Call to train care home staff to screen elderly for malnutrition

As well as an expansion in screening, especially outside hospitals, the MPs called for social care providers to be required to give older people at least one hot meal a day and the help to prepare it.

“Robust and reliable screening tools must be scaled up across the country”

APPG report

The All-Party Parliamentary Group on Hunger warned that at least around 1.3 million older people were malnourished, based on the most recent figures it could find – from 2011.

Malnutrition among older people was “often intertwined with loneliness and social isolation”, noted the group in its report published today and titled Hidden hunger and malnutrition in the elderly.

The group, chaired by Labour MP for Birkenhead Frank Field, received written evidence from 22 organisations and individuals, and held an oral evidence session in Westminster during November.

It noted that there was already a nationally validated screening tool – the Malnutrition Universal Screening Tool (MUST) – developed by the British Association for Parenteral and Enteral Nutrition.

However, the MPs said they heard that, while MUST was well used in hospitals, it was not adequately rolled out in community settings at present.

“That’s where it needs to sit, out in the community. It needs to become business as usual for many more agencies”

Sarah Wren

Screening with the tool was not always undertaken with the “rigour it should be” in care homes and domiciliary care “really should be using it”, according to evidence heard by the group.

According to the report, Sarah Wren, of the Hertfordshire Independent Living Service, said: “That’s where it needs to sit, out in the community. It needs to become business as usual for many more agencies.”

The report also stated that hospitals rarely recorded malnutrition as a primary reason for admission, with primary causes such as disease, illness, injury, or infection often being diagnosed.

“We believe that in an attempt to limit the risk of injury or ill health associated with malnutrition, robust and reliable screening tools must be scaled up across the country so that malnutrition can be identified, diagnosed, and treated much more quickly and effectively in the community,” it said.

The report called on the government to ensure that “at all levels of care” staff were trained to use MUST, or “an equivalent mechanism”, to “identify older people at risk of malnutrition and ensure they receive appropriate food and support to improve their condition”.

In addition, it called on Public Health England and similar bodies in Wales, Scotland, and Northern Ireland to regularly record and publish new data on the extent of malnutrition among older people.

Meanwhile, the group recommended in its report that social care providers should be required, backed by adequate funding, to give those at risk a hot meal and the necessary help to cook it.

“We recommend that social care providers, including third sector organisations, should be given a duty, and the appropriate funding to carry out this duty, of ensuring all older people at risk of malnutrition, and particularly those in receipt of formal social care, receive at least one hot meal every day with nutritional supplements provided if necessary,” stated the report.

“We recommend also that through either a more flexible social care package, or the provision of additional support from third sector organisations, this duty should extend to ensuring older people receive the necessary help to prepare that meal and undertake any other brief activities that could, in the longer run, keep malnutrition at bay,” it added.

In addition, the group said other “new approaches” were required to both protect older people from malnutrition and also operate as a means of helping them interact and socialise with other people.

For example, it cited an enhanced home-visiting service through which adequate meals and support were delivered by community projects to older people who might struggle to leave their own home.

A second approach was for supermarkets to help maintain older peoples’ independent shopping habits, such as by introducing “slow” or “relaxed” checkout lanes, and providing weekly lunch clubs.

“We welcome the call for greater uptake of MUST in both acute and community settings”

Simon Gabe

Commenting on the report, BAPEN president Dr Simon Gabe, said: “We welcome the call for greater uptake of MUST by health and social care professionals in both acute and community settings.

He highlighted that data from surveys carried out by BAPEN had shown that almost 30% patients admitted to hospitals in the UK were at risk of malnutrition.

“Many of those at risk, whether they have disease-related malnutrition or are malnourished because of social or environmental factors, could have been identified and treated in the community,” he said.

Dr Gabe also noted that BAPEN was calling on the Care Quality Commission to introduce questions on nutrition and hydration in its inspections of domiciliary care providers and GP practices.

“There is a clear need to identify more people who are malnourished early, so that action can be taken sooner to support their recovery and to minimise harm,” he said.

“To achieve this, nutrition needs to be built into conversations at every level of the health and social care system, so people who need help can be identified and supported appropriately,” he added.

“Imposing a further duty on social care providers is the wrong approach”

Margaret Willcox

But Margaret Willcox, president of the Association of Directors of Adult Social Services, warned against introducing new wholesale duties for social care providers.

Ms Willcox highlighted that social care staff already “do what they do because they are keen to do anything within their power to help”.

“It is our view that social care solutions should be personalised, and focus on the individual needs of the person in question,” she said. “Imposing a further duty on social care providers is the wrong approach.

“The way forward is to deliver more personalised care… not more rules. Placing more duties on already-pressured social care staff to tackle one issue, rather than providing the funding needed to address the underlying care crisis, will hinder rather than help,” she said.

She added: “If new duties are imposed, then as a bare minimum, social care providers must be given adequate funding to ensure they are effective carried out, otherwise sorting out one human tragedy will create another, as resources are pushed from pillar to post.”