Whilst obesity has been much in the spotlight over the past few years and UK numbers increasing dramatically due to the restrictions of the Coronavirus lockdowns, malnutrition is equally important and GPs have a significant role to play in recognising, treating, and preventing malnutrition.
What is malnutrition?
The World Health Organisation (WHO), describes malnutrition as ‘deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients’ and the term is used to cover two broad groups of deficiencies:
Undernutrition—which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals).
Overweight or ‘overnutrition’ – including obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes, and cancer).
The warning signs of malnutrition among adults:
Some effects of a poor diet on the body to look out for in patients include:
- Loss of muscle strength
- Prolonged healing of wounds
- Prolonged recovery time following an illness
- Low mood / or depression
- Poor concentration
- Frequently feeling cold
- Oral problems, such as dentition
- A recent diagnosis or period of ill health
- Dry, thin, or brittle hair
- Cracked dry nails
- Xerosis (dry skin)
- Loose or poorly fitted clothes or jewellery
- Reduced appetite
- Lack of interest in food and drink
- Tired or lethargic
There may be some pre-existing conditions that put patients at a higher risk of malnutrition, these include:
- COPD due to difficulty eating
- Diseases of the digestive system e.g. Crohn’s, ulcerative colitis
- Dementia that causes a person to forget to eat or lose focus on the importance of their nutrition
- Long term conditions that can cause loss of appetite, increase nausea and vomiting or lead to changes in bowel habit—such as cancer and liver disease.
- Mental health conditions, such as depression or schizophrenia, which may affect one’s desire to eat and their mood.
GP intervention for malnutrition
During ‘normal times’ (pre-COVID-19) malnutrition was found to be more common in those who were socially isolated. Now we are living in a time of social distancing and lockdowns, it is even more important that we know what to look for when seeing or talking to our patients.
Think: Is the patient vulnerable, are they at high risk?
It is ever important to be aware of other impacts of COVID-19. If the patient is shielding, do they have reduced access to shopping, or reduced access to professionals who could identify early signs or risks of malnutrition? Many adults at risk of malnutrition could be missed during the COVID-19 pandemic.
Many older people think that a reduction in food and drink intake is normal as they are less active, however weight loss should not be considered a normal part of ageing.
Consequences of malnutrition
Evidence shows that an elderly person suffering from malnutrition are:
- Twice as likely to see their GP
- Have more hospital admissions
- Stay in the hospital longer
- Experience more co-morbidities
The health and wellbeing of our patients are at the centre of every assessment and consultation we do. Preventing our patients from becoming sick due to malnutrition is of critical importance, especially during this current pandemic. Take the time to ask some questions about your patients’ appetite, how they get their shopping, whether they have lost weight, whether they feel hungry etc., document your findings and refer for advice if you are in doubt.
During our hot topic series our Head of Clinical Performance, Lorraine Gray, will be looking into a new subject each month, providing commentary and advice on pressing issues for clinicians. If you have any topics you would like to know more about, please get in touch.
A former RGN and Matron, Lorraine has over 10 years in senior executive roles in IUC and NHS 111 services and today leverages her operational and clinical experience offer balanced delivery solutions and insights for our clinicians.