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Nutrition for specific groups

Malnutrition and dehydration are dangerous. They can be both the cause and consequence of disease (BAPEN 2010; Water UK 2007). Certain groups are particularly vulnerable however.

Children and young people

Malnutrition, both under-nutrition and over-nutrition, can have a considerable impact on development and activity in children and young people and create problems that continue into adulthood. A position statement from the Royal College of Nursing (RCN) emphasises the important role that nurses have in identifying those who are at a risk of malnutrition and in monitoring this, and provides guidance on assessing nutritional status (RCN 2006).

In addition malnutrition effects a significant number of hospitalised children (Joosten and Hulst 2008) which again has important implications for identification and appropriate nutritional support (More 2008).

Older people

Malnutrition and dehydration are often not recognised among older in-patients, care home residents and among older people treated in the community and there is also a lack of public awareness (Patients Association 2011). "Addressing malnutrition requires an effective delivery chain that cuts acrosss the domains of multiple national and local public agencies, the private, and the non-profit sector" (European Nutrition for Health Alliance 2006, p.8). Often there is a complexity of factors that can influence nutritional status. These include: chronic illness and co-morbidities; medication that can affect appetite, hydration and how the body absorbs nutrients; physical changes - for example impaired mobility affecting ability to shop or access food choice (Nursing Standard 2009. 

The impact can be even greater in the frail elderly. Poor nutrition and hydration equally may arise from a person being physically and psychologically frail, and recognising and responding to frailty itself is a further important factor in good nutritional care in the older age group (Health and Phair 2011).

Improving nutritional care and achieving adequate fluid intake has benefits for those with long term conditions. Poor nutrition is one of a number of factors that increase the likelihood of pressure ulcer development in patients and contributes to the risk of falls in vulnerable people (NHS Quality Improvement Scotland 2009; Patient Safety First 2009). The maintenance of nutrition and hydration in people who have suffered a stroke is important in improving outcomes and helping to prevent complications. Management of dysphagia – swallowing difficulties poses particular challenges in some stroke patients (Rowat 2011).

People with dementia may also experience problems with swallowing and chewing particularly as the dementia progresses. The changes that occur due to dementia can affect a person’s relationship with food and eating (Alzheimer’s Society 2011). Accessibility to and visibility of food and drink and encouraging involvement in preparation of food are increasingly important in helping to promote independence (Social Institute for Excellence 2010).

Learning disabilities

Swallowing difficulties and problems with feeding are also more prevalent in people with learning disabilities, particularly profound disabilities, often caused by neurological problems or structural abnormalities of the mouth and throat (National Patient Safety Agency 2007; RCN 2011). Problems with obesity or being underweight in people with learning disabilities may result from the impact on lifestyle or be caused by specific conditions (RCN 2011).

Palliative and end of life care

Difficulties due to severity of illness, frailty and compromised swallowing are equally relevant to nutrition in palliative and end of life care.  Nutritional care may also pose difficult decisions and dilemmas regarding appropriate use of clinically assisted nutrition and ensuring the comfort of the patient, and ethical and legal issues around patients’ advance decisions and withholding or withdrawing treatment (Royal College of Physicians 2010).

For further information and guidance see Resources for specific groups.

References

These resources were last accessed on 19 February 2013. Some of them are in PDF format - see how to access PDF files.

Alzheimer's Society (2012) Caring for a person with dementia. Everyday care: eating. Alzheimer’s Society website.

BAPEN (2012) Toolkit for Clinical Commissioning Groups and providers in England: Malnutrition matters: meeting quality standards in nutritional care 2nd ed (PDF 4.6MB), Redditch: BAPEN.

European Nutrition for Health Alliance (2006) Malnutrition among older people in the community: policy recommendations for change, London: ENHA. 

Heath H and Phair L (2011) Frailty and its significance in older people's nursing, Nursing Standard, 26(3) 21 September, pp.50-55. [Full text is available through the RCN e-library via the e-journals].

Joosten KF, Hulst JM (2008) Prevalence of malnutrition in pediatric hospital patients, Current Opinion in Pediatrics, 20(5), pp.590-596.

More J (2008)  Don't forget the undernourished children in our midst, Journal of Family Health Care, 18(5), pp.159-160.

National Patient Safety Agency (2007) Ensuring safer practice for adults with learning difficulties who have dysphagia, NPSA website.

NHS Quality Improvement Scotland (2009) Prevention and management of pressure ulcers – best practice statement, Edinburgh: NHS QIS (made available on the Healthcare Improvement Scotland website).

Nursing Standard (2009) Nutrition and older people,  Harrow, Middlesex: RCN Publishing Company.( You can access the full text of this publication if you are a registered subscriber to Nursing Standard. Hard copies of the booklet are also available in the RCN library).

Patient Safety First (2009) The ‘How to’ guide for reducing harm from falls, London: Patient Safety First.

Patients Association (2011) Malnutrition in the community and hospital setting (PDF 412.79KB), Harrow, Middlesex: Patients Association.

RCN (2006) Malnutrition: what nurses working with children and young people need to know and do. An RCN position statement (PDF 1.22MB), London: RCN.

RCN (2011) Meeting the health needs of people with learning disabilities: RCN guidance for nursing staff (PDF 1.7MB) 2nd.ed., London: RCN.

Rowat A (2011) Malnutrition and dehydration after stroke, Nursing Standard, 26(14) 7 December, pp.42-46.

Royal College of Physicians (2010) Oral feeding difficulties and dilemmas: a guide to practical care, particularly towards the end of life, London: RCP.

Social Care Institute for Excellence (2010) Dementia Gateway: eating well for people with dementia, SCIE website.

Water UK (2007) Ask about: older people, Water UK website.