What is malnutrition?
The Dietitian’s Association of Australia calls malnutrition a “silent epidemic”, and it is estimated that 1 in 3 people admitted to hospital are either malnourished or at risk of being malnourished. In aged care facilities, the prevalence is estimated to range anywhere between 32-72 percent.
The most common symptom of malnutrition is weight loss, with a high percentage constituting loss of lean muscle tissue; other symptoms include fatigue, lack of energy, lack of strength, breathlessness, anemia, and changes in health of skin, hair and nails.
Malnourishment in adults reduces the rate of recovery from illness or surgery, and “previous research has proven that malnutrition can also cause complications such as infections and falls, which encourages higher readmission rates”3. Not only is this a burden on the individual’s quality of life, but it also has a significant impact on the associated costs of treatment and care.
The elderly at risk
There are an estimated 10–44 percent of older Australians being at risk of malnutrition. The main contributing factors of malnutrition include:
- Poor dentition
- Side effect of medication
- Chronic illness
- Depression and/or loneliness
- Progressive loss of taste and smell
- Decline in mobility or
- Early satiety
While energy needs decrease as a person ages, many other nutrient requirements remain the same. The exception is for protein, where older adults require approximately 25 percent more protein than younger adults3.
Older adults diagnosed as being malnourished will require nutritional intervention. Recommended strategies for nutritional intervention are:
- Frequent, small meals which are nutrient dense
- Nourishing snacks which are high in protein (e.g. yogurt, cheese and tuna)
- Fortifying regular foods (e.g. adding milk powder to mashed potato or cream to a sauce)
- Incorporating a nutritional supplement
- Ensure the individual has sufficient fluid intake
- Determine if texture modification is required and is at a suitable level
Regular screening of individuals is the primary practice to determine if an individual is at risk of malnutrition. The simplest method of identifying malnutrition is to track weight and weight loss. However, the per kilogram weight loss is only useful in relation to the weight of the individual. For example, a 5kg weight loss in a person weighing 50kg is more significant than that of a 150kg person.
Healthcare professionals will often implement the Malnutrition Universal Screening Tool (MUST). The 5 steps of MUST are:
- Measure height and weight to get a BMI score.
- Note percentage unplanned weight loss and score using MUST tables.
- Establish acute disease effect and score.
- Add scores from steps 1, 2 and 3 together to obtain overall risk of malnutrition.
- Use management guidelines and/or local policy to develop care plan.
A systematic review published by the National Center for Biotechnology Information(NCBI) recommends that “all hospital inpatients on admission and all outpatients at their first clinic appointment should be screened” and “people in care homes should be screened on admission and when there is clinical concern”.