Malnutrition Resources

One of the most prevalent challenges associated with tackling malnutrition is the misunderstanding that surrounds it leading to this condition going unrecognised and untreated. Malnutrition can commonly be incorrectly understood as an inevitable result of the aging process, or a problem only faced by those living in the most extreme poverty. However, it is acutely important to understand that malnutrition caused by disease and illness is a widespread problem in the UK, and nurses can and do play an important
role in identifying and managing malnutrition in their patients, clients or service users.

In 2006, the National Institute for Health and Care Excellence (NICE) released the landmark guidance on nutrition, ‘Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition’ (NICE, 2006). At the heart of NICE guidance and quality standards is the aim to integrate research into practice and reduce gaps between recommended and actual practice. However, successful implementation is dependent on national and local action. To facilitate the implementation of the NICE clinical guidance (CG32), a national multidisciplinary expert panel was convened to explore and develop strategies that would overcome barriers to implementation of the NICE guidance, facilitate access to practical tools, and enhance knowledge to improve the management of disease-related malnutrition in the community. The collaborative work undertaken by the panel, in conjunction with major stakeholders, led to the development of the ‘Managing Adult Malnutrition in the Community’ materials. This article reviews the work of both the initial panel in 2012 and subsequent expert panels, that have delivered and continue to develop resources for nurses and the wider multidisciplinary team to assist in tackling malnutrition, which affects up to three million people in the UK at any time (Elia and Russell, 2009), especially that which arises as a consequence of illness and long-term medical conditions having an impact on appetite and the ability to eat and drink.

Malnutrition is common in patients with chronic obstructive pulmonary disease (COPD), particularly as the disease progresses. This article looks at the nutritional issues facing patients with COPD, including the effects of medication, social and psychological issues. It outlines the role that general practice nurses (GPNs) can play by implementing the newly updated ‘Managing Malnutrition in COPD’ guidance. The guidance encourages incorporation of nutritional screening into COPD care pathways and the optimisation of nutritional intake for those at medium and high risk of malnutrition via dietary advice and oral nutritional supplementation, where appropriate. It also provides practical tips for patients with COPD to help manage common barriers to eating, such as shortness of breath, dry mouth and taste changes.

Nutrition is an important modifiable factor for patients with chronic obstructive pulmonary disease (COPD). Being overweight brings breathing difficulties and being malnourished leads to poorer outcomes. Maintaining a healthy weight and a nutritious diet is a central part of COPD management. This article equips general practice nurses (GPNs) and patients with the tools needed to assess and promote a healthy weight and diet while living with COPD. It explains the reasons for malnutrition and how these can be avoided. Helping people improve their diet as well as the role of oral nutritional supplements (ONS) are explored, and specific issues, such as vitamin D deficiency, are discussed.

Ninety-three percent of elderly adults (over 65) living with malnutrition are residing in the community (Age UK, 2017), and at least one in 10 visits to a general practitioner are by adults that are experiencing malnutrition (British Association of Parenteral and Enteral Nutrition [BAPEN], 2015). General practice nurses (GPNs) will be exposed to patients with acute conditions such as a chest infection or a pressure ulcer, or chronic conditions such as chronic obstructive pulmonary disease [COPD), chronic kidney disease and dementia, which increase their risk of malnutrition. Oral nutritional supplementation is one of the treatments available to treat malnutrition. This article discusses the identification of malnutrition, treatment and appropriate prescribing, through initiation, monitoring and cessation of oral nutritional supplementation.

Malnutrition (undernutrition) affects three million people in the UK (Brotherton et al, 2010) and is responsible for health and social care costs exceeding £19 billion annually in England alone, half of which is due to people over 65 (Elia, 2015). While it is accepted that good nutrition is important to maintain health, there is a general lack of responsibility and ownership around the problem of undernutrition in primary care. Lack of understanding, including how to identify and treat it is also widespread. Despite National Institute for Health and Care Excellence (NICE) guidelines stating that all healthcare professionals should be involved in nutritional screening and treatment (NICE, 2006), there are barriers stopping primary care nurses from screening, i.e. challenges of organisational culture and competing priorities (Green and James, 2013; Green et al, 2014).