Combating malnutrition in elderly patients

Malnutrition in hospitals is still a major public concern today and Age UK has been campaigning on the issue since 2006. “Despite the long-running campaign, we still often hear from patients and their families about frankly appalling treatment in hospitals,” said Mary Milne, senior campaigns officer for Age UK, at a recent meeting organised by the Patient Safety and Geriatrics and Gerontology sections of the Royal Society of Medicine. “It is important to remember that each one of these cases is a personal family tragedy. Although it is a policy issue, which needs to be dealt with at a high level, it is also a very personal and human issue relating to fundamental dignity and care.” Malnutrition should be considered as a key patient safety issue, particularly among the elderly, where a high percentage of people in the community are already malnourished. The third Nutritional Screening Week survey, conducted by The British Association for Parenteral and Enteral Nutrition (BAPEN) identified that, in 2010, 34% of patients were found to be at risk of malnutrition.1 The European Nutritional Health Alliance found that four out of 10 older people admitted to hospital had malnutrition on arrival and patients over the age of 80 admitted to hospital had a five times higher prevalence of malnutrition than those under the age of 50.2 “Sadly this issue is not being identified or dealt with on admission to hospital and the number of malnourished patients being discharged from hospital is even greater than the number being admitted,” said Ms Milne. Six out of 10 older people are at risk of becoming malnourished, or their situation getting worse in hospital.2 Ms Milne went on to highlight that malnutrition should not just be regarded as an issue for geriatricians and those working on elderly wards. “The majority of patients in hospital are aged 60 or over and the numbers continue to grow as the elderly population continues to rise. So, it should be an issue for all wards and for all medical staff.”

 The effects of malnutrition

The effects of malnutrition can include muscle weakness, increased risk of infection, and poor wound healing: all of which can result in a longer hospital stay for the patient. In 2006, when Age Concern first launched its Hungry to be Heard campaign, the estimated cost of malnutrition to the NHS was around £7.3 billion a year.3 The Hungry to be Heard campaign identified that patients were being given inappropriate food. This did not relate to the quality of the food on offer, but to its appropriateness for the patient. Many meals can be difficult for an elderly patient to chew, for example. Another issue identified was that patients were not being given the appropriate help and support to eat their meals. “A fundamental concern highlighted by the Hungry to be Heard campaign, which is still relevant today, is that eating well is not seen as a priority in the hospital environment,” said Ms Milne. National Institute for Health and Clinical Excellence (NICE) guidelines, issued in February 2006, recommend that all patients should be screened on admission to hospital – for their weight, measurements and a BMI calculation – this should be repeated on a weekly basis throughout the patient’s hospital stay to ensure that any weight loss is identified. “This guidance is clearly not being followed as often as it should be,” said Ms Milne. “Many of the cases heard by Age UK demonstrate that a patient is clearly losing weight and that this fact is not identified as an issue during their hospital stay.” To counter this, Age UK produced a programme of seven recommended steps designed to highlight good practice and end the problem of malnutrition in hospitals.