clinical focus
in aged care facilities once a month, sometimes less. This is a
fraction of the time that clinical, care, food service and medical
staff are present, so managing malnutrition requires a team effort.
Malnutrition
model of care
OSCAR Hospitality is trialling
a method of malnutrition
prevention that is yielding
promising results.
By Liz Purcell
M
alnutrition is a major public health issue in Australia,
with 40–70 per cent of residents in aged care facilities
malnourished. It is a silent epidemic that affects the
sickest and most vulnerable in our communities, and those
confined to institutional care are the most susceptible.
Malnutrition is both a cause and a consequence of disease
and ill health. It does not discriminate against age, sex, race,
religion, culture or, most importantly, size – which means it’s not
overtly apparent. We must look for and be aware of it. It can be
difficult to detect unless extreme, particularly in a society where
overnutrition is so prevalent.
Undetected malnutrition affects every system in the body. It is
physically, psychologically, emotionally and socially debilitating.
It robs the body of its ability to fight infection, is directly related
to the increased incidence of pressure injuries and falls in older
adults, and when underlying illness and age are accounted for,
malnutrition predicts a greater than threefold risk of death within
12–18 months in older Australians.
All this in turn significantly contributes to the enormous fiscal
burden malnutrition places on our economy, which will continue
to rise with our ageing population and increasing health and social
care costs. However, this also indicates that incentives to prevent
malnutrition pose a sizable cost-saving opportunity within the
aged care sector.
Although it continues to be relatively unrecognised and
untreated, malnutrition is preventable and treatable. First we need
to increase the awareness of this debilitating condition.
WHO IS RESPONSIBLE FOR MALNUTRITION PREVENTION
AND MANAGEMENT?
Aged care facilities are provided general guidance by accreditation
standards, which state, in relation to nutrition, that “care recipients
receive adequate nourishment and hydration”.
We (quickly) need to define “adequate”, as the potential for
wide-ranging confusion, interpretation and subsequent negative
and unnecessary clinical outcomes is immense.
Accredited practising dietitians have the knowledge and skills to
diagnose and treat malnutrition, so they are the obvious choice to
lead efforts in this area. However, dietitians are often only present
WHAT CAN BE DONE?
Following retrospective auditing and data collection on the
incidence of pressure injuries, falls and hospital admissions,
OSCAR Hospitality’s dietetic team developed a Malnutrition Model
of Care, which can be customised to meet the specific needs of
individual facilities.
The model incorporates tools and education modules designed
to raise malnutrition awareness and promote earlier intervention
within aged care facilities.
There are several key components to the model, which include:
• A dietitian-led working party, who advocate for a united,
resident-centred approach to improved nutrition. While our
approach is to work from the ground up, it is imperative to have
support at the executive level also.
• ‘Nutrition Champions’ identified and trained at each facility,
to carry out routine nutritional screening, allowing for earlier
identification and intervention.
Their additional responsibilities include:
– boosting the profile of nutrition within the facility by initiating
small nutrition-related projects and strategies to tackle
malnutrition, under expert guidance and support*
– ensuring that nutrition is a priority for care homes
– being a point of contact for staff
– learning to identify nutritional ‘red flags’ and being the direct
liaison with the facility dietitian to tackle these issues.
* The dietitians use a facilitated approach to train the
Champions in nutrition screening, identification of red flags
and tackling basic nutrition concerns, while also training the
Champions to recognise high-risk residents, who require
earlier dietetic assessment and intervention.
• Regular interactive nutrition workshops to improve malnutrition
awareness.
• A new nutrition component in the annual OSCAR Hospitality
awards night to recognise and celebrate nutrition achievements
and innovation.
BENEFITS AND RESULTS
When implemented successfully, this malnutrition model of
care empowers staff to implement local initiatives to promote
improved nutrition, increase cost savings through a reduction
in pressure ulcers, falls and hospital admissions, and improve
consumer awareness and nutrition provision.
Results from the initial stages of our pilot in Victoria have
shown positive clinical outcomes from both the consumer and
staff perspective. The six-month retrospective and prospective
audit results indicate a 15 per cent reduction in falls and a 17 per
cent reduction in hospital admissions, with the average length of
hospital stay down by 0.5 days. Staff reported extremely high staff
satisfaction ratings.
We intend to start locally, obtain credible data and engage the
right people to leverage support and build sustainable momentum
for malnutrition recognition and intervention.
Ultimately, malnutrition remains an enormous issue, which can
be improved with a higher profile. ■
Liz Purcell is an accredited practising dietitian. She is lead
dietitian with OSCAR Hospitality.
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