BackgroundDespite policy guidance and quality standards, the majority of older adults with or at risk of malnutrition living in the community still remain under‐detected and under‐treated by health and social care professionals. The present study aimed to evaluate the concurrent validity of the Patients Association Nutrition Checklist against the ‘Malnutrition Universal Screening Tool’ (‘MUST’).MethodsThis cross‐sectional study involved 312 older adults recruited from 21 lunch and social groups. All participants were screened as per standard methodology for ‘MUST’. For the Patients Association Nutrition Checklist, they provided information about signs of unintentional weight loss in the past 3–6 months, experiencing loss of appetite or interest in eating. Chance‐corrected agreement (κ) was assessed.ResultsMean (SD) age of participants was 79.6 (8.3) years and body mass index was 27.8 (5.6) kg m–2. The majority (n = 197; 63%) were living alone. Using ‘MUST’, the overall prevalence of malnutrition was 9.9% (n = 31) comprising 6.7% at medium risk and 3.2% at high risk. There were 21.8% of participants (n = 68) rated at risk of overall malnutrition by the Patients Association Nutrition Checklist. Moderate agreement was observed between the two tools (κ = 0.47, P < 0.001).ConclusionsThe Patients Association Nutrition Checklist has potential for early identification of malnutrition risk, attributed to unintentional weight loss and appetite changes with signposting to basic dietary advice and appropriate support. Further work is required to understand how this tool could be effectively used by stakeholders including volunteers, community workers and home care staff.
Background In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those at risk may help to reduce malnutrition risk, reduce the resulting need for healthcare use and improve quality of life. Interventions are needed to raise older adults’ risk awareness, offer relevant and meaningful strategies to address risk and support general practices to deliver treatment and support. Methods Using the Person-based Approach and input from Patient and Public Involvement representatives, we developed the ‘Eat well, feel well, stay well’ intervention. The intervention was optimised using qualitative data from think aloud and semi-structured process evaluation interviews with 23 and 18 older adults respectively. Positive and negative comments were extracted to inform rapid iterative modifications to support engagement with the intervention. Data were then analysed thematically and final adjustments made, to optimise the meaningfulness of the intervention for the target population. Results Participants’ comments were generally positive. This paper focuses predominantly on participants’ negative reactions, to illustrate the changes needed to ensure that intervention materials were optimally relevant and meaningful to older adults. Key factors that undermined engagement included: resistance to the recommended nutritional intake among those with reduced appetite or eating difficulties, particularly frequent eating and high energy options; reluctance to gain weight; and a perception that advice did not align with participants’ specific personal preferences and eating difficulties. We addressed these issues by adjusting the communication of eating goals to be more closely aligned with older adults’ beliefs about good nutrition, and acceptable and feasible eating patterns. We also adjusted the suggested tips and strategies to fit better with older adults’ everyday activities, values and beliefs. Conclusions Using iterative qualitative methods facilitated the identification of key behavioural and contextual elements that supported engagement, and issues that undermined older adults’ engagement with intervention content. This informed crucial revisions to the intervention content that enabled us to maximise the meaningfulness, relevance and feasibility of the key messages and suggested strategies to address malnutrition risk, and therefore optimise engagement with the intervention and the behavioural advice it provided.
IntroductionMalnutrition remains underdetected, undertreated and often overlooked by those working with older people in primary care in the UK. A new procedure for screening and treatment of malnutrition is currently being implemented by a large National Health Service (NHS) trust in England, incorporating a programme of training for staff working within Integrated Community Teams and Older People’s Mental Health teams. Running in parallel, the Implementing Nutrition Screening in Community Care for Older People process evaluation study explores factors that may promote or inhibit its implementation and longer term embedding in routine care, with the aim of optimising sustainability and scalability.Methods and analysisImplementation will be assessed through observation of staff within a single area of the trust, in addition to the procedure development and delivery group (PDDG). Data collection will occur at three observation points: prior to implementation of training, baseline (T0); 2 months following training (T1); and 8 months following training (T2). Observation points will consist of a survey and follow-up semistructured telephone interview with staff. Investigation of the PDDG will involve: observations of discussions around development of the procedure; semistructured telephone interviews prior to implementation, and at 6 months following implementation. Quantitative data will be described using frequency tables reporting by team type, healthcare provider role group, and total study sample (Wilcoxon rank-sum and Wilcoxon signed-rank tests may also be conducted if appropriate. Audio and transcription data will be analysed using Nomarlization Process Theory as a framework for deductive thematic analysis (using the NVIVO CAQDAS software package).Ethics and disseminationEthical approval for the study has been granted through institutional ethical review (Bournemouth University); NHS Research Ethics committee approval was not required. Dissemination will occur through presentations to academic and practitioner audiences and publication results in peer-reviewed academic journals.
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