Results show significant improvements in Scotland in awareness of malnutrition and screening practices.
Today BAPEN publishes five Nutrition Screening Week (NSW) Reports which cover the UK as a whole and its four nations; England, Northern Ireland, Scotland and Wales. The Reports contain the amalgamated data of its four Nutrition Screening Weeks which took place over a five year period between 2007 and 2011, each in a different season of the year. The Nutrition Screening Weeks surveys in Scotland involved a total of 133 hospital centres and 3,934 patients). Across the UK as a whole surveys involved a total of 661 hospital centres and 34,699 patients admitted to hospitals making this the biggest survey into the prevalence of ‘malnutrition’* ever conducted
The Scottish report shows that there have been significant changes and improvements in awareness of ‘malnutrition’, as well as in nutritional screening practice and in the organisation of nutrition support services. Significantly the improvements in awareness and performance indicators related to the management of malnutrition coincided with the implementation of and inspections concerning NHS QIS Standards on Food, Fluid and Nutritional Care. In addition unlike the UK as a whole, and the other nations of the UK there was improvement in the proportion of hospitals with access to a Nutrition Support Team, which are important for the management of complex nutritional conditions and which were available in over 7/10 participating centres in 2011.
By 2011 almost all participating centres screened at least 76% of patients on admission, audited screening practice each year and weighed and measured patients on admission. Importantly improvements were also made on discharge communications with almost 98% of the centres including nutritional information. Access to a nutritional support team recommended for the management of more complex nutritional cases had also risen from approx. 50 – 70%.
“At the start of the surveys many hospitals in Scotland had already made improvements to the organisation of nutritional care following the publication of the NHS QIS standards in 2003** so not all items were found to improve significantly during the survey period. However, there was a consistent trend towards improvements over time particularly. Unlike the rest of the UK there was a marked increase in the number of hospitals that had access to a nutritional support team. There is room for further improvement but the Scottish NSW data are very encouraging.” Marinos Elia, BAPEN Lead, Nutrition Screening Week.
The overall mean prevalence of ‘malnutrition’ in patients admitted to hospitals in the UK was 29% but there was variation between the nations, with the highest in England (30%) and lowest in Scotland (24%). Most were at high risk. Explanations for the national differences are complex and need to take into account the different healthcare systems that operate in the devolved nations such as; the distribution of care between hospitals and the community; the number of beds per capita of population, which is greater for Scotland than England; the differences in screening policies, screening practice, audits, standards and inspections. In addition, national differences in age, gender, BMI distribution and types of diseases also affect the individual populations.
The prevalence of malnutrition on admission to hospitals in Scotland varied significantly between seasons being higher in the summer (29% and winter (27%) than in the autumn (23%) and spring (21%) The higher prevalence in winter can be related to a number of factors: greater social isolation in the cold weather which may result in reluctance of people to go out shopping or visit their GP to have their health problems attended to; more severe accidents on icy surfaces; more severe hypothermia, and more prolonged and severe chest infections. The well-known effects of malnutrition causing weakness, lethargy, impaired temperature regulation and immunosuppression could predispose to such problems during cold weather.
Age related Data
There were marked differences between certain characteristics of adults admitted to hospital and the general population of Scotland. The mean age of those admitted to hospital was 65.7 years, some 17 years higher than that of the general adult population of Scotland. While the mean BMI was slightly lower than the general population more people were admitted to hospital who were underweight (<20 kg/m2) or severely obese (>40 kg/m2) than were found in the general population.
Overall the prevalence of ‘malnutrition’ was about 32% higher in those aged 65 years than those less than 65 years of age.
Source of Admission
In all the surveys, during all seasons, the majority of patients were admitted from their own homes and at least 1 in 5 were at risk of ‘malnutrition’ on admission, Those at highest risk were patients admitted from care homes but these accounted for the smallest proportion of admissions.
The NSW surveys in all the nations have re-emphasised the widespread nature of ‘malnutrition’. They have also confirmed that the prevalence of ‘malnutrition’ varies according to many factors including: the source of admission; the type of ward (being higher in care for the elderly and oncology wards than orthopaedic wards); disease category (being higher in gastrointestinal and respiratory diseases than musculoskeletal and cardiovascular diseases), and presence of cancer (being higher in those with cancer than those without).
In Scotland as with the UK as a whole the prevalence of malnutrition in women was higher than in men by a mean of 6%. The difference was more marked in those aged 65 years or older
“Since the NSW surveys involved nutritional screening on admission to hospital, mainly of patients from their own homes, the data reflect problems that arose in the community which could be identified prior to admission. Policies aiming to prevent the problems from developing or to initiate treatment at an early stage need to focus on the community and to integrate services between care settings. Hospitals have a role to play in identifying ‘malnutrition’ and communicating the results to the community so that treatment initiated for inpatients or outpatients can be continued in the community.” Christine Russell, BAPEN Lead, Nutrition Screening Week.
*. ‘Malnutrition’ – refers to those at medium + high risk according to ‘MUST’ (http://www.bapen.org.uk/screening-for-malnutrition/must/introducing-must)
** NHS Quality Improvement Scotland (2003) Food, Fluid and Nutritional Care in Hospitals. Edinburgh
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Notes for Editors
The Nutrition Screening Week surveys involved a total of 661 hospital centres and 34,699 patients across the UK. The majority of data were provided from England (406 hospital centres and 26,065 patients) and to a progressively smaller extent from Scotland (133 hospital centres and 3,934 patients), Wales (83 hospital centres and 2,939 patients) and Northern Ireland (39 hospital centres and 1,650 patients). It is the biggest survey into the prevalence of malnutrition ever conducted. Whilst the individual results have been announced annually, these new Reports highlight seasonal and country specific trends and chart the changes made to organisational infrastructure for providing nutritional care and malnutrition screening in various care settings.
The current 5 reports are based on the amalgamated data from the four surveys. A copy of these Reports can be downloaded at:
Malnutrition, in terms of undernourishment, is both a cause and consequence of disease in adults and children. It is common and affects over 3 million people in the UK with associated health costs exceeding £13 billion annually.1 It is often unrecognised and untreated, yet it has a substantial impact on health and disease in all community care settings and hospitals.1,2
The benefits of improving nutritional care and providing adequate and appropriate hydration are immense, especially for those with long term conditions and problems such as stroke, pressure ulcers or falls. The evidence shows clearly that if nutritional needs are ignored health outcomes are worse and meta-analyses of trials suggest that provision of nutritional supplements to malnourished patients reduces complications such as infections and wound breakdown by 70% and mortality by 40%.2
- Elia M, Russell CA (eds). Combating malnutrition; Recommendations for Action. A report from the Advisory Group on Malnutrition, led by BAPEN. Redditch: BAPEN, 2009.
- Stratton RJ, Green C and Elia M. Disease related malnutrition; an evidence-based approach to treatment. Oxford:CABI, 2003.