Malnutrition among Older People in the Community

Malnutrition among Older People in the Community. Policy Recommendations. This report was produced jointly by BAPEN, the European Nutrition for Health Alliance and the International Longevity Centre, UK in association with the Associate Parliamentary Food and Health Forum.

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Executive Summary: Recommendations for Policymakers

Malnutrition must be incorporated into the public health agenda

  • Malnutrition is a significant, and neglected, public health problem. It affects over 10% of people over the age of 65.
  • Malnutrition costs more than £7.3 billion per year, and over half of these costs are expended on people over the age of 65.
  • The causes of malnutrition are both social and clinical: they include underlying disease, decreased mobility, limited transport to local shops, social isolation and poverty.
  • Malnutrition is an important marker for inequalities in health, social care and housing, between regions and within localities.

Addressing malnutrition in older people in the community requires an inter-sectoral approach

  • Malnutrition among older people in the community is too complex a problem to be addressed by the NHS alone, or even government alone.
  • The government must lead in tackling malnutrition by appointing a government tsar on nutrition, preferably within the Department for Local Government and Communities.
  • Tackling malnutrition must involve an effective delivery chain that cuts across the domains of multiple national and local public agencies, the private, and the non-profit sector.

Raise awareness of malnutrition amongst older people, their families and the public at large

  • The Department of Health must lead an awareness campaign to dispel the myth that becoming thinner is a natural part of the ageing process.
  • Older people, their carers and families must be informed about the markers for malnutrition, its causes, effects and consequences within the context of good nutrition in later life.
  • Public agencies must utilise all available contact points (sheltered housing, healthy living centres, supermarkets and local shops), to empower older people and their close contacts to seek out better nutrition and prevent the root causes of malnutrition.
  • Communication efforts should involve older people in the design and dissemination of information on good nutrition to ensure that the appropriate formats and channels are used.

Ensure that access to nutritional food is incorporated into local and community planning

  • The Department for Communities and Local Government must set up a dedicated programme that ensures that local authority planners build upon initiatives such as community food mapping, and incorporate access to nutritional food into community planning.
  • Local communities should work together to encourage the strengthening of the social context in which people are most likely to take an interest in good nutrition.
  • Best practice examples of initiatives that raise awareness of nutrition should be disseminated to encourage improved access to good nutrition by older people themselves, their family and carers.

Develop adapted and accredited training in nutrition for all health, social care professionals and associated personnel

  • Raise awareness among all those working with older people in the community of the signs, symptoms and consequences of malnutrition and its prevention.
  • Map the gaps and needs for training of different professional groups in nutrition.
  • Establish professional accreditation and qualification standards in nutrition and relate these to the education, training and skills development frameworks that are emerging nationally for different health and social care personnel (e.g. National Qualifications Framework, UK Credit Frameworks, Skills Escalators).
  • Appoint a specific co-ordinating role within government to lead on nutrition in liaising with Royal Colleges & Universities that provide accreditation and qualification.
  • Differentiate levels of training to be adapted to different levels of staff (health and social care assistants, qualified professionals, specialists vs. generalists etc).
  • Include in training all those involved in the provision of services to older people, including informal carers.
  • Require every organisation regularly involved in providing health, care, support and housing services to older people in the community to have a Champion at national level and Advocates at local level to complete this training and lead its cascade through their organisation.

Embed the practice of screening for malnutrition in the community by health, social care and community service providers and professionals

  • The Department of Health must oversee and fund research to determine the appropriateness of different malnutrition screening tools in the community by different professional/care providers, in particular the Malnutrition Universal Screening Tool (‘MUST’).
  • Develop appropriate training support for all individuals who may be required to screen for malnutrition in their older clients.
  • Adapt this training to make it available to individuals providing informal care.
  • Ensure appropriateness of use at every stage and continued support for those receiving training.

Define standards and pathways of care for preventing and treating malnutrition in the community

  • Develop, publish and make widely known the agreed ‘pathway’ for the prevention and treatment of malnutrition through the development of a National Service Framework.
  • Devolve resources to communities to ensure that older people, once identified as malnourished or at risk of malnutrition, are helped to access information, support and appropriate treatment for malnutrition.
  • Ensure that all proposed pathways for care are person-centred and engage older people and their families in the course of care.
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