{"id":6529,"date":"2018-03-19T11:28:07","date_gmt":"2018-03-18T22:28:07","guid":{"rendered":"http:\/\/purefoodnz.wpengine.com\/?post_type=post&amp;p=799"},"modified":"2018-03-19T11:28:07","modified_gmt":"2018-03-18T22:28:07","slug":"malnutrition-the-skeleton-in-the-community-wardrobe-2","status":"publish","type":"post","link":"https:\/\/thepurefoodco.com\/blog\/malnutrition-the-skeleton-in-the-community-wardrobe-2\/","title":{"rendered":"The Skeleton in the community wardrobe"},"content":{"rendered":"\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"The Skeleton in the Community Wardrobe\" width=\"800\" height=\"450\" data-src=\"https:\/\/www.youtube.com\/embed\/8f4Cpz3JhMI?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" class=\"lazyload\" data-load-mode=\"1\"><\/iframe>\n<\/div><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>In the beginning<\/strong><\/h4>\n\n\n\n<p>In 1974 Charles Butterworth wrote \u201cThe Skeleton in the Hospital Closet\u201d, an article referring to the lack of awareness amongst clinicians about the incidence of malnutrition in UK hospitals (1).<\/p>\n\n\n\n<p>It\u2019s astounding to realise that over 40 years later there have been no sustainable solutions to recognising nutrition risk in older people and treating it at an early stage (2).<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Paying the price<\/strong><\/h4>\n\n\n\n<p>A 2011 UK study documented the significant cost of malnutrition. Over a 6 month period, the healthcare cost of managing malnourished patients was NZD $3343, more than double the amount of managing non-malnourished patients (NZD $1430) (10) . It\u2019s clear that if you\u2019re malnourished you have a higher risk of developing pressure injuries or falling; costly outcomes for both health services and, more importantly, to the older persons\u2019 health-related quality of life.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>The root of the problem<\/strong><\/h4>\n\n\n\n<p>Where Dr Butterworth saw malnutrition as a skeleton in the hospitals\u2019 closet my thoughts are that, in 2018, the skeleton isn\u2019t in the hospital\u2019s closet but in the communities\u2019 wardrobe. &nbsp;<\/p>\n\n\n\n<p>There\u2019s research confirming better health outcomes for older people who have a higher BMI than recommended for younger adults (3). Our idea of what a healthy weight is needs to change as we age. We live in a society where \u201cslim\u201d and \u201cthin\u201d are sought after goals for younger adults. However, putting these expectations on older adults has serious health and financial consequences for seniors and those caring for them.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>In our own backyard<\/strong><\/h4>\n\n\n\n<p>In New Zealand we now have research which confirms what community and residential care dietitians have been observing for years; that is malnutrition and the risk of malnutrition in our senior population starts in the community.<\/p>\n\n\n\n<p>Assessments completed with people who had recently been admitted to hospitals or residential care in Auckland, show a high incidence to people (43%) who were malnourished and an even higher number of older people (47%) at risk of malnutrition (4, 5, 6).<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>A quick and easy solution<\/strong><\/h4>\n\n\n\n<p>After 40 years of neglect, the good news is we can do something about this under recognised problem hiding in \u201cCommunity Wardrobes.\u201d<\/p>\n\n\n\n<p>The low cost solution to preventing malnutrition is using simple, validated nutrition and dysphagia risk screening tools.<\/p>\n\n\n\n<p>Depending on where you\u2019re working or who you\u2019re working with, here are some great screening tools to look at:<\/p>\n\n\n\n<ul>\n<li><a href=\"http:\/\/www.mna-elderly.com\/forms\/mini\/mna_mini_english.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><em>Mini Nutritional Assessment &#8211; Short Form<\/em>&nbsp;(MNA\u00ae-SF)<\/a><em>:<\/em>&nbsp;a screening tool designed for residential care facilities which only take 5 minutes to complete (7).<\/li>\n\n\n\n<li><a href=\"http:\/\/www.nutritionscreen.ca\/escreen\/\" target=\"_blank\" rel=\"noreferrer noopener\"><em>Screen 2:<\/em><\/a>&nbsp;self-administered screening tool designed for older people to self administer in GP Surgeries, or when visiting other health professionals (8).