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AIMS OF THE SESSION
• Quiz – Understanding?
• Malnutrition in the UK – Causes & Consequences
• Standards & Guidance
• How Are We Doing?
• What’s Needed?
TRUE OR FALSE?
• The costs of dealing with malnutrition in the UK are twice that of dealing with obesity
• Quality of the diet matters even more as we get older
• Signs of malnutrition take several months to show
• Our sense of smell can be reduced by up to 90% as we get older
• The threshold for detecting sweet taste is 3x higher in older adults than adolescents
• The entire skeleton is turned over every 7 years
• % of Care Home Residents at Risk of Malnutrition
– On admission
– Overall
SCALE AND COST OF MALNUTRITION IN THE UK
Three million people are living at risk of malnutrition in the UK, with the cost estimated to be £13 billion every year (BAPEN 2009)
Obesity Malnutrition0
2
4
6
8
10
12
14
4.2
13
Cost to NHS £billion
Communities with no or little contact
Communities in contact with services
Care Homes
Hospital
93%
5%
2%
3 m
illio
n m
alno
uris
hed
3 MILLION MALNOURISHED
WHY SO COMMON IN OLDER ADULTS?
Nutritional requirements stay high or
increase but appetite decreases
The entire body is turned over every seven
years – materials come from diet
Immune system & muscles start
to show deficiency after just a few days
SENSE OF TASTE & SMELL
• Impaired senses of taste and smell
• Sugar detection threshold 3x higher on older adults than adolescents
Chemical senses in elderly free living
women
10
50
73
0 50 100
Smell
Salt taste
Smell and taste function as %of that in young womencontrols
WHAT IS THE STANDARD? - CURRENT REGULATIONS
CQC Outcome 5“Meeting Nutritional
Needs”
National Care StandardsStandard 13 – “Eating
Well”Standard 14 – “Keeping
Well”
National Min Standards for Care Homes For
Older PeopleStandard 16
Regulation and Quality Improvement
AuthorityStandards 8 & 12
2001
Better Hospital Food
CQC Dignity & Nutrition inspections 2011/12
Council of Europe resolution (2003)
10 Key Characteristics of Good Nutritional Care (2007)
National Institute for Health and Clinical Excellence (2006)
Protected Mealtimes (2003)
High Impact Actions for Nurses (2010)
RCN Nutrition Now Campaign (2007)
Age UK Hungry to be Heard (2006)
CQC Essential Standards for quality and safety (2010)
WAG Nutrition and Catering Framework (2002)
NI Get your 10 a day (2007)
Scotland Food in Hospitals (2008)
Patient Environment Action Team Assessments (annually)
DH Nutrition Action Plan (2008)
Scotland – Promoting Nutrition in care homes for older people (2009)
Healthcare Improvement Scotland – Improving Nutrition (2012)
WHAT IS THE STANDARD - LOTS OF ACTIVITY.........................
NPSA10 Key Characteristics of Good Nutritional Care Toolkit (2009)
2012
HOW ARE WE DOING?
2011 2010 2008 20070%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Risk of Malnutrition
Source: BAPEN Screening Survey 2011
More than 1 in 3 Adults Admitted to Care Homes at
“Risk”
CARE HOME CHALLENGE
0-1 month 2-3 months 4-6 months Overall0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Risk of Malnutrition
INCREASED REGULATORY FOCUS - CARE HOMES
• Inspection 500 Homes 2012
• 1 in 6 NOT meeting Nutritional Needs
• 1 in 5 Nursing Homes failing
• Minimum Standards
• 4000 Homes – 140,000 residents
ONGOING FOCUS
• NACC “Meeting Outcome 5”
• Healthcare Improvement Scotland
• British Dietetic Assoc.
• Malnutrition Task Force
WHAT DOES GOOD NUTRITIONAL CARE LOOK LIKE?
Top tips• Have Nutrition and hydration Champions, one
carer and one from the catering team
• Ask your local speech and language specialist and dieticians to do training sessions
• Suppliers to provide free specialist training on food preparation and service for special needs
• Use Regulators Quality standards to evaluate your service before inspections
• Have regular feedback from Residents and implement what they say!
• Robert...................
WHAT’S NEEDED - GUIDANCE?
• Greater understanding of the importance of Nutrition
– Mandatory training
– Homes and Assessors
• Clear Nutritional Standards across all Regulators
• Clear Nutritional Standards across all Sectors
• Awareness that Care Home Catering is challenging