Risk
- Nutrition – Malnutrition is caused by a lack of nutrients in our diet, either due to a poor diet or problems absorbing the nutrients from food.
- Malnutrition increases the risk of frailty and falls. It also makes complications, such as fractures or pressure sores from a ‘long lie’ following a fall, much more likely.
- Hydration – dehydration can lower blood pressure and cause weakness and dizziness, thus increasing the likelihood of falling.
- Not drinking enough fluids can increase the risk of fatigue and lethargy, as well as UTI’s and chest infections, all of which increase the risk of falls.
Reason
- Older people are at more risk of malnutrition due to such things as: reduced appetite, diminished sense of smell and taste, difficulty digesting food, gum or teeth problems or poorly fitting dentures, a dry mouth, feeling fuller more quickly, reduced motivation, reduced manual dexterity (use of hands) to cut up food or to put food in the mouth, and problems with swallowing (dysphagia).
- Ageing and frailty can affect our activities of daily living and mealtime routines, which can lead to a reduced to nutritional intake.
- Many older people are affected by multimorbidities, making this group particularly at risk of malnutrition.
- Many chronic conditions can affect the ability or desire to eat, predisposing individuals to malnutrition.
- Older people, and particularly those with reduced mobility may be reluctant to drink fluids for fear of needing the toilet at an inconvenient time. They may not have a sense of how much they have drunk, or they may have reduced mobility, which may make it difficult for them to get a drink for themselves.
- Good nutrition, especially adequate protein and energy intake, helps limit and treat age-related declines in muscle mass, strength and functional abilities. Adequate Calcium and Vitamin D also reduce the risk of fractures.
- Adequate hydration reduces the risk of UTI’s and falls.
Interventions
- Identifying and treating malnutrition is an important part of falls prevention.
- Screening for malnutrition, using a validated tool such as the Malnutrition Universal Screening Tool (‘MUST’) should be undertaken, with appropriate intervention and monitoring, and onward referral to a dietician where the person is at high risk.
- Individuals at risk of malnutrition or dehydration should have a care plan which:
- Records risk and identifies underlying causes.
- Sets clear goals of the interventions (e.g. improving nutritional intake, reducing the risk of falls, improving strength or functional abilities that are specific to the person’s needs).
- Has a daily food and fluid target which can be completed throughout the day, so that progress can be monitored against goals, and modified appropriately.
- Ensures those at risk of falls and or frailty are encouraged to consume protein at each meal and after exercise (with a referral to a dietitian for further advice, as appropriate).
- Encourages people to drink 6 to 8 drinks per day (about two litres) every day. As well as water, these drinks can include fruit squash and milky drinks, and should also consider foods with a high fluid content such as melon or soup.
- Ensures there are processes in place to monitor and document fluid intake and signs of low-intake dehydration.
- Shows that there is active promotion of fluid intake (e.g. offering regular fluid intake, offering a variety of drinks, making fluids visible attractive and accessible, providing assistance with drinking where required, or any other strategies that have been discovered that work for the individual). Appropriately sized cups or glasses, or clear ones for better visibility may promote better fluid intake. Remember also, that drinks that are thickened for people with dysphagia (difficulty swallowing) may be more appealing if they are served already mixed, rather than being mixed in front of the person.
- Shows evidence of the efforts that are being made to find strategies that work for that individual where there are barriers or difficulties with fluid intake.
Considerations
- It is important that the individual’s capacity to make decisions around this specific area is considered and documented.
- Individuals who have capacity regarding these decisions can make choices about what, and how much, they would like to drink. You need to document their ability to make this decision, as well as what they chose every time is it relevant.
- You may need to inform them of the benefits if they are not aware, or you may need to remind them if they have difficulty remembering things.
- If the individual is assessed as not having capacity regarding these decisions, this needs to be documented appropriately and interventions need to be implemented and documented as part of a Best Interests Decision, using appropriate paperwork.
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