Malnutrition too often goes unnoticed. When nutrition hits the headlines, it is typically regarding obesity or the ‘desirability’ of losing weight. However, there is a fundamental importance to understanding that malnutrition, caused by disease and illness, is a widespread problem in the UK.
When malnutrition is not identified and treated, patients may face the consequences, which depend on their condition, but can include loss of muscle mass and function (poorer mobility, impaired respiratory function), poorer quality of life, poorer response to treatment and recovery from surgery and a higher mortality. Importantly, once identified this condition is largely treatable, with a nutrient-dense diet (energy- and protein-rich foods, snacks, desserts and drinks), including a breadth of vitamins and minerals, together with the use of nutritional supplements and tube feeding/parenteral nutrition as appropriate. Dietitians and nutrition nurses can advise and support.
Although anyone can be at risk of malnutrition, particular groups and demographics are at greater risk. These include people with long-term conditions, such as diabetes, kidney disease, and chronic lung disease, and people with chronic progressive conditions, such as dementia or cancer. Furthermore, people who are frequently in hospitals are at greater risk of malnutrition, with 70% of patients weighing less on hospital discharge (Elia, 2003).
The BAPEN Malnutrition and Nutritional Care Screening Survey Report provides both a local and national picture of malnutrition prevalence and, since the survey has been carried out for four consecutive years, helps us to understand long-term trends. It was encouraging to have participation from all four nations in the UK in the 2022 survey and the hope is that, with greater participation each year, we will be able to build a more comprehensive picture of malnutrition by country, setting, diagnostic group, and other demographic factors.
Results from the 2022 Screening Survey (Stratton et al, 2022) revealed that nearly half (45%) of all adults screened across health and care settings in the UK were found to be at risk of disease-related malnutrition. This is the highest figure since this survey began. The prevalence of malnutrition was highest in individuals with cancer (62% at risk), gastrointestinal conditions (50% at risk), respiratory conditions (48% at risk), frailty (45% at risk) and neurological diseases (43% at risk).
It was also found that, when assessing malnutrition prevalence by setting, the highest prevalence was in those in the community, either in their own homes (56% at risk) or resident in care homes (55% at risk). In hospitals, 44% of patients were at risk of malnutrition.
BAPEN knows all too well that the current malnutrition landscape is far from desirable, and we must communicate this to bring about meaningful, widespread changes that sees malnutrition screening and treatment more commonplace. Moving the needle and creating long-lasting change takes time but it is through holding holistic conversations with those in our care and each nurse and other health professionals taking responsibility for malnutrition and nutritional care that will drive positive change, ultimately improving outcomes for individuals and reducing the burden on society.
Nurses can and do play a vital role in identifying and managing malnutrition in their patients, clients or service users. Nurses are encouraged to familiarise themselves with the Malnutrition Universal Screening Tool (MUST), a reliable and easy to use screening tool that helps to identify malnutrition risk. Recognising the problem is the most important first step. Once individuals and those involved in their care are aware of the problem of malnutrition, the cause can be identified and managed if appropriate. Subsequently, the right nutritional care can be put in place to reverse the downward cycle. This support will depend on the individual, their condition and their setting (at home, in hospital etc), and can include practical support with eating and drinking, shopping, cooking, encouraging nourishing snacks and beverages, referral to a dietitian and the prescription of medical nutrition (eg, oral nutritional supplements, tube feeding). You can find out more information about MUST online (https://www.bapen.org.uk/screening-and-must/must/introducing-must).
The screening survey uses the MUST tool and is a brilliant example of how we can continue to work to better understand the malnutrition landscape so that we can improve care for our patients. With this in mind, the 2023 BAPEN Malnutrition and Nutritional Care survey is currently open and is live until 30 November. It is through contributions to the national screening surveys that we can develop a national impetus to gather the necessary information to address malnutrition on an everyday and systemic level. Find out more about the screening survey here (https://bit.ly/ScreeningSurvey2023).
In the meantime, if you are looking to initiate conversations with older people about malnutrition, every year, BAPEN works alongside the Malnutrition Task Force to deliver UK Malnutrition Awareness Week. As part of the campaign, we share ‘Ask, Look, Listen’ prompts that can be used as a guide to help you address the challenges regarding whether people are getting enough food and drink. These prompts, and other important information, can be found on the BAPEN website (https://tinyurl.com/4a78y5rn).