Abstract
BackgroundMalnutrition is associated with increased morbidity and mortality, and is very common in frail older people. However, little is known about how weight loss in frail older people can be managed in primary care.AimsTo explore the views and practices of primary care and community professionals on the management of malnutrition in frail older people; identify components of potential primary care-based interventions for this group; and identify training and support required to deliver such interventions.Design and settingQualitative study in primary care and community settings.MethodSeven focus groups and an additional interview were conducted with general practice teams, frailty multidisciplinary teams (MDTs), and community dietitians in London and Hertfordshire, UK (n = 60 participants). Data were analysed using thematic analysis.ResultsPrimary care and community health professionals perceived malnutrition as a multifaceted problem. There was an agreement that there is a gap in care provided for malnutrition in the community. However, there were conflicting views regarding professional accountability. Challenges commonly reported by primary care professionals included overwhelming workload and lack of training in nutrition. Community MDT professionals and dietitians thought that an intervention to tackle malnutrition would be best placed in primary care and suggested opportunistic screening interventions. Education was an essential part of any intervention, complemented by social, emotional, and/or practical support for frailer or socially isolated older people.ConclusionsFuture interventions should include a multifaceted approach. Education tailored to the needs of older people, carers, and healthcare professionals is a necessary component of any intervention.
Highlights
Malnutrition in the form of undernutrition is estimated to affect 1.3 million people aged >65 years living in the community in the UK.[1]
There was an agreement that there is a gap in care provided for malnutrition in the community
Challenges commonly reported by primary care professionals included overwhelming workload and lack of training in nutrition
Summary
Malnutrition in the form of undernutrition is estimated to affect 1.3 million people aged >65 years living in the community in the UK.[1]. Data from prospective studies have shown that older people who are classified as overweight based on the body mass index (BMI) range for the general adult population live longer than those who are underweight. A U- or J-shaped curve of the association between BMI and mortality has been observed in several studies.[7,8,9,10,11] According to National Institute for Health and Care Excellence (NICE) guidelines, nutrition support should be considered in people who are malnourished, as defined by one of the following: a BMI 10% in the last 3–6 months, or a BMI 5% within the last 3–6 months.[12]. Malnutrition is associated with increased morbidity and mortality, and is very common in frail older people. Little is known about how weight loss in frail older people can be managed in primary care
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