The Wessex AHSN is working with a range of voluntary sector organisations to help raise awareness of undernutrition in the community and to evaluate approaches for how best to do this. At present there is limited evidence available to support the use of volunteers in identifying and supporting older people at risk of undernutrition; so we are looking to publish our work in this area in due course. Some of our current projects include:
One Community Nutrition in Practice
Following training by a dietitian, this pilot project (which was completed in November 2017), involved volunteers from One Community being present in a GP practice in Eastleigh, Hampshire one morning a week to screen patients over 65 for undernutrition, and provide some basic dietary advice to those identified as 'at risk' of undernutrition. The volunteers spent a total of six months in the practice. The aims are 1) to evaluate the voluntary sector could have a role in supporting GPs and nurses in screening, and 2) to highlight the prevalance of undernutrition risk in general practice in Eastleigh and provide evidence around whether screening in general practice should be carried out routinely. Our evaluation report can be downloaded from the 'resources' section on the right.
Piloting a new Nutrition Checklist with domiciliary care workers & with the Fire Service
In April 2017, a three-month project was launched working with Pramacare, a domiciliary care company in Dorset. It aims to understand how a new ‘Nutrition Checklist’ tool could be used by care locality managers and other staff to identify clients who may be at risk of undernutrition and put appropriate care plans in place, as well as assessing the barriers and facilitators to using the checklist.
The checklist is a modified version of the original ‘Nutrition Checklist’ developed and recently launched by the Patients Association. The original Patients Association checklist was designed to be completed by patients themselves, particularly on discharge from hospital. We have modified the checklist to make it suitable for use by domiciliary care workers with their clients who are not trained to undertake traditional nutrition screening using tools such as ‘MUST’. The checklist consists of key questions to focus discussions around weight and nutrition and provides clear advice and signposting to appropriate support for older people living in the community. Care locality managers have received training on undernutrition, how to use the Nutrition Checklist, and what actions to take for individuals identified at risk of undernutrition. The project is currently being evaluated through focus groups and review of the data collected.
Following on from this, another project was undertaken between November 2017 and January 2018 to understand how the Nutrition Checklist (which was further modified from the work with domiciliary care) could work with the Fire Service. Four questions from 'part A' of the checklist were asked by Hampshire Fire & Rescue officers to older people during safe and well visits. Those who were identified as likely to be at increased risk of undernutrition 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 'part B' of the checklist. This project has been evaluated and our evaluation report can be found in the 'Resources' section of this page.
Age Concern Hampshire
This project stems from the challenges of screening for undernutrition risk in community settings and peoples' own homes, where measuring body mass index (BMI) is often impractical. Undernutrition awareness training, which included identification of unintentional weight loss, giving basic dietary advice, signposting and how to use the PaperWeight Nutrition Armbands was provided to Age Concern Hampshire volunteers (Food & Friendship, Older People's Action in the Locality (OPAL) and Village Agents volunteers) by a dietitian. The armbands are a simple paper tool developed by Salford Royal NHS Foundation Trust and Age UK Salford, designed to highlight a mid upper-arm circumference less than 23.5cm, which indicates someone is likely to be underweight. Whilst these armbands seem to act as a conversation starter, they are not always being asked alongside questions around unintentional weight loss. This project has been evaluated and our evaluation report along with a case study can be found in the 'Resources' section of this page.
Development of the Nutrition Wheel
We have worked with a team of Adult Nursing and Midwifery students at Bournemouth University who developed an initial prototype of a tool as part of their assignment on service improvement. The tool has since been further developed with input from a multidisciplinary group, and has taken the form of an interactive ‘wheel’, which can be used with people working with older people in the community for whom nutritional screening using ‘MUST’ may not be appropriate (e.g. voluntary sector workers who lack training and equipment to undertake ‘MUST’ screening). The 'Nutrition Wheel' will involve the older person being asked some key questions to determine their risk (using the questions from 'part A' of the Nutrition Checklist), and then guides on the provision of appropriate first line advice and signposting. The tool is not a replacement for ‘MUST’, but aims to provide a pro-active way to identify people at risk who may not be accessing traditional health and social care services.
The Bournemouth University students carried out some initial feasibility work through informal discussions with older people and staff / volunteers from a variety of voluntary sector organisations. A research assistant from Bournemouth University is now carrying out a formal research study (with ethics approval) into the feasibility of using the Nutrition Wheel through working with voluntary sector organisations in Dorset. We aim to publish the results of this work in Autumn 2018.
The aim of this four-month pilot project was to evaluate the potential effectiveness of Dorset POPP (through Early Help / Dorset POPP Community Development Worker (CDW) for Access to Food and Nutrition) in carrying out undernutrition screening using standard questions (to identify recent weight loss) and the PaperWeight Nutrition Armbands following training. Following identification, the CDW provided basic nutrition information, resources and signposting to people at risk. The majority of older people were screened at Early Help / POPP home safety events throughout Dorset. For more information about Dorset POPP, please visit their website. This project has been evaluated and our evaluation report can be found in the 'Resources' section of this page.