NHD clinical - NAGE
by Lisa-Jayne Cruickshank Medicines Management Dietitian
Lisa-Jayne Cruickshank has specialised in working with older people since 2004. She is now working with NHS Warwickshire in a full-time Medicines Management role. Lisa-Jayne is a member of the NAGE committee and is studying MSc Gerontology at Kings College, London.
Improved access to nutrition needed for our
ageing population The NHS faces difficult times ahead, with service demands increasing, together with pressure to make cost savings. People aged 65 years and over account for approximately 60 percent of NHS hospital admissions and 70 percent of NHS bed days (1). The number of older people in the United Kingdom is increasing, raising concerns that more strain will be put on NHS services. It is therefore essential that effective and efficient services are set up for older people in the community to improve health and reduce admissions to hospital.
Malnutrition costs the NHS £13 billion each year (2). In the United Kingdom, more than three million people are malnourished or are at risk of mal- nutrition, with the majority of these people (approximately 93 percent) in the community (3). Early identification and treatment of malnutrition will have a huge impact by reducing NHS costs and improving patient outcomes and quality of life. Dietitians encourage the use of nutritional screening tools to identify malnutrition risk. However, in- dividuals who do not access NHS ser- vices will probably not be screened, which may result in a person in the community becoming extremely mal- nourished and consequently requiring extensive and costly NHS and social care. By being more aware of at risk groups, screening can be directed to the correct people so that those most at risk are less likely to be missed. Availability of family may determine access to care for older people. Stud- ies have shown a positive relationship between receipt of care with being a parent and living in multi-generation- al households (4). Due to improved survival, a larger number of older people are living with a spouse and are therefore likely to receive some informal care. However, fewer older people live with their children and therefore the number of older people living alone is also increasing. It is expected that the number of people who divorce will continue to increase, which may be of concern since it has been found that divorced individuals receive less care from their family members. Older people who are divorced are less likely to remar- ry. Even if they do remarry, they still receive less care from their children.
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This is particularly the case for older men (5). Social relationships are also an important indicator of morbidity and mortality. Social isolation can be as detrimental to health as smoking (6). Single older people and socially isolated people are highly vulnerable to risk of malnutrition. These popula- tion groups need to be identified on a local basis so that they can have clear signposting to and be offered easy access to nutritional interven- tions, such as social meal activities, cooking lessons and shopping trips.
‘In the United Kingdom, more than three million people are malnourished or are at risk of malnutrition…’
People with a low income are at in- creased risk of poorer health. Older people with limited income may strug- gle to afford good quality meals. Infor- mation and education sessions could be provided to this population group to advise upon store cupboard items and how to achieve a healthy diet on a low income. Older people may be unable to access supermarkets due to inability to use public transport or only having access to expensive transportation, such as taxis. Initia- tives should be set up to assist older people with limited funds to receive their shopping.
Dietetic posts specialising in nutri- tion for older people are unfortunately not commonplace, meaning there is a lack of dietetic skill and knowledge available to bring about initiatives ap- propriate for older people. In addition, public health money is usually aimed at nutritional interventions for families. In view of the shift to an ageing popu- lation and the huge costs that result from malnutrition, dietitians should highlight the importance of improv- ing nutrition for our current and future older population with commissioners. Otherwise, it is likely that the cost of malnutrition for the NHS is likely to continue to rise.
References 1 Oliver, D (2008) ‘Acopia’ and ‘social admission’ are not di- agnoses: why older people deserve better. R J Soc Med, 101: 168-174 2 British Association of Parenteral and Enteral Nutrition (2009) Combating Malnutrition: Recommendations for Action. BAPEN, Worcs 3 Elia M, Russell CA (eds) (2009) Combating malnutrition; Rec- ommendations for Action. A report from the Advisory Group on Malnutrition. BAPEN, Redditch 4 Tomassini, C (2005) Chapter 2: Family and living arrange- ments. In: National Statistics, ed. Focus on older people. Lon- don: National Statistics 5 Glaser K, Tomassini C, Stuchbury R. Differences Over Time in the Relationship Between Partnership Disruptions and Support in Early Old Age in Britain. Journal of Gerontology: Social Sci- ences, Vol. 63B, No. 6: 359–S368 6 House, JS (2001) Social Isolation Kills, But How and Why? Psychosomatic Medicine, 63: 273-274
This article has been written in association with NAGE
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