Know the signs, lower the risk

A keen eye, good record-keeping and some preventative steps can help control malnutrition. 

Nurses are often the first point of contact when it comes to managing patients who are malnourished, so it is important to stay well informed.

The silent epidemic

Malnutrition is a major health issue in Australian hospitals and across the broader community. This silent epidemic affects about one-quarter to a third (23 per cent to 34 per cent) of hospital patients in Australia. In community and residential aged-care facilities, malnutrition rates can be as high as 8 per cent to 30 per cent and 40 per cent to 70 per cent, respectively.

Malnutrition greatly affects a patient’s quality of life, due to:

• Longer hospital stays

• Higher risk of being re-admitted to hospital

• Higher number of doctor visits

• Increased risk of falls, hip fractures and pressure ulcers

• Increased risk of infection and complication rates.

Are your patients at risk?

When assessing whether your patients may be at risk of malnutrition, consider the following issues:

• Appetite: Sudden or ongoing loss of appetite, medications (particularly poly-pharmacy) or prolonged fasting.

• Dentition: Missing teeth, ill-fitting dentures or poor jaw strength.

• Strength: Difficulty with feeding independently or opening single-serve packages, or fatiguing quickly whilst eating.

• Weight: Weight loss can be an important warning sign for malnutrition. It’s also important to remember that overweight and obese patients can still be malnourished.

Three strategies to boost food and fluid intake

• Small frequent meals: Increasing the number of meals and snacks (such as adding an extra mid-meal snack or supper meal) can boost energy intake.

• Food fortification: Fortifying meals and snacks (by adding cream in soup, butter or cheese on vegetables, serving cheese and biscuits as a snack), can greatly increase the protein and energy in the diet.

• Recruit a support team: Speak to an accredited practising dietitian for advice on nutritional supplements and individualised support; contact a speech pathologist if swallowing difficulties are evident, or consult an occupational therapist if strength or motor skills are an issue during feeding time.

Prevention is better than cure

Malnutrition is not a normal part of ageing – or a normal part of any illness. Here are some simple ways to monitor your patients and identify whether they are malnourished, or at risk of malnutrition:

• Use a screening tool: Implementing a simple malnutrition screening tool (MST) in your workplace is an easy and cost-effective way to treat and prevent malnutrition. There are many tools available, so speak to your manager or local dietitian to see which one suits your needs.

• Refer to a nutrition support team: Refer patients to your local dietitian for support and ask her how to manage patients with malnutrition.

• Record eating behaviour and weight change: Asking questions and recording information can help track and identify those at risk. For example:

• Report food and fluid intake in a quantitative way (such as “3/4 lunch eaten”, rather than “ate well”).
• Monitoring weight regularly for signs of changes, documenting the results and referring to a dietitian as early as possible.

Referring to dietitian

You can organise a visit for your patient to an accredited practising dietitian (APD) through:

• Self-referral

• Referral by a general practitioner (GP) to a private-practice APD or community service APD

• Referral by home and community care (HACC) or aged-care assessment teams to APDs that are HACC-funded or in private practice.

Medicare can provide rebates for visits to APDs treating chronic health conditions under a team care plan that is coordinated by a GP.

Claire Hewat is the CEO of Dietitians Association of Australia.

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