NUTRITION FEATURE
Risk Low
Medium
High
How to identify malnutrition
Indicators
Not thin , weight stable or increasing Good food intake or appetite
Thin and / or some unplanned weight loss Poor appetite and / or reduced food intake
Very thin and / or unplanned weight loss Very poor appetite and / or much reduced food intake
COVID-19 increases nutritional needs and depletes body stores . It can also reduce the ability to eat and drink as normal , with symptoms such as breathlessness , fatigue or loss of taste and smell reducing food intake .
As part of their practice , occupational therapists can play a very valuable role in the opportunistic identification of malnutrition risk in older patients in the community under their care , so they can offer first line dietary advice and , where appropriate , alert other multidisciplinary team members to risk .
This is especially important where direct access to the range and number of healthcare professionals may have been restricted in the pandemic .
Good nutrition is particularly important during a pandemic for promoting health , aiding recovery and rehabilitation from illness , supporting immunity and maintaining muscle strength for activities of daily living and independence .
In general , well-nourished adults living in the community are less likely to have admissions to hospital or to care , shorter duration of stays if they are admitted , and fewer GP appointments and prescriptions , as well as better quality of life .
Those who have not been infected by COVID-19 may also be at increased risk of malnutrition . Social distancing , quarantine and shielding have reduced the provision of community meals , for example at lunch clubs . For many , they have resulted in lower levels of assistance and prompts with eating , cooking or shopping from family or carers , and to isolation and low mood , which reduce appetite . Top tips for recognising malnutrition include :
• where social distancing makes formal and physical screening methods difficult , use subjective questions about the red flags for malnutrition risk ( weight loss , poor appetite and reduced food intake / difficulties eating ) to assess degree of risk , the need to take practical action or refer on where appropriate ( see figure above );
• suggest an online self-screening tool for use by patients , their carers or as part of a remote healthcare consultation ( www . malnutritionselfscreening . org /; and
• remember that overweight or obese patients may also be at risk from the effects of malnutrition .
Putting food first
‘‘
Good nutrition is particularly important during a pandemic for promoting health , aiding recovery and rehabilitation from illness , supporting immunity and maintaining muscle strength for activities of daily living and independence .
During the COVID-19 pandemic , local care pathways for malnutrition have , by necessity , become more flexible , especially where discharge from hospital has been rapid . In many cases , malnutrition can be prevented or helped by timely , practical and effective ‘ food first ’ advice from a variety of healthcare professionals in multidisciplinary teams , including occupational therapists . Given the variety of patient journeys through the pandemic , evidence based COVID-19 specific nutrition care pathways and linked resources tailored to patient needs have been developed by The Malnutrition Pathway and The Association of UK Dietitians ( BDA ) to support community health professionals in this role ( see table on page 32 ).
Occupational therapists in malnutrition management
There are a number of things that occupational therapists can do to support malnutrition management .
Occupational therapists can explore the reasons behind weight loss , poor appetite , or difficulty with food intake . It can be helpful to raise awareness that malnutrition is not an inevitable consequence of infection , illness or ageing and that nutrition plays a role in health and recovery .
You can also encourage a variety of nutrient dense foods , eaten little and often ; this can include regular meals alongside nutritious snacks , desserts or milky drinks every few hours . Promote protein rich foods ( such as meat , fish , eggs , cheese , milk , beans , pulses or nuts ) as part of every meal . Adequate protein is especially important to regain of muscle mass and strength and to repair damaged tissues .
Occupational therapists can suggest food fortification ( for example . adding four tablespoons of dried milk powder to a
OTnews February 2021 31