Malnutrition Effects on Quality Of Life

Malnourishment Effects on Quality Of LifeThe focus of this perspicacity is feeling of life and partingicularisedally this topic considers how mal sustainment affects quality of life of confederation settings patients. harmonise to the stinting Governments way let out Older people living in partnership pabulum holds, obstruction and interventions a literature review, mal bread and butter is an umbrella term for undernutrition, overnutrition and imbalance viands white plague (The Scottish Government, 2009). Malnutrition has previously been described in the various ways (The Scottish Government, 2009). However, for purpose of this sagacity the following term lead be use as defined by World Health Organisation (WHO) the cellular imbalance between the supply of nutrients and energy and the bodys demand for them to ensure growth, maintenance, and specific hunts (see European Nutrition for Health Alliance, 2005). concord to Saunders, metalworker and Stroud (2010) 2 per cent of the UK existence is under cargo unit Body Mass Index (BMI) is press down than 18.5 kg/m. However, they agreed that patients could be salvage at insecurity of malnutrition whatever their BMI is (Saunders, metalworker and Stroud, 2010).Malnutrition, as well as slightly other factors, has negative effect on the persons quality of life (The Scottish Government, 2009). In the UK, hospitals admission rate and death rate were greatest in patients with BMI below 20 (kg/m2) (Teo and Wynne, 2001). During nutrition top trace in the UK various settings it was prepargon that malnutrition doubles endangerment of mortality in the hospital patients and triples morality in some clock time(a) patients in hospitals following execute (RCN and NPSA, 2009). Cargon Homes nutrition survey shown that 30 per cent of service users recently admitted to negociate nationals were at danger of malnutrition (RCN and NPSA, 2009).According to Hickson (2006), malnutrition may be lowe r-ranking to certain health conditions which is increasing chances for patients to amaze undernourish and those risk factors lead be discuss later in this assessment (Hickson, 2006 and Teo and Wynne, 2001). However, European Nutrition for Health Alliance (2005) argued that malnutrition should be classified as independent unhealthiness (European Nutrition for Health Alliance, 2005), its due to undernutrition has a negative effect on all organs systems such as vigor-skeleton, cardiovascular, respiratory, gastrointestinal, endocrine systems and in addition, malnutrition has a psychosocial effect (Saunders, metalworker and Stroud, 2010).It was assemble that undernutrition could cause following health conditions in the goodish separates and has advance exacerbation effects upon existent illnesses or injuries, minify psychological offbeat (increase anxiety, depression apathy, and discharge of concentration and self-neglect) (Webb and Copeman, 1996 and Saunders, metalworker and Stroud, 2010). According to Morley and Kraenzle (1995), balanced fast in general, is improving cognitive and memory surgical procedure in aged(a) (see Vetta et al, 1999).Chandra (1993) found that undernutrition is depressing organism immune eng get along with (see Webb and Copeman, 1996). It could be due to impaired cell-mediated immunity and cytokine, complement and phagocyte make for this most comm unless could lead to developing bacterial and parasitic infections and unretentive wounds healing (Saunders, Smith and Stroud, 2010).Malnourished patients bind reduced muscle function, loss of cardiac muscle and reduce cardiac output, which results in impact on the renal function (Saunders, Smith and Stroud, 2010). The same individuals beat reduced respiratory rejoinder to oxygen deficit by brusque diaphragmatic and respiratory muscle function (Saunders, Smith and Stroud, 2010), increased risk of hypothermia, increase risk of waterfall and injuries (Webb and Copeman, 1996). I n addition, redaction of fill in and muscles set atomic number 18 more open signs of malnutrition (Saunders, Smith and Stroud, 2010). According to Clayton (1991), malnourished aged(a) clients affirm a despicable prognosis for recovery from following fractured femur, hypothermia, pressure ulceration and other conditions (Clayton, 1991). tornado risk is high then calcium, magnesium and vitamin D in fix is insufficient, during the heaviness loss b genius mass is simplification as well (Saunders, Smith and Stroud, 2010).Early st years of malnutrition leads to loss of digestive enzymes that result in bigotry of lactose. The colon loses its ability to absorb liquid, electrolytes, and secretions of small and large bowels, which results in dissolution (Saunders, Smith and Stroud, 2010).According to Saunders, Smith and Stroud (2010), endocrine system is affected in malnourished