ELDERLY
MALNUTRITION IN THE ELDERLY: THE ROLE OF COMMUNITY PHARMACY
ALTHOUGH IT’S OFTEN ASSOCIATED WITH THIRD WORLD COUNTRIES, MALNUTRITION IS ACTUALLY COMMON AMONG THE ELDERLY IN THIS COUNTRY. AS SUCH, IT’S VITAL THAT PHARMACY STAFF IN ALL SECTORS – BUT PARTICULARLY IN COMMUNITY PHARMACY – RECOGNISE THE BENEFITS THAT THEIR INTERVENTIONS CAN HAVE ON THE NUTRITIONAL STATUS OF THEIR PATIENTS.
A
t any one point in time there may be more than three million people in the UK, who
are either malnourished or at risk of malnutrition: a situation which costs the UK in excess of £13bn a year.
Monitoring weight is a very quantifiable measure by which individuals (and their carers) can keep a proper record to check if they are at risk of malnutrition, so community pharmacists are in an ideal position to identify at-risk patients in both community and care homes. Requests, for example, for liquid medicines for patients with swallowing problems may highlight a reduced nutritional intake that warrants further investigation.
BUT HOW EXACTLY IS MALNUTRITION DEFINED? Malnutrition is actually a general term that refers to both under-nutrition and over-nutrition. Undernutrition is due to inadequate food intake, dietary imbalances, deficiencies of specific nutrients and over-nutrition due to excess food consumption. The National Institute for Health and Clinical Excellence (NICE) guideline 32 defines malnutrition as ‘a state in which a deficiency of energy, protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome. Under-nutrition can have a severe effect on a patient’s health and wellbeing and general quality of life.
EFFECTS OF MALNUTRITION 50 - PHARMACY IN FOCUS
Patients suffering from malnutrition may have a reduced ability to fight infection, develop apathy and depression, and have impaired wound healing ability, reduced muscle strength and fatigue. Wider health and wellbeing effects may include a reduced quality of life and a reduced ability to work, shop, cook and self care.
WHY ARE THE ELDERLY MOST AT RISK?
Elderly people, particularly those who are housebound or have limited mobility, often do not have a social support network in place to assist with tasks such as food shopping and cooking. This group also tends to include those who are ill with long- standing diseases.
The fact that the population is ageing – over the last 25 years the number of over 65s increased from fifteen per cent in 1984 to 16 per cent in 2009: an increase of 1.7 million. Since it’s estimated that, by 2034, 23 per cent of the population will be aged 65 and over, the number of people suffering from malnourished can only increase.
HOW MALNUTRITION BEGINS Unfortunately, it’s too simplistic to attribute malnutrition to one simple cause such as too little food or a diet that’s lacking in nutrients. In most cases, malnutrition is caused by a combination of physical, social and psychological issues such as:
• Health issues: older or elderly people very often have health
issues, such as dementia or congestive heart failure that can lead to decreased appetite or cause difficulty in eating. Other factors such as dental issues and difficulty in swallowing can also play a role.
• Restricted diets: such as limits on salt, fat, protein or sugar, can also contribute to inadequate eating practices.
• Budget concerns: older adults on limited budgets often choose to forego buying groceries, particularly if they have to pay for expensive medications.
• Reduced social contact: this not only causes people to lose interest in cooking, but to lose interest in eating..
HOW TO SPOT MALNUTRITION Unfortunately, the signs of malnutrition can be difficult to detect in the elderly, particularly in those who don’t seem ‘at risk’. Nevertheless, uncovering problems at an early stage can help to prevent complications later, so it’s a good idea to make yourself and your staff aware of the signs so that malnutrition can be detected.
• Watch for weight loss: this is not only visible to the eye, but can also be detected by the fact that a patient’s clothes seem to be more loose fitting than normal.
• Does the patient seem to have dry, cracked lips? Or is their mouth pale looking?
• Do they seem to have difficulty speaking due to a dry mouth?
• Are they complaining about having false teeth that no longer fit?
• Is their hair either thinning or growing sparser? (This is a standard sign of ageing, but watch for signs of excessive thinning.)
• Does the patient appear weak or disorientated?
• Does their skin appear to be ‘breaking down? Does it seem loose or does it look/feel drier than usual?
• Is the patient complaining about having wounds that are taking longer to heal?
• Does their skin feel dry and warm to the touch?
• Are they complaining about excessive thirst?
• Are they complaining of infrequent urination and dark yellow urine?
All of these can be signs that a patient may be malnourished. Very often it is the patient’s complaints that will alert you to the fact that something is wrong, but often the signs of inadequate nutrition will be visibly obvious.
THE NECESSARY STEPS TO TAKE The first step is to identify those who you may suspect of being at nutritional risk or potentially at risk, and who may benefit from appropriate nutritional intervention. There are many nutrition screening tools in use across the world. In the UK, however, the most commonly used screening tools in all care settings is the Malnutrition Universal Screening Tool (MUST), which was launched in 2003 by the British Association For Parenteral And Enteral Nutrition (BAPEN). This tool detects over-nutrition as well as under- nutrition and is linked to a flexible
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