At least a third of care home residents are affected by malnutrition, according to new analysis, which concludes more work is needed to tackle it as a “major” issue.
The research was undertaken by charitable association BAPEN and pulls together results from four surveys carried out between 2007 and 2011, involving a total of 474 care homes and 3,971 residents across the UK.
Said to be the largest ever survey of malnutrition in care homes, it found evidence of progress when it came to awareness, increased screening and care for those affected.
However, it also found people who arrived at homes already underweight and malnourished were more likely to get worse and identifies key areas for improvement in practice.
Around 10% of care homes reported they did not provide any training for staff on malnutrition screening, said a report drawing together the survey findings.
Meanwhile, a significant proportion of homes were unaware of key standards for weighing scales crucial to ensuring accurate assessment of weight and identifying those at risk.
“More integrated health and social care strategies to combat the problems would be beneficial”
For the purposes of the study, malnutrition was defined as medium or high risk on the Malnutrition Universal Screening Tool (MUST) – developed by BAPEN and used in many care homes.
The surveys, carried out with the British Dietetic Association and Royal College of Nursing and supported by government and chief nurses, focused on care home residents admitted during the previous six months.
The analysis found malnutrition was more common among people admitted from hospital and other care homes than among those previously living at home.
Nearly 40% of those who had come from hospital and 37% from other care homes were malnourished, compared to 30% admitted from their own home.
However, that may be because people already in health and social care may well be more frail and ill than those who had been living independently until recently, noted BAPEN.
There was also variation between types of care home, with malnutrition less common in exclusively residential homes at 27%, compared to other types at 38%, with the latter generally involving more intensive nursing care for the severely ill.
Worryingly, the research found those people who entered a care home underweight and malnourished were more likely to continue to lose weight.
Most residents who were underweight when admitted were still underweight when the surveys were done up to six months later.
Malnutrition was more common among female residents, affecting 38% compared to 30% of men.
“There have been some improvements in the operational infrastructure for the management of malnutrition, but there is still room for further improvement”
Unsurprisingly, it tended to increase with age and varied according to the diseases people suffered. Cancer patients were more likely to be malnourished alongside those with multiple health problems, as opposed to a single condition.
Positive trends included the fact more care homes had access to dietetic services, which support those with nutritional problems. In 2007, 84% reported access to such services but this was up to 95% by 2011.
Pretty much all care homes used some type of nutritional screening tool, with 90% of those using MUST – sometimes alongside other resources.
There was an improvement in the proportion of homes recording the height of residents on admission – a key measure in calculating body mass index.
In 2007, just 71% of homes surveyed were routinely recording height on admission but that was 90% in 2011.
However, just 55% of homes in the most recent survey said they definitely knew about standards for weighing scales. About a quarter – 24% – said they were not aware of standards, while 21% said they were not sure or did not answer the question.
There were also concerns about key checks on the quality of nutritional screening done by staff.
Less than three quarters of homes in the most recent survey – 73% – said they audited nutritional screening, while 15% said they did not and 12% were not sure or did not answer.
The report described malnutrition in care homes as “a major health and social care burden” and called for a more collaboration between health and social care services to tackle it.
“While care homes are generally funded to provide social care, the boundaries between social and healthcare are ill defined and sometimes problematic, suggesting that more integrated health and social care strategies to combat the problems would be beneficial,” it said.
“The care home surveys suggest there have been some improvements in the operational infrastructure for the management of malnutrition, but there is still room for further improvement,” it added.