the malnutrition task force dr ailsa brotherton member of the national task force
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The Malnutrition Task ForceIndependent 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
• Devastating consequences• Declining mobility - due to
muscle wasting• Decreased resistance /
delayed healing• Dizziness, leading to falls• Depression• Deteriorating quality of life• Death!
3 million people malnourished or at riskOlder people are more vulnerable affecting 1:10 (0ver a million)36% already malnourished or at risk on admission to hospital
Our ageing population20
10
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
100
110
120
130
140
150
160
170
Projection of Increase in UK Older Population
75+
65+
(201
0=10
0)
Malnutrition Task Force – Salford Pilot Site Background and Introduction
Kirstine FarrerConsultant Dietitian
Salford Royal NHS Foundation Trust
Malnutrition Task Force – Salford Pilot Site Background and Introduction
Kirstine FarrerConsultant Dietitian
Salford Royal NHS Foundation Trust
PHYSICALDisease related malnutrition
Feeding
Swallowing
Low activity
Decreasedorgan reserve
Specificdisease
Multiple drugs(taste)
SOCIAL
Isolation
Poverty
PSYCHOLOGICAL
Depression/bereavement
Dementia
Alcohol
Mobility
Malnutrition in the UK
Vulnerabilit
y
Poor breathing and cough from loss of muscle strength
Psychology – depression & apathy
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
Impaired gut integrity and immunity
Impaired wound healing and susceptibility to pressure ulcers
Liver fatty change, functional declinenecrosis, fibrosis
Consequences of Malnutrition (within days)
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 Care Homes Mental Health Units
Centres (n=)
Patients (n=)
Centres (n=)
Residents (n=)
Centres (n=)
Patients (n=)
2007 Autumn
175 9336 173 1610 22 332
2008 Summer
130 5089 75 614 17 185
2010 Winter
185 9668 148 857 20 146
2011 Spring
171 7541 78 523 67 543
Prevalence 25-34% 30-42% 18-20%
Communities - little or no contact with services
Communities in contact with
services
Care Homes
Hospital
93%
5%
2%
3 m
illio
n m
alno
uris
hed
Individuals at risk of malnutrition
The Malnutrition Carousel
HOSPITAL
NURSING HOME
CAREHOME
HOME
Malnutrition
PRIMARY CARE dependency GP visits prescription costs hospital admissions
SECONDARY CARE complications length of stay readmissions mortality
The effectiveness of Nutrition Support
0 10 20 30 40 50 0 5 10 15 20 25 30
30 RCT, n = 3258RR 0.59 (CI 0.48 to 0.72)
10 RCT, n = 494; RR 0.29 (CI 0.18 to 0.47)
Complications % Mortality %
Controls Controls
Treatment Treatment
The Cost of Malnutrition
Public expenditure associated with <3 million individuals in UK who are malnourished or at risk of malnutrition
2003 - >£7.3 billion p.a
2007 - >£13 billion p.a.
2014 - ?? >£15 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 caresystem. Simply go to the part that relates to your organisation and take action’’
Reliable systems of nutritional care
IDENTIFYDesign systems to screen all patients using a validated
screening toolUse local CQUINs
TREATDevelop personal nutritional care
plans
EDUCATION& TRAINING
STRUCTURES AND PATHWAYS
Continuity across
boundariesSenior
Leadership
PREVENTWork with Public
Health, Local Government and
Social Services
Good nutritional care for every individual, in every setting, on every day
Salford Integrated Care Programme: Malnutrition Launch Event, May 2014
Jack SharpExecutive Director Service Strategy and DevelopmentSalford Royal NHS Foundation Trust
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
Integrated Care for Older People
“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 OutcomesKing’s Fund, 2010
High levels of need
National and international evidence
Significant populationgrowth
Significant cost of care
Poor experience of care
Service duplication
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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 measuresEmergency 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%)
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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
• 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
Journey so far
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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
• 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
Opportunities to align with MTF priorities
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
106
83
31
YesNoDont KnowDepends
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
46
131
41
YesNoDont KnowDepends
Over the past week do you think you have been eating enough?16% felt they had not been eating enough over the previous week
160
32 11
YesNoDont KnowDepends
Have you had a smaller appetite lately?32% said they had a smaller appetite lately
67
135
4
YesNoDont Know
Reasons people gave for not eating enough
Illness / medical conditionEats less now on own - loss of meal providerLess hungry /no motivation/ lost enjoyment in food/no reason to keep to regular mealtimesToo busyOther
What people said they’d do if they found themselves losing weight without intending to
Go To DoctorsEat MoreAsk FamilyNothing / Wouldn't be worriedDont KnowOther - 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.