Nutrition - self management

Malnutrition can easily develop in elderly and frail people living in the community, and supporting better nutrition early on can help in preventing some hospital admissions, or at least aid recovery and rehabilitation. A Patients Association survey reveals a lack of awareness amongst patients and carers regarding risk of and prevention of malnutrition or where to seek advice. Regular weight monitoring is cited as one example of an easy way for vulnerable individuals to monitor for a potential risk though checking weight is often overlooked (Patients Association 2011).

The Welsh Assembly Government (2011) has developed a care pathway for community settings. Its ultimate aim is to help to get individuals to the point where they can manage their own situation as much as their health allows. The pathway also underlines the need for all practitioners to use opportunities with frail and vulnerable patients and clients to raise awareness of good nutrition, and to look out for signs of any difficulties with eating and drinking. A diagram and associated resources suggests questions that can be asked and actions that might need to be taken.

Self management of nutritional care is particularly important for people with long-term conditions who are also more vulnerable to malnutrition. A case study within the interim report on the Improving Nutritional Care programme, describes an intervention to provide people with chronic obstructive pulmonary disease (COPD) with improved nutritional support, and increase their awareness and knowledge as part of developing their own care plans (Scottish Government 2011, case study 3 pp.10-11).

There is also a need to set up systems to enable and support the self-management of artificial nutrition support. Statement 4 of the NICE quality standard for nutrition support in adults(18 years and older), underlines the importance of training for adults who are receiving oral nutrition support, enteral or parenteral nutrition, and their carers in managing the nutrition delivery system, including the storage of feed, and in monitoring their wellbeing so that any adverse changes are quickly recognised (NICE 2012).