Looking out for those ‘at risk’ of malnutrition in the community

April 07, 2020 3 min read

Some people who are self-isolating at home may be at increased risk of malnutrition. This article explains what malnutrition is, how it relates to coronavirus (COVID-19) and ways for healthcare professionals to support these individuals.

 

What is malnutrition?

A person is classified as malnourished if they meet a set of criteria which often includes a low Body Mass Index (BMI), significant and unintentional weight loss over a defined period of time, and/or reduced nutritional intake over a defined period of time (1).

Common signs and symptoms of malnutrition include:

  • Loss of appetite
  • Weight loss – i.e. loose clothing and jewelry
  • Tiredness, loss of energy
  • Difficulty concentrating
  • Changes in mood such as anxiety and depression
  • Delayed wound healing
  • A general sense of weakness

 

How does it relate to COVID-19?

The UK government has asked everyone in the UK to stay at home and only leave the house for essential purposes. They’ve also advised anyone at increased risk of severe illness from coronavirus (COVID-19) to be particularly stringent in following social distancing measures.

This includes people aged 70 or older (regardless of medical conditions) and people with certain chronic diseases. It’s estimated that over 3 million people are malnourished, with 93% living in the community and 1.3 million aged over 65 (2).

There’s an association between malnutrition with some of the chronic diseases listed by the government, such as chronic kidney disease (3), chronic obstructive pulmonary disease (4), and heart failure (5).

Other risk factors for malnutrition (which are particularly relevant at the moment) include:

  • Poverty and deprivation
  • Loneliness and bereavement
  • Difficulties accessing and preparing food
  • Physical disability

 

Why does it matter?

If malnutrition and frailty are undetected, this can lead to serious consequences for the patient and the wider healthcare system.

Not only does malnutrition impact a person’s nutritional status; it can affect every system in the body, leading to adverse changes in body form and function.

Physical effects include (6):

  • Impaired immunity leading to increased susceptibility to infections
  • Pressure sores
  • Delayed wound healing
  • Muscle wasting
  • Adverse changes to the gastrointestinal structure and function
  • Generalised weakness
  • Increased risk of falls
  • Increased risk of bone conditions such as osteoporosis

Other studies have shown that malnutrition is associated with more hospital readmissions, longer length of stay, increased complications and greater risk of mortality (7).

On a wider scale, malnutrition is a significant burden on healthcare resources and budgets, and malnutrition in England has been estimated to cost £19.6 billion per year (2011-12 figures) (8).

 

How can we detect malnutrition amongst patients in self-isolation?

The British Dietetic Association has released some useful information on screening tools for healthcare professionals and care homes to use with individuals, here. There is further information on nutrition risk screening tools for healthcare professionals on the AYMES website.

It may not be possible for healthcare professionals to conduct face-to-face nutrition risk screening with patients who are self-isolating. Therefore, individuals, family, friends, and neighbours may find this nutrition checklist useful for identifying whether someone needs extra nourishment.

 

What support can be offered?

A Food First approach is a simple way of providing enhanced nutrition to those who are or who are at risk of becoming malnourished. It can be useful for patients who still have a good appetite. The British Dietetic Association Malnutrition Food Fact Sheet has lots of information and advice on a food first approach.

Strategies include fortifying foods to increase the nutritional density of the diet without increasing the volume of food consumed.

Several foods which can be used to fortify the diet include:

  • Double Cream
  • Full Fat Milk
  • Honey/Syrup/Sugar
  • Butter
  • Cheese
  • Milk Powder
  • Oils such as olive oil

Additional snacks can be used to improve nutritional intake and examples include, cakes, biscuits, crisps, cheese and crackers, and custard. Encouraging patients to consume nourishing drinks that provide more energy and protein than tea, coffee or water is also an effective strategy.

AYMES Retail is an over-the-counter alternative to AYMES Shake, available to order online or at pharmacies, by patients who need an extra boost but don't require a prescription. Providing up to 266 kcal per serving when mixed with 200ml whole milk, it’s available in a range of flavours, helping to alleviate flavour fatigue.

It’s important to recognise that with many in self-isolation, usual shopping patterns and eating habits may be disrupted. There is plenty of support available to help older and vulnerable people to eat well, including online food delivery services, meals-on-wheels, and local neighbourhood volunteer support groups.

If you’re worried about an older or vulnerable person, you can also register them with the government to receive additional support.