pains. For example, chronic malnutrition lead change the pancreatic exocrine function by reducing the insulin secretion (Saunders, Smith and Stroud, 2010).An compose is currently running(a) a nursing and residential parcel out home for ancient patients as well as nursing and social recruitment progressncy, which is covering biggest part of the North West of England. Being allocated in hospitals and nursing homes the reservoir sight that patiences nutrition needs are being met well but where are still some areas for remediatement. During the study carried out in the large the UK hospitals, it was found that 40 per cent patients admitted to hospitals were malnourished and two-thirds subsequently scattered clog during their hospital stay (Teo and Wynne, 2001).During the service users abideing in the carry on home precedent working in, carried out in January this year, all 14 service users buzz off stated that they are satisfied with solid fodder they are getting. However, two patients are still at risk of malnutrition. They have been referred to the GP for dietician fin ancial backing. The source strongly believes that nursing home is providing adequate food to the service users. ply manager in the UK hospitals compare to chefs in nursing home have a small budge of 11 to 15 per patients a week (Teo and Wynne, 2001). The authors care home spends around 30 per service user a week. However, in March 2007, Royal College of Nursing (RCN) carried out survey sceptical nearly 2200 of their member relating nutrition issues. Survey has revealed that 42 per cent verbalize the food provided for patients were below overage expectancy (RCN, 2011).In various reasons disposal and health profession organisations are now advising for routing screening of all patients admitted to any(prenominal) healthcare facilities (RCN and NPSA, 2009). In authors opinion, the main priority for addressing this issue is promoting patiences health and wellbeing and cutting financial cost. For example, annual financial cost of treatment malnutrition patience and any associated illnesses in the UK was estimated around 7.3 billion pounds. This figure includes treatment malnourished patience in the hospital setting, round 3.8 billion pounds and long-term care facility such as care home, round 2.6 billion (Elia M., et al., 2005).Causes of MalnutritionThe author is currently looking after two service users who are make headway on the MUST. All two patients are elderly from 65 to 80 years old, with different background and health conditions. Patient No 1 is 87 years old female, was diagnosed with Alzheimers Disease, history of Transient Ischemic besiege (TIA), high blood pressure, right wrist fracture and Dysphasia. Current BMI is 19, which was unchanging after referral to dietician and commencing on oral supplements, than BMI was 17 back in the October 2010. Patient No 2 is 72 years old man, diagnosed with intoxicant excess, CA oesophagus, Gout, Heart Failure. Current BMI is 23, which was stably increasing over erst period(prenominal) months following ad mission to nursing home, than his BMI was 17. Both patients have a poor relish at present. Nursing homes staff can non establish reasons for anorexia and BMI reduction in one patient. in that location are number of risk factors, which could cause malnutrition among elderly population. However, the most important factor leading to undernutrition is reducing of oral expenditure (Saunders, Smith and Stroud, 2010). Inadequate dietary intake is depending on various factors (Saunders, Smith and Stroud, 2010), which could be divided into three main categories medical, social and psychological (Hickson, 2006). Firstly, age related to changes such as changing in appetite or sensory (Teo and Wynne, 2001). Working in the care homes author noticed, an appetite is reducing with advanced age. Some people refused or preferred to omit meals, for example, one patient does not take breakfast, then the author asked her why she is not taken breakfast that patient replied that she is not a breakfast person. In addition, during the study carried out in regular army it was discovered that elderly population are consumed less energy intake and follow more traditional eating pattern then jr. population (Teo and Wynne, 2001). Poor appetite or anorexia is a most common factor leading to malnutrition in both young and old generation (Hickson, 2006). However, during the study commenced by Roberts et al (1994), it was found that ageing seemed to affect the ability to control food intake and burthen lost will take longer to re-gains in elderly men compare to young (see Hickson, 2006). In addition, match to work of De Castro (1993), older people are less responsive to stomach contents than younger people, in term of hunger (see Hickson, 2006). Anorexia may occur as serve up of aging