Title: The impact of malnutrition on patient-centred outcomes and health and social care resources in elderly people accessing healthcare services in the community
Funder: Health Education England

Abstract: One million people aged over 65 years are malnourished or at risk of malnutrition1. The vast majority live in the community yet there is a lack of studies evaluating the effects of community-based nutritional interventions2. Malnutrition has widespread adverse effects on the body and in the presence of illness results in delayed recovery, poor quality of life and increased risk of death, yet evaluation of nutrition interventions has tended to focus mainly on achieving weight gain3. Little is known about which other outcomes may be important to nutritionally vulnerable patients and so this project is designed to undertake preliminary work in this area. The aims of this project are: 1. To establish which outcomes are most important to older people accessing healthcare services in the community 2. To design and test the validity of a patient reported outcome measure (PROM) for nutritionally vulnerable individuals who might benefit from nutritional intervention 3. To determine the impact of malnutrition on patient-centred outcomes and health and social care resources in older people accessing healthcare services in the community The project will be conducted using a mixed methods approach including a systematic review and both qualitative and quantitative components. A systematic review will be undertaken to identify valid, reliable and sensitive outcome tools e.g. quality of life questionnaires that might be suitable for use in patients receiving nutritional intervention. A portfolio of tools will be compiled and a series of focus groups will be run for older people accessing healthcare services in the community to identify which outcome tools are most preferred by participants and to identify any other outcomes they consider to be important. Since a significant proportion of the target group are likely to be housebound, data generated during the focus groups will be used to inform the design of a semi-structured interview to be undertaken in a participant's home or over the phone. Data generated by the systematic review and the qualitative studies will be used to design a PROM for use in nutritionally vulnerable individuals requiring nutritional intervention. The construct and content validity of the PROM will be tested by a multi-disciplinary expert group. Face validity will be tested by patients and carers. The predictive validity and reliability of the PROM will be tested as part of a cohort study designed to determine the impact of malnutrition on patient-centred outcomes and health and social care resources. The cohort study will be conducted in 300 community-based older people accessing healthcare services. Participants will be recruited in a number of settings including intermediate care units, GP surgeries and health centres. After giving informed consent (assent will be sought if the person lacks the capacity to give informed consent) data will be collected at baseline and 12 months either in the care unit or in the participant's own home. An interim assessment at 6 months will be conducted over the phone. Data will be collected on nutrition risk status, clinical condition, social and functional status and quality of life. All participants will be asked to consent to data being collected electronically relating to any hospital and A&E admissions, GP visits and health and social care packages they receive during the 12 months of the study. Participants will be categorised at baseline according to their nutrition risk score (high, medium or low risk) and statistical and health economic analyses will be undertaken to determine if there are any significant differences in outcome i.e. health and social care costs, quality of life and mortality, between the low, medium or high nutrition risk categories.

Lay abstract: Malnutrition i.e. being thin or losing weight, delays recovery from illness and has adverse effects on quality of life and ability to perform everyday activities. Evaluation of interventions to improve nutrition in malnourished individuals currently focuses on weight change. However, little is known about which outcomes may be important to patients. This project will review existing literature and supplement this with patient interviews and questionnaires to establish outcomes that patients consider to be important. The information gathered will be used to design an outcome tool that will be tested in a study of 300 older people living in the community.

Research activity codes: 6.9 RESOURCES AND INFRASTRUCTURE (TREATMENT EVALUATION)
Health categories: GENERIC HEALTH RELEVANCE