Identifying malnutrition and boosting nutritional intake in aged care

Undetected malnutrition affects every system in the body. It is directly associated with increasing complex clinical needs, increased vulnerability to illness with associated functional decline, increased dependency and subsequent increased health care costs. Even when underlying illness and age are taken into account, it predicts a greater than threefold risk of death within 12 to 18 months in older Australians.

The major cause of malnutrition in developed countries is disease, but the condition is strongly compounded by factors such as:

• lack of awareness,



• lack of recognition of its debilitating consequences,



• lack of nutritional screening within aged care facilities,



• minimal regard for nutrition as a vital component of care,



• failure to refer onto a Dietitian



• failure to utilise appropriate nutrition support.

Malnutrition is not weight discriminatory and can occur across a spectrum of shapes and sizes. Unintentional weight loss at any size justifies further investigation and intervention.

Nutrition & unintentional weight loss in aged care results in:

Costs Malnutrition undoubtedly places a considerable burden on our economy. Based on recent health economic figures, the cost of identifying and managing malnutrition is estimated to be £13 billion per annum in the UK and €9 billion in Germany alone.

Although similar Australian data is not available, we know that direct consequences of malnutrition such as pressure injuries are estimated to cost the Australian economy $3 billion per annum (~$10,000 per patient per year). A similar picture presents for falls, their estimated cost ranging from $1- $2 billion per year, with a particular prevalence in aged care facilities as up to half of all residents fall at least once a year. Cangelosi MJ reported in her 2014 study that the requirements for residential care placement contributed the most to overall long term costs in Australia.

This, coupled with the fact that several key reports identify the over 65’s as being the most ‘at risk’ of malnutrition and with 8.5 million Australians or ~21% of our population estimated to fill this age bracket by 2053, this is something which demands immediate attention.

How can we create sustainable change? Dietitians specialise in nutrition/disease relationships and are trained to diagnose and treat malnutrition which can be prevented or successfully treated when detected early. Despite this, we too are forced to work within the realms of limited resources. With facility visits routinely limited to ‘ad hoc’ and so many other demands placed on ever decreasing budgets, nutrition is a resource which is frequently shelved for “another day”.

Never has it been so crucial to work smartly and innovatively.

In order to boost our profile and bring nutrition to the table, we need to collaborate with all professions across the continuum of care and engage with all levels from the ground up. Guiding and motivating ground floor staff to actively participate in nutrition care, while also building credible cases for executive support.

Investing time in cultivating relationships and reputations, imparting knowledge and educating on the added value dietetics can offer, is time well spent. Dietitians need a visible presence at staff handovers, medical and resident/relative meetings, as well as active participation in quality improvement facility activities, audits etc.

Enlisting the support of medical staff, GP’s and Practice nurses through nutrition training is vital. We need to raise awareness about malnutrition and put it on everyone’s agenda.

Creating, Cultivating, Collaborating

Interested and dedicated food service staff are integral to the successful implementation and provision of nutritionally adequate meals.

Building a culture that promotes optimum nutritional intake can be achieved through;

• Collaborating with chefs and cooks on menu design and reviews and the provision of fortified and special diets needs to be standard practice.



• Listening to their needs and providing appropriate training and resources on various aspects of nutrition to instil motivation and confidence at every level.



• Identifying care staff with a particular interest in nutrition and enriching this through one to one training of basic and essential nutrition skills i.e., nutrition screening, meal environment assessments and assistance with meals.



• Liaising directly with these front line staff, imparting knowledge passionately and rewarding effort to improve job satisfaction and staff morale. This is fundamental to sustainable advances in institutional settings.

The dietitian plays a pivotal role in building momentum and ultimately achieving a greater nutrition profile within aged care but we need your support to achieve optimal, collaborative person-centred improvements.

Liz Purcell Liz Purcell, Accredited Practising Dietitian, has a particular interest and advanced clinical knowledge in gastroenterology, intensive care and aged care. Liz has held positions with the NHS, UK, Director of Dietetics at Bundaberg Hospital QLD and is currently Lead Dietitian with OSCAR Hospitality. Liz is presenting at the Institute of Hospitality in HealthCare Conference (IHHC) in Tasmania, 17-19 October.