as well as during underlying illnesses (Teo and Wynne, 2001 and Hickson, 2006).Hetherington (1998) argued that changing in taste and scent out could lead to loss of appetite through a perceived decline i n the pleasantness of food. Loss of taste and smell could be associated with advance age and medications therapy mechanism of these changes are remains unfathomable (see Hickson, 2006). In authors care environment patients prefer to eat strong olfactory modality and taste meals such as a roast meat with gravy, bacon, pitch which are being served with traditional sauces or salt and vinegar to uphold patients to their food. According to Hickson (2006), a few works have been done to incur out that improving the flavour of the food can reform diet intake and follow weight increase in hospitals and residential district healthcare patients (Hickson, 2006). A few patients do not like vegetables, intake of which have being recommended by NHS 5 a day complain base on the WHO (NHS, 2009).Patient No 1 and Patient No 2 do not have own teeth which is reducing ability to chew tender food. For both patients oral hassles have not been reported. However, harmonise to Finch et al (1998), N ational Diet and Nutrition survey, energy consumption was lower in edentate individuals compare to individuals with own teeth (see Hickson, 2006).Dysphasia or swallowing problem is leading concern in reducing dietary intake (Hickson 2006). The author has experienced that often care and catering staff do not understand the different between soft and liquidised diet and which diet should be given to each patients with dysphasia. Moreover, care staff that is responsible for feeding patients, obligatory processant, every often do not understand the sings for swallowing problem. This concern has been turn to in the care home that the author is working in by appointed care staff for appropriate training section provided by Liverpool Primary Care Trust (PCT). According to research carried out by Mowe et al (1994), swallowing problem is showing up in 64 per cent of in-patience elderly (see Hickson, 2006). In addition, Gariballa et al (1998) argued that post Cerebrovascular Accident (CVA) patients with Dysphasia had a worse nutrition status then those patients without swallowing problems (see Hickson, 2006).The author strongly believes that malnutrition caused by various factors combined together such as old age and health or mental health problem (Saunders, Smith and Stroud, 2010). In the UK, it was estimated that around 8 per cent of patients with chronic diseases living in the community are malnourished (Teo and Wynne, 2001). According to Hickson (2006), diseases-related malnutrition is usually associated with cancer, physical disabilities, endocrinology disorder and respiratory disease, gastrointestinal disorders, neurological disorders, sources of infection and other psychological factors such as depression and Dementia (Hickson, 2006 and Teo and Wynne, 2001). Medical factors increase the risk of patient to become malnourish through, for example, nausea or vomiting, diarrhoea or constipation, anorexia and malabsorption (Hickson, 2006).Cultural factors or social (Vetta et. al. 1999) and food habits are also playing an important subprogram in developing malnutrition as independent illness (Hickson, 2006). As example, an individual who had a long-term hospital stay or had no nutrition support while in the community would not used to have full nutritional meals. Moreover, individual who has been admitted to the authors care home used to take fast food or sandwiches at all the time while at home, instead of cooked meals. According to Hickson (2006), there are lifestyles and social risk factors for malnutrition in elderly people are lack of familiarity about(predicate) food, nutrition and cooking, isolation and loneliness, poverty, inability to shop or prepare food (Hickson, 2006).Dementia has a great effect on individuals relationship with food (Alzheimers Society, 2011). Dementia patients or patients with low mental status appeared to lost weight due to reducing self-feeding ability, acute sense of smell and taste that is depending on seve ralty and progression of disease (Teo and Wynne, 2001). Berkhout et al (1998) has confirmed that weight lost in demented patients is caused by patients ability to feed them rather than by dementia as illness (Hickson, 2006).According to Incalzi et al (1998), study carried out for in-hospitals patients found out that cognition is cavictimization impairment to ability or desire to eat (see Hickson, 2006). Progressive dementia is usually associated with uncontrolled weight lost and changing eating habits (Claggett, 1989 see Hickson, 2006).Nutrition screening and risk assessmentIn 2007, RCN commenced Nutrition Now campaign, which has a wide response from members