Detection And Management Of Malnutrition Flashcards
Reasons for malnourishment
- clinical: disease severity, pain, GI function, dental issues, swallowing difficulties, medication, surgery
- social: financial, issues getting to shops/ care services, social isolation
- psychological: bereavement, depression, anxiety, apathy, loneliness
Impact of malnourishment
- on individual: lack of muscle strength and function, reduced QoL, increased infection risk, apathy, increased mortality and morbidity
- impact on carers: hopelessness, anxiety
- healthcare system: twice the amount of GP visits, 3x more hospital admissions, 2x more healthcare costs, costs £5 billion per year in direct healthcare costs, £13 billion per year in health and social care costs
The 4-step nutritional care process
1) identification: screening (this can be done by non-nutritional professional)
2) assessment: nutrition professional
3) treatment: nutrition professional
4) monitoring: professionals across health and social care
Nutritional care process: IDENTIFICATION
- identifies patients with nutritional issues and those at high risk of nutritional issues
- conducted by non-specialists
- using MUST tool, where a score of 2 indicates high risk individual which is referred to a dietician (involves measures of BMI, weight change, and risk of no nutrient intake in next 5 days)
Nutritional care process: ASSESSMENT
1) anthropometry: weight history (if lost 10% BW in 3-6 months very clinically significant), height (can be measured by surrogate measure eg. Demi span or ulna length if cannot stand, or by patient recall), BMI (if <18.5 then chronically undernourished), body composition (for AT and FFM, DEXA scan)
2) biochemical and lab data
3) clinical condition: comorbidites etc
4) dietary intake: via patient interviews (24 hour recall, 7-day diet diaries), or by record techniques (carers or patient fills out food and drink chart for 3-5 days)
5) environmental, psychological and social issues: need to employ occupational therapists and social workers to deal with social deprivation, loneliness and isolation
Nutritional care process: TREATMENT
1) dietary counselling: always first option, can involve family too. Encourage snacking, variety. Longer germ solution
2) food fortification: can be done at home with addition of milk powder, butter, cream. Helps for those with poor appetite
3) oral nutrition supplements: best evidence for supporting better morality and morbidity outcomes in >75 years. Need to ensure drinking between meals (dose depends on need), and have variety too, with a clear exit plan
4) supportive interventions: red trays (need help with eating), protected mealtimes, lunch clubs, cookery classes
Nutritional care process: MONITORING
- aims: to ensure support is provided safely and clinical complications are treated early, assess if nutritional objectives are met, alter support as needed
- monitor nutrient intake, fluid and GI function daily, then twice weekly
- monitor weight weekly
- monitor anthropometry monthly
- monitor clinical condition daily then ad libitum
- looking for: weight changes, meeting patient specific goals, symptom relief, barriers to change, knowing when to stop