The Malnutrition
Task Force
Dr Ailsa Brotherton
Member of the National Task Force
The Malnutrition Task Force
Independent group of experts across health, social care and local
government united to address the problem of preventable
malnutrition in older people, with ministerial support.
Our mission
To ensure the prevention and treatment of
malnutrition is embedded in all care and community
support services and awareness is raised amongst
older people and their families
Malnutrition
3 million people malnourished or at risk
Older people are more vulnerable
affecting 1:10 (0ver a million)
36% already malnourished or at risk
on admission to hospital
• Devastating consequences
• Declining mobility - due to
muscle wasting
• Decreased resistance /
delayed healing
• Dizziness, leading to falls
• Depression
• Deteriorating quality of life
• Death!
Our ageing population
Projection of Increase in UK Older Population
170
75+
160
140
65+
130
120
110
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
100
2010
(2010=100)
150
Commitment to Act: Pledges
Malnutrition Task Force – Salford Pilot Site
Background and Introduction
Kirstine Farrer
Consultant Dietitian
Salford Royal NHS Foundation Trust
Malnutrition Task Force – Salford Pilot Site
Background and Introduction
Kirstine Farrer
Consultant Dietitian
Salford Royal NHS Foundation Trust
Malnutrition in the UK
PHYSICAL
Disease related
malnutrition
Mobility
Feeding
PSYCHOLOGICAL
Depression/bereavement
Dementia
Swallowing
Low activity
Decreased
organ reserve
Specific
disease
Multiple drugs
(taste)
Alcohol
SOCIAL
Isolation
Poverty
Consequences of Malnutrition (within days)
Psychology –
depression & apathy
Poor breathing and cough
from loss of muscle
strength
Liver fatty change,
functional decline
necrosis, fibrosis
Impaired wound
healing and
susceptibility to
pressure ulcers
Impaired gut
integrity and
immunity
Poor Immunity and
infections
Decreased Cardiac
output
Hypothermia – decline in
all functions
Renal function – limited
ability to excrete salt
and water
Loss of muscle and bone
strength - falls and fractures
Inadequate food intake is common in hospital
• European Nutrition Day survey* found that of patients aged >75
years only1:
– 46% ate all of breakfast
– 34% ate all of lunch
– 35% ate all of dinner
• Older inpatients in a hospital elderly care unit in the UK were
judged to be eating inadequately and only 67% had
assessments2
*748 units in 25 countries, total n=16455, aged >75 years n=4799.
1. Schindler KE, Schuetz E, Schlaffer R, Schuh C, Mouhieddine M, Hiesmayr M. NutritionDay in
European hospitals: risk factors for malnutrition in patients older than 75 years. Clin Nutr 2007; 2:10.
2. Patel MD, Martin FC. Why don’t elderly hospital inpatients eat adequately? J Nutr Health Aging 2008;
12(4):227-231.
Prevalence of malnutrition
Hospitals
Centres
(n=)
Care Homes
Patients
(n=)
Centres
(n=)
Resident
s (n=)
Mental Health
Units
Centres
(n=)
Patients
(n=)
2007
175
9336
173
1610
22
332
2008
Summer
130
5089
75
614
17
185
2010
185
9668
148
857
20
146
2011 171
Spring
7541
78
523
67
543
Autumn
Winter
Prevalence
25-34%
30-42%
18-20%
Individuals at risk of malnutrition
Care Homes
93%
5%
Communities in
contact with
services
Hospital
2%
3 million malnourished
Communities - little or no
contact with services
The Malnutrition Carousel
NURSING
HOME
CARE
HOME
Malnutrition
SECONDARY CARE
  complications
  length of stay
  readmissions
  mortality
HOSPITAL
HOME
PRIMARY CARE
  dependency
  GP visits
  prescription costs
 hospital admissions
We know what
excellent nutritional
care looks like
Nutrition support in
adults 2006
February 2006
The effectiveness of Nutrition Support
10 RCT, n = 494;
RR 0.29 (CI 0.18 to 0.47)
30 RCT, n = 3258
RR 0.59 (CI 0.48 to 0.72)
Controls
Controls
Treatment
Treatment
0
10
20
30
Complications %
40
50
0
5
10
15
Mortality %
20
25
30
The Cost of Malnutrition
Public expenditure associated with <3 million
individuals in UK who are malnourished or at risk
of malnutrition
2014 - ?? >£15 billion p.a.
2007 - >£13 billion p.a.
