The importance of combating malnutrition in care

Abstract

Malnutrition results from a deficiency of macronutrients (energy and protein) and micronutrients (vitamins and minerals), that may impact on body composition, function and/or clinical outcomes (National Institute for Health and Care Excellence, 2006). A range of factors, including impaired food intake (seen in individuals who are anorexic or have difficulties swallowing), increased nutrient requirements (seen during infection) and/or loss of nutrients which may be present in individuals with inflammatory bowel disease, have been known to cause malnutrition (Dunne, 2009). The cost of malnutritionMalnutrition has a significant cost in terms of its impact on morbidity and mortality. In addition, malnutrition places an enormous financial burden on the NHS, due to its effect on wound healing, skin integrity and length of hospital stay. It has also been recognised that malnutrition is potentially a reversible risk factor for pressure ulcers and other conditions (Meijers et al, 2010). Therefore, putting measures in place, such as early identification of those at risk of malnutrition through screening and developing strategies for enhanced feeding programmes, will promote the nutritional status and clinical outcomes of residents.According to Merrell et al (2012), approximately 32% of people aged 65 years and over, and 23% of those below 65 years of age in the UK are malnourished. A further estimated 7 million people in the UK are at risk of malnutrition, costing about £13 billion per year (Merrell et al, 2012). Many of those at risk of malnutrition are in hospitals (estimated at 150 000 people), care homes (approximiately 600 000) and sheltered accommodation (around 700 000), while around 6 million people living in the community are dependent on others for their nutritional requirements (Merrell et al, 2012).Malnutrition may predispose individuals to poor health outcomes including fall rates, diseases, delayed recovery and increased hospitalisation (Neyens et al, 2010;Palm et al, 2010). Therefore, the prevention of malnutrition and these poor health outcomes should be seen as crucial patient safety issues (Neyens et al, 2010). Merrell et al (2012), observed that while malnutrition in hospitals has been well documented, there appears to be a lack of commensurate effort with respect to research into malnutrition in care homes, despite the high number of those at risk of malnutrition living in these settings. Types of malnutrition in the care homeThere are different types of malnutrition which can be found in the care home with a range of clinical manifestations, including skin and hair changes, and weight loss. While some residents may present with energy deficiency, protein deficiency or protein-energy malnutrition, other types of malnutrition may manifest in the form of micronutrient deficiencies (such as minerals and/or vitamins deficiencies). There could also be a combination of these nutritional deficiencies.'A further estimated 7 million people are at risk of malnutrition, costing about £13 billion per year'