Prevalence of malnutrition and use of nutritional support in Peterborough Primary Care Trust
Authors: Cawood A.L. , Smith A. , Dalrymple‐Smith J. , Bolch R. , Pickles S. , Church S. , Stratton R.J. 
Published: July 2008

Background:  Recent NICE guidance recommends that people in care homes should be screened with a validated tool such as the Malnutrition Universal Screening Tool [MUST (Elia, 2003)] on admission and where there is clinical concern (NICE, 2006). Nutrition support should be used for those who are either malnourished or at risk of malnutrition (NICE 2006; Stratton & Elia, 2007). Before implementation of MUST in care homes within the Peterborough PCT area, a cross sectional survey was undertaken with the aim of determining documentation of nutrition information, current screening practices, prevalence of malnutrition risk and use of nutrition support.

Methods:  A cross sectional study of nutritional care in 703 care home residents [mean age 84 (27–104) years] across 19 care homes (54% residential; 46% nursing) in Peterborough PCT was carried out for 4 months in 2007. The survey of care home notes collected information on; equipment, documentation of nutritional information (e.g. weight, height, weight loss), use of screening tools, and use of nutritional support including food fortification, dietary advice, use of supplements, and seeing a dietitian. To establish the prevalence of malnutrition risk, available nutritional information (n = 566) from the notes was used to classify residents risk using the MUST criteria.

Results:  All care homes (n = 19) had weighing scales with 74% having sitting and/or hoist scales, and 21% having standing scales only. Stadiometers were unavailable in all homes. Most (91%) of the residents had a recent weight documented and 58% had a documented height. Eighty‐one per cent of residents had been screened, mostly monthly, but nine different tools were used across the care homes. Using available data to calculate MUST indicated that 32% of residents were at risk of malnutrition (13% medium; 19% high) with a higher prevalence in nursing compared to residential homes (38% versus 25%; P = 0.001 Chi squared). The majority (64%) of residents at high risk of malnutrition using MUST were not receiving any form of nutritional support; in contrast 9% at low risk of malnutrition were receiving support including food fortification, oral nutritional supplements, and dietetic care.

Discussion:  This survey suggests that using MUST more than a quarter of residents in care homes are at risk of malnutrition. However, inconsistency in screening practices (frequency, types of tools and equipment available) can impair the identification of at risk residents preventing the appropriate use of nutrition support.

Conclusions:  There is a need to improve the identification and treatment of malnutrition and reduce inappropriate use of nutritional support in care homes. Therefore a programme is planned to implement routine screening with MUST, use of evidence based care plans, followed by an audit to evaluate its effects on the nutritional care of residents.

References  National Institute for Health and Clinical Excellence (NICE). (2006) Nutrition Support in Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. Clinical Guideline 32.

Stratton, R.J. & Elia, M. (2007) A review of reviews: A new look at the evidence for oral nutritional supplements in clinical practice. Clin. Nutr. (Suppl. 2), 5–23.

Elia, M. ed. The “MUST” report (2003). Nutritional Screening for Adults: A Multidisciplinary Responsibility. Vol. 2. Suppl. 1. Redditch, UK: BAPEN.