of public as well as members of multidisciplinary teams. The RCN Principles for Nutrition and Hydration were published in 2007. That principals aim to help of all health professionals grades to improve nutrition and hydration of patience. This paper is highlighting three principles of nursing care accountability, responsibility and management to improve the patience nutrition and hydration (RCN 2011).Nutrition screening pathway, nutrition risk assessment are widely used which assist nursing staff to indentify the risk of malnutrition or/dehydration and appropriate actions to be taken. Risk of malnutrition screening should be a routine process in all healthcare settings (RCN and NPSA, 2009). In the authors care home as required all service users are being screened for malnutrition on the admission and once a month or more often if required, using Malnutrition Universal Screening Tool (MUST) as recommended by government bodies and Care Quality Commission (CQC) as adaption body. Part of the admission documentation is to collect and record patiences food likes and dislikes. According to Saunders, Smith and Stroud (2010), MUST is reliable and valid screening tool in diagnostic or prediction of malnutrition (Saunders, Smith and Stroud, 2010). However, nutrition assessment was only done for patients who have bee n referral to their GPs following scoring, weight loss of 1 to 2 per cent per week, 5 per cent per month or 10 per cent over period of six months (Mitchell, 2003).According to RCN and NPSA (2009), purpose of nutritional assessment is details identification of nutritional status and for spare dietary invention to be formulated and implicated (RCN and NPSA, 2009). In the authors care home, dietician or dieticians assistant based on the information provided by staff cherish on duty normally carries out the nutritional assessment. As removed as author concerns, nutrition assessment should be done by care home nurses as they are working in culmination contact with patients and their families on the daily basis, know come apart persons food likes and dislikes. However, special nutrition trainings are not always available to the nursing home staff. This could lead to complicated nutrition issues not to be addressed as quickly as they should be due to community dieticians waiting time is usually 6 weeks.In the authors nursing home all unavoidable equipments are available such as weight scales and height measures. However, weight scales calibration has not been done which could lead to poor nutrition screening assessment (NPSA).After completing the MUST, the author and colleagues will formulate the individualised care plan for each patient in order to meet nutritional requirements. Nutrition care plan could be based on the information or guidance provided by dietician or other health professions.TreatmentAccording to Hark and Morrison (2003), the nutrition needs of healthy older adults are mainly the same as for middle age adults (Hark and Morrison, 2003). The intake of food containing Calcium, Vitamin D, Folate, Vitamin B12 and B6 should be increased for the elderly population (Hark and Morrison, 2003). Protein intake recommendation is variable from 0.8 g/kg per day in the USA (Mitchell, 2003) to 0.75 g/kg in the UK (McKevith, 2009). However, according to Mitc hell (2003), one established nutrition needs recommendation cannot be used for all ages population (Mitchell, 2003). In addition, patients lifestyle, height and weight should be taken in account (Mitchell, 2003).There are number of fundamental support of nutrition available at present such as enteral and parenteral nutrition support (Hark and Morrison, 2003). At this assessment only oral nutrition support (ONS) will be discussed. The aim of the nutrition support is to ensure an individual gets fair to middling energy, proteins, macronutrients and micronutrients to meet patients nutrition requirements (Saunders, Smith and Stroud, 2010). Saunders, Smith and Stroud (2010) argued that provision of regular meals with better nutrition content, wide menu choice and assistant with feeding should be enough to meet nutrition requirement and reduce nutrition risk (Saunders, Smith and Stroud, 2010).Numerous studies show that nutrition support could reverse weight loss, only if underlying healt h conditions under control (Saunders, Smith and Stroud, 2010). However, not all patients react at the same way (Hickson, 2006). At what reasons care and treatment should take an account of individual needs and preferences (RCN and NPSA, 2009). In practice, knowledge of food preferences and past medical history, following personalised nutrition care plan, serving patients with small meals (Teo and Wynne, 2001) or using a small house could advertise service user to finish all meal.Currently some of the UKs hospitals commenced to