Malnutrition - The Public Health Issue Overshadowed by Obesity - Joanne Casey
-
Upload
institute-of-public-health-in-ireland -
Category
Health & Medicine
-
view
305 -
download
0
description
Transcript of Malnutrition - The Public Health Issue Overshadowed by Obesity - Joanne Casey
Malnutrition: The Public Health Issue overshadowed by Obesity
A multidisciplinary initiative to close the
gap on malnutrition
Malnutrition is a condition that occurs when a person’s diet does not contain the right amount of nourishment.
It means ‘poor nutrition’ and can refer to:• under nutrition – when you don’t get enough nutrients• over nutrition – when you get more nutrients than you need
Promoting Good Nutrition Strategy 2011 DHSSPSNI
The prevalence of malnutrition of patient admitted to hospital in NI is 29%
Malnutrition:A global Public Health Issue
Causes of Malnutrition Cause Example
Increased nutritional requirements • Infection• Involuntary movement• Trauma• Major surgery
Reduced nutritional intake • Dysphagia• Pain
Increased nutritional losses • Malabsorption• Diarrhoea• Wound exudate
Those at greater risk of malnutrition include people:• Over the age of 65 years• With long-term conditions e.g. kidney disease, chronic lung disease• With chronic progressive conditions e.g. dementia, cancer • Who abuse drugs or alcohol• Who use multiple prescriptions and over-the-counter medications (Polypharmacy)
Causes of malnutrition:Additional risk factors
Risk factor Example
Poverty • Inability to access good food• Inability to afford good food
Psychosocial factors • Isolation / Loneliness• Confusion• Depression
• Anxiety• Dementia • Bereavement
Mobility • Poor mobility • Disability
• Poor transport links• Difficulty accessing local
shops
Functional constraints • Inability to prepare food• Poor dental / oral health• Sensory disability
• Difficulty using food containers
• Difficulty reading food labels
Clinical effects of Malnutrition
Immunity – Increased risk of infection
HypothermiaImpaired gutintegrity andimmunity
Renal function - loss of ability to excrete Na & H2O
Decreased Cardiac output
Ventilation - loss ofmuscle & hypoxic responses
Psychology –depression & apathy
Anorexia
Loss of strength
liver fatty change, functional declinenecrosis, fibrosis
Impaired wound healing
Adapted from Nutrition Now Workshop
Consequences of Malnutrition
• Increased risk of – Pressure sores– Respiratory infections– Falls– Complications following surgery– Poor quality of life
• Tripled risk of mortality in older patients in hospital• More than quadrupled risk of mortality 6 months after discharge
Treatment
Financial implication
• £13 billion in the UK in 2007• More than DOUBLE the amount spent on obesity and overweight
• Clinical costs include– 65% more GP visits – 82% more hospital admissions– 30% longer hospital stay
• Better nutritional care 3rd largest potential cost-saving to NHS
Obesity Malnutrition0
2
4
6
8
10
12
14
NHS expendature on Obesity and Malnutrition 2007
£ bi
llion
Oral Nutrition
2009
2010
2011
2009
2010
2011
2009
/10
2010
/11
2011
/12
2009
2010
2011
England Wales Scotland NI
£0
£2
£4
£6
£8
£10
£12
UK regions: spend per head
Oral Nutritional Supplements
In certain conditions some foods have characteristics of drugs and the Advisory Committee on Borderline Substances (ACBS) advises as to the circumstances in which such substances may be regarded as drugs
Oral nutrition supplements are prescribable products that can be used as a simple, effective method of providing nutrition support to people who are malnourished.
Joint Initiative
MEDICINES MANAGEMENT DIETITIAN INITIATIVE
The Public Health Agency
Health & Social Care Board
Delivery of enhanced outcomes for patients, ensuring appropriate use of Oral nutritional Supplements & management of malnutrition which has delivered prescribing efficiencies which can be redirected into patient care
Target Population Targeted sample of GP practices:0.5- 1.94 % of patients registered with these GP practices are on ONS • People who are prescribed oral nutritional supplements who are
not under the care of trust dietitians
Intervention
• Offered a individual Nutritional Assessment to targeted individuals • Provide nutritional advice , education and care plan• Training
Food FirstThe ‘food first’ approach is the term used for general dietary guidance to improve food intake. It includes strategies such as:• Increasing food frequency• Modifying food intake• Fortifying foodsto increase the consumption of energy and nutrient-dense foods and nourishing drinks.
Strategy Example
Increasing food frequency Little and often, small frequent meals:3 small nourishing meals and 2-3 nourishing snacks daily
Modifying food intake Swap :• 1 pint of semi skimmed milk to full cream milk for an extra 100kcals• Low fat margarine to butter for an extra 50kcals per slice of buttered bread• Light / diet yoghurt to rich creamy yoghurt for extra 100kcals per pot
Fortifying foods Extra 100-150kcals:2 teaspoons jam / honeyMatchbox size grated cheeseTablespoon butter / margarineTablespoon double cream
Extra 150-200kcals1 Tablespoon chocolate spread1 Tablespoon peanut butter1 Tablespoon mayonnaise1 Tablespoon desiccated coconut
Measurable Outcomes
Quality ■ 72 practices complete ■ 1605 patients assessed ■ ‘Food first’ where appropriate
Patient Experience Questionnaire: ■ 92% of patients reported
comparable or improved wellbeing following appointment with the dietitian
GP Questionnaire: ■ 94% GPs very satisfied with
communication with the practice before the initiative and what the initiative entails
Efficiency
£ 1,008,565
annual efficiency to date in 2014
GP Comment:“A very worthwhile project undertaken with little or no disturbance in the practice. The admin was well organised and the expertise of the dietitian was very appreciated.”
Safety87% patients with MUST ≥2 had stable or increased BMI @ 8/52
94% patients maintained or increased BMI 8/52 after ONS stopped
Patient perception of ONS