Preventing malnutrition in later life

Our take on new figures showing a rise in older people dying in hospital with malnutrition listed as a factor

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New figures from the Office for National Statistics have shown that the number of people dying in hospital with malnutrition as an underlying cause or as a contributory factor is rising.

Malnutrition was listed on 351 death certificates in England and Wales in 2016. It was the underlying cause of 66 deaths, up from 59 in 2015 and the highest number in the last decade.

These are shocking statistics and have, quite rightly, gathered attention in the media and among MPs.

But this isn’t a problem that’s confined to our hospital corridors. We need a unified cross-settings and cross-sector approach to tackle this issue, with defined support in the community where many older people are most at risk – in fact 90% of older people who are malnourished or at risk are living in their own homes.

The reasons why a person might become malnourished are complex.

For many older people, poor health or mobility difficulties can make it harder to shop for food and cook independently. For others, loneliness, isolation or depression can mean they simply lose the motivation to eat well.

Cuts to vital services in the community are leaving many older people without the support they need. Meals on wheels, lunch clubs and community transport services – which can provide older people with access to a nutritious meal – are disappearing.

In addition, our public health messages concentrate on the dangers of overeating, the obesity epidemic and the need to eat less. We’re a society that often assumes losing weight is a good thing or that it’s completely normal to become thinner as we age.

But this is not the case.

We know that those living with or at risk of malnutrition in the community are more vulnerable to adverse health outcomes. They are more likely to visit their GP and be admitted to hospital than someone who is not malnourished.

Indeed, nearly one in three of all older people admitted to hospital are already malnourished or at risk of malnutrition.

As a result it’s absolutely vital that older people admitted to hospital or a care home are screened for malnutrition, and that any treatment and support they need is reflected in their care plan and people are referred as appropriate.  And part of that support is to ensure all care settings are mindful of the issues around packaging, of patients being ready and encouraged to eat, of ensuring that people receive additional help when they need it.

Malnutrition should be clearly stated on the discharge notification so it can be followed up in the community.

Ultimately we all have a responsibility to take nutrition and hydration seriously and ensure that older people, wherever they are, get the help and support they need to eat well. If we’re really going to end preventable malnutrition among our older population, we need a whole systems approach.

 

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