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 Associationt to develop and test two new tools - the Patients Association Nutrition Checklist and the Nutrition Wheel. Due to their simplicity and ease of use, these tools show potential for the early identification of undernutrition, and include signposting and advice to support people to access appropriate services, including services that can support people with social factors contributing to their undernutrition. These tool have the ability to highlight 'clinical concern' which could then act as a prompt to screen using a validated screening tool such as 'MUST' (NICE clinical guideline 32 states that in the community, 'screening' should be carried out on initial registration to a GP practice, at other clinic opportunities and wherever there is a 'clinical concern', e.g. unintentional weight loss or poor appetite).
We have worked with the Patients Association to develop the Patients Assocation Nutrition Checklist and have carried out pilots with domiciliary care, the fire service and the voluntary sector. The Patients Association Checklist comes in two formats - one specifically aimed at patients themselves to complete, and the other, a version for professionals and volunteers to complete. The professional/volunteer version consists of Section A - four key questions to focus discussions around weight, unintentional weight loss and appetite, and Section B - additional questions to focus on the reasons for the increased risk of undernutrition and provide a framework for giving simple advice and signposting to services that can provide support. It has space to record specific advice given and recommendations made, along with a section to record follow up plans. The 4 key questions that make up Section A have validated against 'MUST' and shown to have moderate agreement. A project report, along with the poster and oral communication presented at BAPEN 2018 can be accessed from the 'resources' section. The Patients Association Nutrition Checklist was launched on 12th December 2018. The final report can be downloaded from the 'resources' section, and the Patients Association Nutrition Checklist can be accessed from the Patients Association website.
The ‘Nutrition Wheel’ is a new interactive tool we have developed and tested with volunteers. The tool aims to identify whether someone is at increased risk of undernutrition by asking some simple questions (the four questions from Section A of the Patients Association Nutrition Checklist, with some additional questions to focus discussions for those thought to be at increased risk), and then provides some basic advice and signposting to help support the person to improve their nutrition and wellbeing. A tear-off advice pad is being developed, and a PDF copy of this can be downloaded from the 'resources' section.
For more information on the Nutrition Wheel, including its development, please click here. A final version of the Nutrition Wheel is currently being produced, along with a short promotional video, in preparation for the Nutrition Wheel launch in March 2019.