISATIONS INCLUDING LOCAL COUNCIL AND VOLUNTEER ORGANISATIONS FOR NEEDS AND ADVICE FOR SOCIAL SUPPORT
Who developed the Nutrition Wheel?
The development of the Nutrition Wheel was a collaboration between Wessex AHSN, Bournemouth University, the Patients Association and the Malnutrition Task Force. Key collaborators (and their qualifications where relevant) include:
Annemarie Aburrow (Consultant Dietitian for Wessex AHSN)
Kathy Wallis (Associate Director, Wessex AHSN)
Dr Jane Murphy (Professor in Nutrition and Registered Dietitian, Bournemouth University)
Lesley Carter (Clinical Lead, Malnutrition Task Force)
Gloria Clark (Project Manager, The Patients Association)
Where can I get more information and resources?
The following organisations produce useful downloadable leaflets and have additional information on undernutrition:
- Wessex AHSN OPEN toolkit - View, download or print the “Eating Well Feeling Good” – a leaflet which provides information on undernutrition identification and treatment and is suitable for anyone to read
- Malnutrition Pathway - View, download or print “Your guide to making the most of your food” – an A4 leaflet which gives simple ideas on how people can get the most nutrition from the food they are eating
- Malnutrition Task Force - View, download or print “Are you eating enough? Advice for older people” – a booklet which provides information about the signs of unhealthy weight loss and what you can do
- Dairy Council - View or download the “Bring it Back” leaflet and/or postcard set. Hard copies can be requested through the website