Malnutrition In The UK – An Avoidable Problem?

Andrew Williams - Care Homes

AIMS OF THE SESSION

• Quiz – Understanding?

• Malnutrition in the UK – Causes & Consequences

• Standards & Guidance

• How Are We Doing?

• What’s Needed?

TRUE OR FALSE?

• The costs of dealing with malnutrition in the UK are twice that of dealing with obesity

• Quality of the diet matters even more as we get older

• Signs of malnutrition take several months to show

• Our sense of smell can be reduced by up to 90% as we get older

• The threshold for detecting sweet taste is 3x higher in older adults than adolescents

• The entire skeleton is turned over every 7 years

• % of Care Home Residents at Risk of Malnutrition

– On admission

– Overall

SCALE AND COST OF MALNUTRITION IN THE UK

Three million people are living at risk of malnutrition in the UK, with the cost estimated to be £13 billion every year (BAPEN 2009)

Obesity Malnutrition0

2

4

6

8

10

12

14

4.2

13

Cost to NHS £billion

Communities with no or little contact

Communities in contact with services

Care Homes

Hospital

93%

5%

2%

3 m

illio

n m

alno

uris

hed

3 MILLION MALNOURISHED

WHY SO COMMON IN OLDER ADULTS?

Nutritional requirements stay high or

increase but appetite decreases

The entire body is turned over every seven

years – materials come from diet

Immune system & muscles start

to show deficiency after just a few days

SENSE OF TASTE & SMELL

• Impaired senses of taste and smell

• Sugar detection threshold 3x higher on older adults than adolescents

Chemical senses in elderly free living

women

10

50

73

0 50 100

Smell

Salt taste

Smell and taste function as %of that in young womencontrols

WHAT IS THE STANDARD? - CURRENT REGULATIONS

CQC Outcome 5“Meeting Nutritional

Needs”

National Care StandardsStandard 13 – “Eating

Well”Standard 14 – “Keeping

Well”

National Min Standards for Care Homes For

Older PeopleStandard 16

Regulation and Quality Improvement

AuthorityStandards 8 & 12

2001

Better Hospital Food

CQC Dignity & Nutrition inspections 2011/12

Council of Europe resolution (2003)

10 Key Characteristics of Good Nutritional Care (2007)

National Institute for Health and Clinical Excellence (2006)

Protected Mealtimes (2003)

High Impact Actions for Nurses (2010)

RCN Nutrition Now Campaign (2007)

Age UK Hungry to be Heard (2006)

CQC Essential Standards for quality and safety (2010)

WAG Nutrition and Catering Framework (2002)

NI Get your 10 a day (2007)

Scotland Food in Hospitals (2008)

Patient Environment Action Team Assessments (annually)

DH Nutrition Action Plan (2008)

Scotland – Promoting Nutrition in care homes for older people (2009)

Healthcare Improvement Scotland – Improving Nutrition (2012)

WHAT IS THE STANDARD - LOTS OF ACTIVITY.........................

NPSA10 Key Characteristics of Good Nutritional Care Toolkit (2009)

2012

HOW ARE WE DOING?

2011 2010 2008 20070%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Risk of Malnutrition

Source: BAPEN Screening Survey 2011

More than 1 in 3 Adults Admitted to Care Homes at

“Risk”

CARE HOME CHALLENGE

0-1 month 2-3 months 4-6 months Overall0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Risk of Malnutrition

INCREASED REGULATORY FOCUS - CARE HOMES

• Inspection 500 Homes 2012

• 1 in 6 NOT meeting Nutritional Needs

• 1 in 5 Nursing Homes failing

• Minimum Standards

• 4000 Homes – 140,000 residents

ONGOING FOCUS

• NACC “Meeting Outcome 5”

• Healthcare Improvement Scotland

• British Dietetic Assoc.

• Malnutrition Task Force

WHAT DOES GOOD NUTRITIONAL CARE LOOK LIKE?

Top tips• Have Nutrition and hydration Champions, one

carer and one from the catering team

• Ask your local speech and language specialist and dieticians to do training sessions

• Suppliers to provide free specialist training on food preparation and service for special needs

• Use Regulators Quality standards to evaluate your service before inspections

• Have regular feedback from Residents and implement what they say!

• Robert...................

WHAT’S NEEDED - GUIDANCE?

• Greater understanding of the importance of Nutrition

– Mandatory training

– Homes and Assessors

• Clear Nutritional Standards across all Regulators

• Clear Nutritional Standards across all Sectors

• Awareness that Care Home Catering is challenging

Questions? Happy to take any Questions?