Marking UK Malnutrition Awareness Week (October 11-17), Leni Wood, Nutrition and Wellness Manager at Nellsar, looks at the different complexities and solutions to ensuring care home residents get the nutrition and hydration they need to avoid malnutrition.
According to the British Dietetic Association (BDA), malnutrition is a major public health issue costing the NHS over £19bn per year in England alone. There are approximately 3m people in the UK who are malnourished or at risk of malnutrition; 93% are living in their own home, 5% are living in care homes, and just 2% are in hospitals.
In addition, the NHS reports that those who are 65 years and over are particularly at risk of malnutrition. (1) The consequences of malnutrition include increased risk of illness and infection, slower wound healing, increased risk of falls, reduced quality of life and reduced independence among others. (2)
Working as a nutrition specialist in social care means that I come across many people over 65 who are at risk of malnutrition. Particularly those living with conditions such as dementia, dysphagia, a history of eating disorders, or depression. I work closely with residents and teams on individualised menus and therapeutic meal planning to support those who need a boost in nutrition.
Dementia and appetite
Malnutrition doesn’t happen to everyone with dementia and each person living with it will experience symptoms in a different way. The disease is as unique as the individual and can be unpredictable.
Families, care teams and nutrition teams can support all factors affecting a person’s appetite by focusing on the individual rather than the condition. Knowing someone’s favourite foods, or foods which hold a positive memory, can really help encourage them to eat.
Knowing what kind of portions someone prefers or their preferred cups and plates, for example, can make a big difference. It’s also important for some people to have a routine as they enjoy having their meals at set times throughout the day.
Encouraging social engagement and tailoring leisure activities to suit individual needs can also help a person living with dementia increase their appetite. For many people, eating socially really helps them to enjoy their meals better. For others, eating alone is preferred as they are sensitive to busy environments or might feel embarrassed to eat in public. It really does depend on the individual which is why it is so important to know their life history.
Another condition that can be a risk factor for malnutrition is dysphagia. This is when a person experiences swallowing difficulties and might be prescribed a texture modified diet or thickener in their drinks by a GP or Speech and Language Therapist.
A person is usually prescribed a textured diet when they have a neuro or cognitive related illness such as Alzheimer’s or dementia or have had a stroke. When experiencing swallowing difficulties, a textured diet can be the most comfortable and safe way for a person eat.
Furthermore, those prescribed a textured diet such as puréed food shouldn’t become malnourished. However, when a food is puréed, calories and nutrients can be lost because the surface area of the food is increased and less is served per portion. As well as protein and calories, flavour and visual appeal can also be lost when puréed.
At Nellsar, our catering teams use food moulds, piping, and other techniques to remodel puréed food to make it look more appealing and resemble its original appearance. Our chefs use sauces and gravies to add flavour and protein powder to fortify lost protein.
Leni Wood is the Nutrition and Wellness Manager at Nellsar, a family-run group of 13 care homes throughout Kent, Surrey, and Essex. Built on strong foundations, Nellsar has worked hard to build the trusted reputation of its homes and prides itself on being approachable, accountable, and empathic in its relationships with the families it supports.