New initiative tackles malnutrition in facilities

Malnutrition remains a worrying problem in residential aged care, but a research project is trialling the use of a new model of care to tackle the issue, writes Liz Purcell.

Malnutrition remains a worrying problem in residential aged care, but a research project is trialling the use of a new model of care to tackle the issue, writes Liz Purcell.

Liz Purcell
Liz Purcell

Undetected malnutrition affects every system in the body and repeatedly results in increased vulnerability to illness, increased complications and in extreme cases, death.

We are all aware of the obesity epidemic but may not be as familiar with the even greater cost implications imposed by under nutrition and its associated devastating consequences.

Malnutrition frequently goes undetected because it is most prevalent in institutional settings and amongst the frailest and sickest members of our community. Unless extreme, malnutrition can be difficult to detect as it can occur across a spectrum of physical shapes and sizes – you have to look for it, particularly in a society where over nutrition is so prevalent.

Malnutrition is an incredibly expensive problem to have. We know that direct consequences of malnutrition such as pressure injuries and falls are estimated to cost the Australian economy $3 billion and up to $2 billion a year respectively.

A 2014 report by the Dietetic Association of Australian (DAA) confirmed that 40 to 70 per cent of residents in aged care facilities are malnourished. This, coupled with the estimated need for over 3.5 million residential care beds by 2050, clearly demands our urgent attention.

These figures are unacceptable and indicate that preventing malnutrition is an opportunity for the sector to see significant cost savings.

Whose responsibility?

Dietitians have unique skills in diagnosing and treating malnutrition and therefore we are the obvious professionals to lead efforts in this area. However, it remains in everyone’s best interest to manage it.

Although aged care facilities are regulated by the Aged Care Quality Agency, there are currently no national nutrition and/or menu planning standards for aged care.

The accreditation standards require that: “Care recipients receive adequate nourishment and hydration.”

Yet a Department of Health and Ageing evaluation report in 2007 suggested the standard is vague and subject to extensive interpretation – a finding that few nutrition experts would argue with.

The Australian Institute of Health and Welfare recognises malnutrition in its safety and quality indictors – but as recommended, not mandatory.

In 2011 the DAA commissioned a scoping project to identify the literature and documentation relating to nutrition and menu standards in Australia and New Zealand. Key stakeholders agreed that national guidelines were needed and key recommendations were made. In 2013-14 the DAA produced a pre-budget submission which again highlighted areas of concern, made proposals and discussed costs. Yet, despite this and so much more, there is still:

  • No routine basic screening within facilities
  • Minimal nutrition understanding across the board
  • Inconsistent access to dietitians
  • No menu planning guidelines.
  • Considerable costs being incurred as a direct consequence of malnutrition.

The bottom line is that nutrition remains a low priority.

What can be done?

Following retrospective auditing and data collection, OSCAR Hospitality’s dietetic team developed a Malnutrition Model of Care, which can be customised to meet the specific needs of individual facilities.

The model includes tools and activities designed to raise malnutrition awareness and promote earlier intervention within aged care facilities.

Malnutrition is clearly a complex condition, which requires a multifaceted approach.

Australian and UK policies indicate that identification through screening and weighing is critical in the management of the older person with malnutrition. Screening, coupled with optimal nutrition therapy, can achieve significant benefits. But this requires motivated, interested and innovative food service, clinical and care staff. Therefore, we must raise awareness and ignite passion within these teams.

Components of the model

There are several key elements to the model.

First, a working party is established. This group, which is led by a dietitian, will advocate for a holistic approach to improved nutrition and disseminate important nutritional messages from executives to ground staff.

Second, ‘nutrition champions’ are identified at each facility and trained to carry out routine screening to allow for earlier identification and intervention. The nutrition champions will report directly to the dietitian regarding any concerns or issues within the facility.

Third, regular interactive nutrition workshops are introduced to improve the awareness of malnutrition within aged care.

Fourth, innovative projects and strategies to tackle malnutrition are implemented.

Finally, a new nutrition component in the annual OSCAR Hospitality awards night will recognise nutrition achievements and innovation.

Expected benefits

When implemented successfully, this model of care should increase malnutrition awareness, influence change through high-level, strategic planning, and engage all levels across the continuum of care.

The model will also empower staff to implement local initiatives to promote improved nutrition, increase cost savings through a reduction in pressure ulcers, falls and hospital admissions, and improve consumer awareness and nutrition provision.

Further, client and staff satisfaction should also be improved through enhanced nutrition education, expanded roles and supported initiatives.

The initial stages of piloting the model in Victoria have shown positive outcomes from both the consumer and staff perspective.

OSCAR Hospitality dietitians intend to start locally, obtain credible data and engage the right people to leverage support and build sustainable momentum for malnutrition recognition and intervention.

We look forward to reporting on the outcomes of the model’s implementation in future issues of Australian Ageing Agenda.

Ultimately, malnutrition remains an enormous issue and requires a higher profile – we can achieve this with collaborative support.

Liz Purcell is an accredited practicing dietitian and lead dietitian with OSCAR Hospitality.

Tags: clinical, liz-purcell, malnutrition, nutrition, oscar-hospitality,

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