<\/li>\n\n\n\n<li><a href=\"https:\/\/www.nestlehealthscience.com\/health-management\/gastro-intestinal\/dysphagia\/eat-10\" target=\"_blank\" rel=\"noreferrer noopener\"><em>Eat 10:<\/em><\/a><a href=\"https:\/\/www.nestlehealthscience.com\/health-management\/gastro-intestinal\/dysphagia\/eat-10\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;dysphagia screening tool<\/a>&nbsp;used to identify people with swallowing risk (9).<\/li>\n<\/ul>\n\n\n\n<p>All these tools are available online, free of charge and can be used with minimal training by all members of the interdisciplinary community or residential care team.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>One size doesn\u2019t fit all<\/strong><\/h4>\n\n\n\n<p>Don\u2019t fall into the trap of believing the InterRAI assessment replaces nutrition screening in residential care. &nbsp;You still need to complete nutrition screening because while the InterRAI assessment asks some nutrition related questions, it is<strong>&nbsp;not<\/strong>&nbsp;a validated nutrition screening tool and is only completed six monthly or when a resident\u2019s condition changes significantly.<\/p>\n\n\n\n<p>\u201cAt risk\u201d scores from the screening tools described above can be managed through first level intervention and higher risk scores referred for comprehensive assessments with dietitians or speech language therapists. The next blog in this series will cover nutrition interventions and care strategies for people \u201cat risk\u201d of malnutrition or identified as malnourished.&nbsp;&nbsp;<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>A challenge to New Zealand<\/strong><\/h4>\n\n\n\n<p>I\u2019m aware of the amount of national funding and energy New Zealand &nbsp;puts into reducing the risk of falls in older people, yet there is no national initiative set up to identify seniors at &nbsp;risk of malnutrition or swallowing. Both issues significantly affecting the strength and balance, quality of life and health related outcomes for older people.<\/p>\n\n\n\n<p>Targets are set for health outcomes including smoking cessation and falls prevention, why it is that nutrition risk is given such a low priority for the older person?<\/p>\n\n\n\n<p>What would happen if there were incentives and health targets put in place around screening for the nutritional status of older people \u2013 would that be the solution to addressing the current \u201cSkeleton in the Wardrobe\u201d seen across the senior community in New Zealand?<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">By Kaye Dennison (NZRD)<\/h4>\n","protected":false},"excerpt":{"rendered":"<p>In the beginning In 1974 Charles Butterworth wrote \u201cThe Skeleton in the Hospital Closet\u201d, an article referring to the lack of awareness amongst clinicians about the incidence of malnutrition in UK hospitals (1). It\u2019s astounding to realise that over 40 years later there have been no sustainable solutions to recognising nutrition risk in older people [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":6076,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","wds_primary_category":1,"footnotes":""},"categories":[1,433],"tags":[259,261,263],"acf":[],"_links":{"self":[{"href":"https:\/\/thepurefoodco.com\/wp-json\/wp\/v2\/posts\/6529"}],"collection":[{"href":"https:\/\/thepurefoodco.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/thepurefoodco.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/thepurefoodco.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/thepurefoodco.com\/wp-json\/wp\/v2\/comments?post=6529"}],"version-history":[{"count":0,"href":"https:\/\/thepurefoodco.com\/wp-json\/wp\/v2\/posts\/6529\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/thepurefoodco.com\/wp-json\/wp\/v2\/media\/6076"}],"wp:attachment":[{"href":"https:\/\/thepurefoodco.com\/wp-json\/wp\/v2\/media?parent=6529"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/thepurefoodco.com\/wp-json\/wp\/v2\/categories?post=6529"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/thepurefoodco.com\/wp-json\/wp\/v2\/tags?post=6529"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}