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Nurses have an important role in identifying and tackling the problem , and in making proper nutrition and hydration priorities in practice . The benefits of improving nutritional care and providing adequate and appropriate hydration are considerable , especially for those living with long-term conditions and the consequences of problems such as stroke , pressure ulcers or falls . The evidence shows clearly that if nutritional needs are ignored health outcomes are worse . 3
How to take action in local communities Older people and our local communities are facing some exceptionally tough challenges . The ongoing impact of Covid-19 , as well as the cost-of-living crisis , means that even more older people are vulnerable and at risk of becoming malnourished . Within this context and as we approach winter , hydration and nutrition risks need to be identified and tackled in a timely way .
To do this , it is important for nurses and other healthcare professionals to screen systematically for malnutrition in vulnerable patients . Validated tools such as the Malnutrition Universal Screening Tool ( MUST ) 4 can help to identify those at risk , who can then be referred for specialist support if required , signposted to appropriate advice and provided with support to eat and drink . In particular , for patients discharged from hospitals or clinics , information about their nutritional status must be passed on to their community care team .
What to look out for The most obvious sign of malnutrition is unexpected weight loss . This may be gradual or sudden , and may be the result of illness or other factors . Subtle signs to look out for include :
• Ill-fitting clothing , tightened buckles , loose-fitting dentures or jewellery .
• Unusual feelings of lethargy or fatigue .
• Difficulty in planning , accessing and cooking food .
• A loss of , or reduction in , appetite .
• Difficulties with chewing or swallowing , or coughing and spluttering when eating .
• Recent ill health or diagnosis of a long-term condition , or another physical or mental health issue .
• Taking on a caring role .
Other warning signs may be less evident but can be associated with malnutrition that develops slowly and goes unnoticed . These include :
• A change in personal circumstances , such as a bereavement .
• Symptoms of anxiety or depression .
How can nurses make an impact ? We are in difficult and challenging times and the rapidly growing number of vulnerable older people in the community makes tackling preventable malnutrition more important than ever . Nurses working in the community have a prominent position and responsibility to identify the risks . Nurses can take the lead on this by :
• Making nutrition and hydration priorities in nursing practice to increase awareness of the need to keep older people well nourished in the community .
• Understanding that good nutrition and hydration underpins people ’ s health and wellbeing and supports them to stay healthy and independent for longer .
• Raising awareness to help all healthcare professionals , older people and their families and carers to recognise signs of unplanned weight loss , ensuring they have the information to spot a problem early on .
References 1 Volkert D et al . ESPEN guideline on clinical nutrition and hydration in geriatrics . Clin Nutr 2019 ; 38:10-47 . bit . ly / 3xcxS3d . 2 Elia M . The cost of malnutrition in England and potential cost savings from nutritional interventions . Malnutrition Action Group , 2016 . bit . ly / 3d9HOnd . 3 Stratton R , Green C , Elia M ( Eds ). Disease-related malnutrition : an evidence-based approach to treatment . CABI Publishing , Wallingford , UK , 2003 . 4 BAPEN . ‘ MUST ’ Calculator . bit . ly / 2xVcxfQ . 5 Malnutrition Task Force . Using tools to start conversations about eating well in later life . Video , 2021 . bit . ly / 3U5dVVC . 6 Malnutrition Task Force . The Nutrition Wheel . bit . ly / 3qBhjdi . 7 The Patients Association . Nutrition Checklist , 2021 . bit . ly / 2MDDRG8 .
Resources Age UK . Social activities . bit . ly / 2WH02Pr . Malnutrition Task Force . malnutritiontaskforce . org . uk . MTF resources include :
• The BAPEN self-screening tool bit . ly / 3QxFsfv
• Booklet : Eating well in later life . bit . ly / 3QBhxvGMTF .
• Case study : Lyn ’ s Story . bit . ly / 3DetaFW .
• UK Malnutrition Awareness Week . # UKMAW2022 . bit . ly / 3S0GWQJ .
• UK Malnutrition Awareness Week Conference . bit . ly / 3U0dZWT
Lesley Carter is a registered nurse . She is clinical lead , professionals and practice , and Malnutrition Task Force Programme lead at Age UK
Practical approaches and tools Sometimes , starting a conversation , giving a resource or signposting to local voluntary service organisations may be all that is needed to give a person the confidence to resume adequate eating and drinking .
Lunch clubs are opening again , and signposting older people to these will help them with loneliness and lack of confidence , as well as access to better nourishment ( see Resources ).
It is also worth linking up with local voluntary sector organisations like Age UK , who are making home visits and telephone calls specifically to help older and vulnerable people with nutrition .
We know there are barriers to using existing validated screening tools in the community . However , as well as the MUST tool , there are now other , simpler options available that have no need for scales and can still help to identify risks and start conversations . These tools have been developed for use in all community settings and there is guidance available on how to use them . 5
In particular , the Patients Association Nutrition Checklist , and its interactive version the Nutrition Wheel⁶ , offer a new approach to identifying ‘ clinical concern ’ for malnutrition risk at an early stage and the need for MUST screening in accordance with NICE . 7
The Malnutrition Task Force ( MTF ), an initiative from Age UK and the British Association for Parenteral and Enteral Nutrition ( BAPEN ), in association with the Royal Voluntary Service and others , has a website that provides information for the public and professionals ( see Resources ). All the resources are available to download or as hard copies , which can be given to people in the community .
The MTF is asking everyone to look for signs of risks of preventable malnutrition in the older people we love or care for , and is running a UK Malnutrition Awareness Week from 10-16 October , with the theme ‘ Ask , Look , Listen ’:
• Ask . Ask how is the person ’ s appetite , has it changed , and are there any difficulties with cutting , chewing or swallowing food ? Do they feel they are eating and drinking enough ? Have they noticed any unplanned weight loss ? Do they have any new or long-term concerns ?
• Look . Look carefully to assess how well the older person is doing , being on the lookout for tell-tale signs of unplanned weight loss such as looser clothing , rings or dentures . Note how they climb stairs , walk short distances and perform other activities of daily living . Also consider any caring role they might have , and keep your eyes open for signs such as empty fridges or cupboards , and appliances like fridges or cookers not working . Factors such as a local shop closing , inadequate access to public transport and whether they still have the ability to do their own shopping are also important .
• Listen . Listen carefully to what older people are telling you . It may not be directly about eating and drinking but could be about loss , feeling lonely and low , losing interest in things or a lack of energy to take part in activities that usually give pleasure .
As part of the awareness week , the MTF will host a conference , including a virtual , ‘ Sharing of Practice ’ learning day on 10 October ( see Resources ).
Tackling malnutrition is everyone ’ s responsibility . We really are all in this together , especially as the effects of the cost-of-living crisis bite . Nurses can take the lead in the prevention and identification of malnutrition and helping to keep older people healthy and out of hospital for as long as possible this winter .