2003 - >£7.3 billion p.a
NICE Cost Saving Guidance places effective
treatment of malnutrition as 3rd in ranking of
potential biggest cost savers to the NHS
Making it happen
‘’This guide is easy to
use since we have
defined the top three
priority actions for
each level of the care
system. Simply go to
the part that relates
to your organisation
and take action’’
Reliable systems of nutritional care
Good nutritional care for every individual, in every setting,
on every day
PREVENT
IDENTIFY
TREAT
Work with Public
Health, Local
Government and
Social Services
Design systems to
screen all patients
using a validated
screening tool
Develop
personal
nutritional care
plans
Use local CQUINs
EDUCATION
& TRAINING
STRUCTURES
AND
PATHWAYS
Continuity
across
boundaries
Senior
Leadership
Salford Integrated Care
Programme: Malnutrition Launch
Event, May 2014
Jack Sharp
Executive Director Service Strategy and Development
Salford Royal NHS Foundation Trust
Integrated Care for Older People
Promote independence for
older people, delivering:
1. Better health and social
care outcomes
2. Improved experience for
services users and carers
3. Reduced health and social
care costs
Significant
population
growth
Poor
experience
of care
Service
duplication
High levels
of need
Significant
cost of care
National and
international
evidence
“Integrated health and social care for older people has demonstrated the potential
to decrease hospital use, achieve high levels of patient satisfaction,
and improve quality of life and physical functioning”
Curry and Ham, Clinical and Service Integration – The Route to Improved Outcomes
King’s Fund, 2010
27
WORK IN PROGRESS - DRAFT 14/11/13
28
Salford’s approach
• System shift from reacting to
anticipating
• Personalised, shared care
planning; ‘Sally’ at the centre
• Tell your story once, one
assessment, one key worker,
supported by one integrated
system
• Outcomes driven support
2020 improvement measures
Emergency admissions and readmissions
• 19.7% reduction in NEL admissions (from 315 to 253 per 1000 ppn)
• Reduce readmissions from baseline
• Cash-ability will be effected by a variety of factors
Permanent admissions to residential and nursing care
• 26% reduction in care home admissions (from 946 to 699 per 100,000 ppn)
• Savings directly cashable but need to be offset by cost of alternative care (especially
increased domiciliary care)
Quality of Life, Managing own Condition, Satisfaction
• Maintain or improve position in upper quartile for global measures
• Use of a variety of individual reported outcome measures
Flu vaccine uptake for Older People
• Increase flu uptake rate to 85% (from baseline of 77.2%)
Proportion of Older People that are able to die at home
• Increase to 50% (from baseline of 41%)
30
Partnership approach*









Age UK
Care Homes (multiple)
Chamber of Commerce
Citizens Advice Bureau
City West Housing Trust
Community Pharmacy
Domiciliary Care Providers
General Practice
Helping Hands
* includes, but not limited to
 Inspiring Communities
Together
 Mature persons group
 Salford Community Leisure
 Salford CVS
 Salford Multi-Faith Forum
 Unlimited Potential
 Your Housing Group
 Other third sector
organisations
Journey so far
• Summer 2012
Sign up by partners and formation of ICP
• October 2012
Engagement events and co-design
• February 2013
Launch of Neighbourhood Collaborative
• December 2013 Salford Chosen to be one of the national pilot
sites to tackle malnutrition under the
auspices of Age UK on behalf of the
Malnutrition Task Force
• January 2014
City-wide roll-out of ICP agreed
• March 2014
Summit Event to celebrate success so far and
forward planning including MTF aims
What will be different for
Sally Ford and her family?
• Greater independence
 Able to live at home longer
• Reduced isolation
 Increased opportunities to participate
in community groups and local activities
• Confidence in managing
own condition and care
 Sign-off own care plan and agree who it
should be shared with
 Support to monitor own health
• Know who to contact
when necessary
 One main telephone contact number
for advice and support
• Increased community
support, specialist care
when necessary
 Access to a named individual to
coordinate care and support
• Support to plan for later
stages in life
 Agreed plan for last year in life
33
Opportunities to align with MTF priorities
• Sally Friendly City: raising
awareness across the city to, both the
public and food and beverage
providers, about malnutrition and
where to go for help
• Centre of Contact: signpost people
who identify themselves as at risk of
Malnutrition to get appropriate help
• Multidisciplinary Groups:
discussing people who are
malnourished or are at risk and
supporting them with food and drink
diaries, supplements, and onwards
referral if required
• Wellbeing/Care Plan:
will contain best guidance on
supporting good nutrition and
hydration
• Integrated Care Standards:
that all service providers will sign
up to, will include requirements
around education, training an
monitoring of malnutrition, by
GPs, health and social care
practitioners and care homes
Do you think it’s normal for people to lose weight as
they get older?
More than half thought losing weight in older age was normal
1
3
83
Yes
106
No
Dont Know
Depends
Over the winter do you think you may have lost
weight without intending to?
A quarter said they had lost weight over the winter without
intending to
1
4
46
Yes
No
Dont Know
131
Depends
Over the past week do you think you have been
eating enough?
16% felt they had not been eating enough over the
previous week
11
32
Yes
No
Dont Know
160
Depends
Have you had a smaller appetite lately?
32% said they had a smaller appetite lately
4
67
Yes
135
No
Dont Know
Reasons people gave for not eating enough
Illness / medical condition
Eats less now on own - loss of
meal provider
Less hungry /no motivation/
lost enjoyment in food/no
reason to keep to regular
mealtimes
Too busy
Other
What people said they’d do if they found
themselves losing weight without intending to
Go To Doctors
Eat More
Ask Family
Nothing / Wouldn't be
worried
Dont Know
Other - see
nurse/chemist/other help
GROUP EXERCISE 1
• On your Table is an extract from the Malnutrition
Task Force Guides
• This shows the 5 Principles and some important
interventions needed to ‘reduce preventable
malnutrition and dehydration in older people’
• We would like you to help us better understand
how we are currently doing in Salford
• Please share your views on what you think is
happening now, where there are gaps, and what
more we need to do.