11:21am Saturday 11 July 2020

GPs help address malnutrition in older people living at home

A third of older adults entering the hospital system are overtly malnourished, while a further 50% are considered to be at nutritional risk.

“What is most concerning is that most of these patients are discharged home in a poor nutritional state where a downward spiral of ill health results,” according to the project leader Associate Professor Karen Charlton.

“The poor referral systems between hospital and community services means that these frail older people often fall between the gaps and are left to fare for themselves.”

Using the world’s largest databases of nutritional assessment in older patients, the team has found that malnutrition is associated with longer hospital stays, recurrent hospital admissions, and poor clinical outcomes. Even accounting for underlying illness and age, researchers say malnutrition predicted a greater than threefold risk of mortality at between 12 and 18 months of follow-up. The data span more than five years of patient admissions, whereby dietitians have routinely assessed the nutritional status of almost 5,000 people who entered rehabilitation and acute hospitals in the Illawarra.

“But this is not enough for action. In order to make health policy makers sit up and listen, and provide more funding for strategies in the community to address this problem, we need to demonstrate the cost of malnutrition in this age group, Professor Charlton said.

Professor Simon Eckermann, a health economist, has joined the team to estimate the additional burden on the health care services in older patients who are in a poor nutritional state.

The head of the Nutrition and Dietetics Department of the Illawarra Shoalhaven Local Hospital District, Ms Marianna Milosavljevic, said she was proud that her staff are leading the field in best clinical practice to identify malnutrition in hospital.

“We are confident that people at-risk of malnutrition are identified and referred to a dietitian during their hospital stay,” Ms Milosavljevic said.

“However, when they go home, that is when things tend to fall apart . . . they may feel too ill or frail to shop or prepare their own meals, experience poor appetites, or even forget to eat if there is confusion or some cognitive decline.”

Professor Charlton believes that collaborative efforts between researchers and practitioners are key to addressing such complex problems that span the health care system, as well as community-based social services.

“Getting general practitioners involved so that they recognise the problem and refer older people at risk to appropriate services earlier rather than later is crucial,” Professor Charlton believes.

A recently funded Illawarra Health and Medical Research Institute (IHMRI) project aims to introduce change into General Practice that will improve health service delivery to older adults living in the community, by focusing on early identification and management of malnutrition.

The project is a joint partnership between General Practitioners in the region (Illawarra and Southern Practice Research Network – Dr Andrew Dalley, Dr George Albert, Dr Adam Hodgkins), researchers from the School of Health Sciences (Associate Professor Karen Charlton, Dr Karen Walton) and the Graduate School of Medicine (Professor Andrew Bonney), as well as the Illawarra Shoalhaven Local Health District (Professor Jan Potter, Ms Mariana Milosavljevic). A PhD student, Ms Aliza Hamirudin, is also working on the project.

An IHMRI Health Care Delivery Research Theme meeting is being held tomorrow evening (Wednesday 12 September) at the Innovation Campus.

Professor Charlton is confident that the Illawarra can lead the way in this important but often overlooked area.

“Networking opportunities have brought together a range of disciplines, including public health nutritionists, dietitians, geriatricians, and general practitioners. We are in a unique position to tackle the problem of how to identify and address malnutrition in older people in the community – which can hopefully be used as a model nationally.”

Through a UOW Community Engagement grant awarded in 2010, Professor Charlton and Dr Walton (both School of Health Sciences) have worked with local Meals on Wheels organisations to develop additional value-add services that can meet the nutritional needs of clients.

“The whole picture is coming together now – our vision is that the Illawarra region will provide the best services possible to its older residents,” Professor Charlton said.

For further information contact Associate Professor Karen Charlton on 4221 4754.

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