Around three million people in the UK are affected by malnutrition and one in three adults who are admitted to hospital are malnourished. Health professionals are in a privileged position to tackle malnutrition because they are more likely to recognise the signs of malnutrition and muscle loss.
In my opinion, the first line of defence against undetected malnutrition needs to be GPs and other healthcare workers in the community. Many people who are affected may not even realise that they have slowly been losing weight and feeling less energised. Malnutrition can creep up gradually. A doctor who is concerned that a patient is becoming thinner and frailer should encourage that person to talk about their eating habits; have they been unable to finish meals recently? Do their clothes and jewellery feel looser? Also, it is useful to ask whether they are taking regular exercise and whether they are still able to do basic tasks like walking up stairs, getting out of the chair and going shopping independently.
A brief assessment at the GP surgery can be the start of a supported programme with a dietitian who can prescribe oral nutritional supplements if necessary while monitoring the health and wellbeing of the patient. Unfortunately, a shortage of available dietitians means that often only the most severe cases of malnutrition get a referral to a specialist. But doctors and nurses can offer advice and prescribe supplements where appropriate even if there is a long waiting list to see a dietitian. It is always advisable, if using nutritional supplements, to get a prescription from a doctor because these supplements are clinically proven to provide complete nourishment, unlike many of the products available in the supermarkets which are not regulated in the same way. Furthermore, it is the combination of a nutritional supplement coupled with advice and monitoring from a healthcare professional which is most effective.
In the community, opticians and pharmacists are just two other types of health professionals who could play a greater role in helping to identify people at risk and start the conversation about steps to put things right. Advice can be very simple. Eat good quality protein regularly, including eggs, dairy products, meat, pulses, beans and nuts. Make sure you are getting enough Vitamin D. Older people may be vitamin D deficient because they tend to spend less time outdoors. A supplement can bring vitamin D levels up to healthy levels, particularly during the autumn and winter when the body is not able to synthesize Vitamin D in the skin due to a lack of UVB rays.
In a hospital setting, patients may also slip through the net and not see a dietitian simply because of the high demand for this service. This is a problem because older people in hospital often lose muscle mass during their stay, as they are less mobile, or in some cases bed-bound. There have been major improvements in the way that patients are fed while staying in hospital – for example, they may be given assistance and more time to finish their meal – but there could still be improvements. In hospital, meals are served at set times and portion sizes tend to be for standard adults, but many older people may prefer to eat little meals often throughout the day. We suggest a tea plate sized meal which doesn’t overwhelm people, plus lots of little energy-dense snacks in between. Unfortunately, tailor-made approaches for older people are often not available during hospital stays.
After discharge, this support should remain available if it is needed.
Loved ones can play a very important role too. If you notice a friend or relative is struggling and becoming frail, talk about or alert someone who can help. And there is plenty that people can do to help themselves.