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.
From 2014-2018, Wessex AHSN ran the Nutrition in Older People programme. In December 2018, we published our final Nutrition in Older People programme report, along with an executive summary which includes infographics. Please feel free to download these PDFs from the 'resources' section.
All the information, reports and other resources that have come out of this programme have been included on this page, to enable you to use them as a resource or for reference. There are several projects that we have continued into our Healthy Ageing programme (including the Nutrition Wheel and the OPEN toolkit, which have their own areas on our website).
Patients Association Nutrition Checklist
We worked in collaboration with the Patients Association to develop the "Patients Association Nutrition Checklist", which was launched in December 2018. Due to its simplicity and ease of use, the Patients Association Nutrition Checklist can be used in the early identification of undernutrition due to having the ability to highlight 'clinical concern' which could then act as a prompt to screen using a validated screening tool such as the Malnutrition Universal Screening Tool ('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 piloted the Patients Association Nutrition Checklist with domiciliary care, Southampton Fire Service, and the voluntary sector. A report from our pilot with Southampton Fire Service and Age UK Southampton can be downloaded from the 'resources' section.
We also carried out a research project in 2018 to validate the Patients Association Nutrition Checklist against 'MUST'. The Patients Association Nutrition Checklist was shown to have 'moderate' agreement with 'MUST'. This research was published in the Journal of Human Nutrition and Dietetics in October 2019. A project report, along with poster and oral communication presented at the BAPEN 2018 conference can be downloaded from the 'resources' section.
The Patients Association Nutrition Checklist is available in two formats: one specifically aimed at patients themselves to complete (the 'patient version'), whilst the other is a version for volunteers, carers and professionals to complete (the 'staff version'). Wessex AHSN has particularly been involved in the development of the staff version. This version consists of two parts:
Section A - consists of four key questions to focus discussions around weight, unintentional weight loss and loss of appetite. These are the four questions which has been validated against 'MUST', and can be used to identify if someone is likely to be undernourished. Because these specific questions have been validated, the wording of these questions must remain unchanged.
Section B - to be used with people identified as likely to be at of undernutrition from using Section A. Section B consists of additional questions to focus on the reasons for the increased risk of undernutrition, and provide a framework for giving basic advice and signposting to services that can provide support. It has space for you to write down any specific advice given and recommendations made, along with a section to write down any follow up plans.
To download either version of the Patients Association Nutrition Checklist, please visit the Patients Association website. We have uploaded information on our pilots and validation work which can be accessed by downloading the .zip file in the 'resources' section.
Implementing Nutrition Screening in Community Care for Older People (INSCCOPe) and Southern Health
We carried out a service development project for integrated community teams (ICTs) within Southern Health NHS Foundation Trust, to implement a new procedure for nutrition screening and care for older people, drawing on our OPEN toolkit. The project involved the development of a care pathway (to bring more of a community focus), resources (e.g. a bespoke leaflet and webpage), and training (delivered by dietitians to 118 staff in 2017). The project was evaluated through a research project the project was evaluated through a research project ('INSCCOPe'), which investigated the factors that may help or hinder the implementation of the new model, and how it could be embedded into routine care, informed by Normalization Process Theory. The project was funded by the Burdett Trust for Nursing, and led by Professor Jane Murphy from Bournemouth University).
The initial findings from the project generated some key recommendations, including the appointment of staff 'nutrition champions', engaging with senior organisational leadership, and the adoption of an e-learning programme. This led to the recruitment of a dietitian 'project lead' for six months (from April to October 2018) to implement the required changes. The effectiveness of the new procedure was re-assessed in Autumn 2018. For more information about the project, please visit Bournemouth University's INSCCOPe page, or watch our project highlight video.
We have uploaded a file entitled 'Southern Health / INSCCOPe (.zip)' which can be downloaded from our 'resources' section - this file contains information on the new procedure, training slides, awareness leaflet and our poster from the 2017 BAPEN conference.
Two key outputs from this project are:
OPEN Eastleigh project
The OPEN Eastleigh project aimed to develop, implement and evaluate an integrated approach to screening and treatment of malnutrition in the community within a specific geography. The approach included the development of nutritional care pathways, a training package to raise awareness within the community health and social care workforce, an evaluation framework, and a support package. a .zip file can be downloaded from the 'resources' section, which contains a project summary, four volumes of the evaluation report, and a poster that was presented at the BAPEN conference in 2016.
