Helping to prevent malnutrition in older adults in the home | apetito


Helping to Prevent Malnutrition in Older Adults in the Home


Sue Baic, Consultant Dietitian to apetito


Introduction By 2033, an estimated 23 per cent of the UK population will be over 65. As the older generation swells, economic and moral arguments for supporting their domestic independence grow in strength. Ability to access a nutritious diet is a vital factor in establishing a long term solution for the aged.


It is well documented that well-nourished adults need less care and have a better quality of life. Malnourished adults endure more complications, longer hospital stays and higher readmission rates to hospital or care homes; all of which contributes to an annual public expenditure of £13 billion associated with malnutrition.1 As many as three million people in the UK are either malnourished or at


risk of malnutrition. Around 93 per cent of these are living in the community with only 7 per cent in care homes or hospital.2


Many have chronic physical


conditions such as dementia, chronic obstructive pulmonary disease or stroke alongside social and psychological factors which can combine to increase risk. Individuals will suffer various symptoms at different times making it


difficult to diagnose. Providing practical nutritional advice, help to access food and encouragement to eat are all important in preventing malnutrition, whilst screening can identify those “at risk”. Support with shopping, cooking or eating should be considered for “at risk” adults, not just those past the point of coping.


Community health and social care professionals are well placed to identify


risk and signpost potentially effective solutions before malnutrition begins its downward spiral – see Table One. Where shopping and cooking remain difficult despite support, home


delivery of meals becomes essential. Currently in the UK there are more elderly people who receive meals in their own home than in care. Home delivery of meals is available from both local authorities and from the private sector.


For


many this service forms a valuable point of social contact as well as nourishment. Meal service providers are well placed to detect changes in appetite, identify malnutrition risk and act as a monitor and prompt to encourage clients to eat regularly. Home delivered meals are designed to conform to both food and nutritional


standards with minimum levels for macro and micronutrients in main course and desserts as well as ethnic, cultural and religious needs.3, 4


Home delivered


meals are also available to meet the requirements of those clients on special diets including higher energy meals for those needing extra calories, gluten free meals for coeliac sufferers, and texture modified dishes for dysphagic clients. Financial independence in making food choices remains important for


many. Increasingly many older adults, not just those at risk of malnutrition, choose private delivery of frozen meals. These meals are easy to order and store, can be quickly and conveniently heated in an oven or microwave and eaten at a time which best suits the person. Support to customers is available from a dedicated customer support line and from delivery staff who are criminal record bureau (CRB) checked. Staff will place orders in the freezer if requested and can instruct new clients in their own homes how best to heat their meals.


Menus can be changed regularly with a varied range of dishes, including


both hot and cold desserts, designed to meet individual preferences. Many main course meals come in a choice of portion sizes and prices, which helps reduce waste and makes them suitable for a wider cross section of those at risk.


Conclusion To reduce risk of malnutrition, access to nutritious food is vital for ensuring cost effective health care in an ageing population.


It can help


people stay independent for longer in the comfort of their own homes. Services to help with shopping, cooking and eating, including home delivery of meals, can all be developed according to individual needs. Personalisation and a greater choice of provision of services may be increasingly important since as with many other aspects of care, one size will not fit all when it comes to food access.


Table One: Interventions to promote shopping, cooking and eating in older adults at risk of malnutrition


Support with Door to door, easily accessible, low cost transport e.g. Dial shopping


Superstore free bus service Internet ordering and home delivery of shopping


Supermarket store tours for groups of older adults e.g. tailored for those on low income or with type 2 diabetes


Support with “Cook and eat” clubs – weekly courses on basic cooking cooking


skills, healthy eating and budgeting – targeted at particular groups e.g. widowed men or older adults with a low income


Guidance on suitable store cupboard and fresh/frozen foods, basic cooking equipment and easy cook recipes


Adapting kitchen for aids and equipment to help cutting, gripping and opening in food preparation


Support with Adapting home for aids and equipment to help with eating eating


Use of finger foods if using cutlery is troublesome


Use of social eating settings to boost intake e.g. luncheon clubs/day centres/ community cafes or eating together sessions in sheltered housing


Food fortification to increase calories and/or protein including use of oral liquid nutritional supplements. Home delivery of hot or frozen meals


References: 1. Elia M & Russell C (2009) Combating Malnutrition: recommendations for action. BAPEN. http://www.bapen.org.uk/pdfs/reports/advisory_group_report.pdf. Accessed November 2010. 2. Wilson L (2010) International Longevity Centre ( ILC- UK)Personalisation, Nutrition and the Role of Community Meals. A report from a round table discussion chaired by Baroness Greengrass. www.ilcuk.org.uk Accessed November 2010. 3. National Association of Care Catering NACC (2010) Recommended Standards for Older People in Residential, Day Care and Community Meals. https://thenacc.org.uk/news_item/news_file/122/NACC_Nutrition_Standards_2010.pdf. Accessed November 2010. 4. The Caroline Walker Trust (2004) Eating well for older people. Practical and nutritional guidelines for older people in residential and community care. Second Edition. http://www.cwt.org.uk/pdfs/OlderPeople.pdf. Accessed November 2010.


Complete Nutrition Vol.10 No.6 December/January 2010/11 | 53


e.g. wrist supports, adapted cutlery and crockery, non slip mats or plates, insulated cups and plates to keep food and drink warm


a ride, Access Bus, Shoplink, which enables clients to complete a weekly shop


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69