use red tray scheme for serving the meals to patients. A purpose of using red trays is to alert hospital staff that patience with red tray is at nutrition risk and need assistance or supervision with diet intake (Bradley and Rees, 2003 see Davis, 2007).Protection of mealtime scheme is also widely spread head across the UK. The purpose of this scheme is to create an environment for hospital patients discontinue from hospital activities and unnecessary distu rbance during a mealtime. In addition, this scheme is to assist nursing staff with concentration on the meeting nutrition need of hospital patients (NS, 2007).People with Dementia could loss an ability to use cutting tool that could lead to weight loss and malnutrition. Providing those patients with available finger food could improve nutrition status (Alzheimers society, 2011).Teo and Wynne (2001) argued that the possible benefits from using energy supplements in elderly patients have received little or no evaluation in clinical practice (Teo and Wynne, 2001). However, during the study carried out by Volkert et al (1996), it was found that patients consuming food supplement while in-patience and 6 months in community have develop positive nutritional status compare to congregation of patients without food supplements (see Teo and Wynne, 2001). The author has come across the situation then GP has refused to prescribe food supplement to one of the patience and recommended full fat milk instead. In addition, during controlled trial for six months in patients who have been accomplish from hospital and prescribed ONS has no economic benefit. To compare, using ONS in community is be more than using ONS in hospitals (Elia et al., 2005).However, malnourished patients using could be at risk of re-feeding syndrome, which could results in death (Saunders, Smith and Stroud, 2010). Re-feeding syndrome is associated with water computer storage leading to fluid overload due to decay of potassium, magnesium, phosphorus and sodium in blood plasma (Mallet, 2002). Saunders, Smith and Stroud (2010) recommended that during re-feeding saviour malnourished patients potassium, phosphate and magnesium should be prescribed and thiamine (for patients with history of alcohol excess) (Saunders, Smith and Stroud, 2010).ConclusionThe UK elderly population is rising, currently about 16 per cent of the population is above 65 (Hickson, 2006) and by 2050 over 30 per cent European populati on will be over 60 which will result in prevalence of malnutrition to rise (European Nutrition for Health Alliance, 2005). many a(prenominal) changing associated with aging have been documented, however, how senescence leads to the health conditions, related to aging, is still unknown (Mitchell, 2003). It was found that ageing is leading to slow reduction of weight and modification in body composition. It is due to declines in bone, muscle mass and body cell mass. Bone mass reduced due to miserable intake of Calcium and inadequate exposure skin to the sunlight to encourage production of Vitamin D (Sahyoun, 2002). In general, people are gaining weight until they sixtieth birthday and after gradually reducing weight, usually 10 per cent between 70 and 80 (Mitchell, 2003). Weight loss related to aging and malnutrition should be indentified during initial nutrition assessment.In addition, community healthcare is confront many concerns. Firstly, malnutrition remains under-recognized pr oblem facing patients, their families and health professions (Saunders, Smith and Stroud, 2010). Secondly, according to, Hark and Morrison (2003) argued that there are no single physical or biochemical screening tools could accurate predict the nutrition status in elderly (Hark and Morrison, 2003). Food prices are constantly rising and ONS are costing too much to the local PCT. In the authors opinion, providing service users with good quality food, offer choice of menu and snacks between meals are solution to constrict malnutrition.The significant role in education medical students and junior doctors in nutrition has widely recommended (Saunders, Smith and Stroud, 2010). However, inadequate knowledge in nutrition of nursing and care staff could increase risk of malnutrition (Saunders, Smith and Stroud, 2010). In the authors care home nutrition in elderly is not mandatory training for the care staff. Following this assessment, the author will provide pertinent care staff with infor mation on the nutrition in elderly service users. This could be achieved through supervision sections and face-to-face talks. Moreover, there it is possible, elderly population and their families should be informed about the latest nutrition recommendations related to their age, lifestyle and health conditions and should encouraged to apply those recommendations to individuals lives (Sahyoun, 2002).