Dorset Malnutrition Programme
The project started back in 2015, when an initiative to implement screening and nutritional care pathways for the health and social care teams in the community started in a single GP practice in Wool, Dorset. The initiative was rolled out across five GP practices in Purbeck later in 2015, and then into Christchurch locality in early 2016, involving a total of 13 GP practices. The Purbeck pilot was one of five national Malnutrition Task Force pilots. The patients screened as part of this project were unlikely to have been identified without this project, as the majority of staff had not previously been trained on nutritional screening. An electronic data collection form was also developed to support this work.
The successes and positive outcome of piloting this work with Purbeck and Christchurch then led to the roll out of this integrated approach across the whole of Dorset in 2017. For more information about the project and how it's progressed to date, please visit Dorset County Council website.
Food is a 'MUST'
Food is a 'MUST' was a South Wiltshire initiative centred on locally agreed, evidence-based pathways to identify and manage undernutrition in community settings. It involved providing training for care home staff following by a 6-month audit including reviewing the impact of training, number of people screened, 'MUST' scores and proxy outcome measures. In South Wiltshire, a care home pilot was carried out, which provided more intensive support to care home team following training, based on written agreement between the dietitians and the care home management to meet the objectives of the project. A follow up review and visit one month post-implementation showed that training and use of documentation enabled the care home staff to develop effective care plans which met best practice recommendations for identifying and managing malnutrition. A .zip file can be downloaded from the 'resources' section, which contains a project summary, presentation and poster.
In partnership with NHS Portsmouth CCG, Portsmouth City Council and Portsmouth Dietitians, Wessex AHSN carried out a project to explore the feasibility of community pharmacies in raising awareness of undernutrition in older people, and assess whether providing training to pharmacy staff led to improved awareness of undernutrition and specific conversations with older people. After training, staff from four pharmacies carried a 3-month initiative involving having conversations with customers about their weight, recent weight loss and eating habits using a structured questionnaire. As part of the conversation, they then provided basic information, signposting and resources to support people. We have produced a project summary, evaluation report, presentation and poster for this work, which can be downloaded from the 'resources' section as a .zip file.
Working with the voluntary sector
We have carried out several projects with the voluntary sector over the course of the programme. A .zip file can be downloaded from the 'resources' section, which contains evaluation reports for these projects.
One Community (Eastleigh) - Volunteers from One Community were trained by a dietitian, and attended a GP practice one morning a week to screen patients aged over 65 for undernutrition, using 'MUST'. Those found to be at risk were given basic dietary advice and signposting. The aims of the project were to evaluate whether the voluntary sector could have a role in supporting GP practices with screening, and to highlight the prevalence of undernutrition within the practice
Age Concern Hampshire - Volunteers were given training by a dietitian on undernutrition and how to use the PaperWeight Armbands. They were then asked to pilot the PaperWeight Armband with older people at home visits and events. This project highlighted the need for alternative tools to support the identification of undernutrition in the community, and was instrumental in our work on the Patients Association Nutrition Checklist and the Nutrition Wheel
Dorset Partnership for Older People Programme (Dorset POPP) - a project was carried out to evaluate the effectiveness of the Dorset POPP Community Development Worker in using the PaperWeight Armband to help identify undernutrition following training
Age UK Southampton
- a project was carried out to pilot the Patients Association Nutrition Checklist with the Fire Service and Age UK Southampton. The four questions from Section A of the Checklist were asked by Hampshire Fire & Rescue officers during safe and well visits
. Those identified 'at risk' were then referred to Age UK Southampton
whose Navigator service was able to carry out a visit to assess the person more thoroughly and provide basic advice and signposting using Section B of the Checklist.
The programme held three conferences (in 2015, 2016 and 2018) to share highlights from projects, and encourage networking for people working with older people in the community. The highlight videos for the most recent two conferences can be watched by clicking on the links below. We also produced videos of all the individual presentations from all conferences. Please visit our video section to watch these.
The posters and presentation slides from each conference can be accessed by downloading the relevant .zip file in the 'resources' section.
Projects from the Nutrition in Older People programme have been published in a variety of magazines and journals. These can be accessed by downloading the .zip file from the 'resources' section.
The programme also achieved some awards - in June 2018, we were awarded 'highly commended' for the HSJ Value Awards in the category 'Improving value in the care of the frail elderly' for our work with the Pan Dorset Malnutrition Programme. In 2018, our programme was shortlisted for the Complete Nutrition Awards in the category 'Community Nutrition Professional of the Year'. Our 'OPEN toolkit and training package to reduce undernutrition' poster was winner of the 'training and education' category at the Patient Safety Congress 2017.
The programme published six newsletters, and these can be accessed by downloading the .zip file from the 'resources' section.