Nutrition screening survey in the UK in 2007. Nutrition screening survey and audit of adults on admission to hospitals, care homes and mental health units.

Abstract

Malnutrition in adults on admission to hospitals and care homes affects almost 1 in 3 subjects, who were mostly in the high risk category.Malnutrition is common in all types of care homes and hospitals, all types of wards and diagnostic categories, and all ages.It is also common in mental health units. Nutritional screening policies and practice vary between and within health care settings, whilst malnutrition continues to be under-recognised and under-treated. Summary The Nutrition Screening Survey1.1 This report provides a summary of the largest nutrition screening survey undertaken in the UK.Reporters from 175 hospitals, 173 care homes and 22 mental health units in the UK completed a general questionnaire and an anonymous patient questionnaire as part of a national audit on nutritional screening.Unlike previous studies that used different criteria to identify malnutrition in various care settings, this survey used the same criteria based on the 'Malnutrition Universal Screening Tool' ('MUST') in all care settings.Data were collected on patients during the first three days of admission to hospitals and acute mental health units, and on residents admitted to care homes and long stay / rehabilitation mental health units in the previous six months. Hospitals 2.1Of 9336 patients who were screened on admission to hospital, 28% were found to be at risk of malnutrition, (high risk, 22%; medium risk, 6%).The combination of these two risk categories is henceforth referred to as 'malnutrition' for simplicity. 2.2Since the presence of 'malnutrition' at or shortly after admission to hospitals suggests that it largely originated in the community, strategies to prevent and treat malnutrition in the community setting should be considered. 2.3'Malnutrition'variedsignificantly according to source of admission (25% from home, 31% from another hospital, 32% from another ward, and 43% from a care home), type of admission (32% for emergency admission, 20% for elective admission), and type of ward (e.g.43% in oncology wards and 15% in orthopaedic/trauma wards).It was also greater in hospitals that had a screening policy than those that did not (28% v 24%), and considerably greater in large hospitals with 1000 beds than in those with <1000 beds (38% v 26%). 2.4'Malnutrition'was common in all age groups and diagnostic categories, but it was significantly more common in women, who were older than men (29% v 26%), in subjects aged over 65 years than under 65 years (30% v 24%), and in certain diagnostic categories than others (e.g.gastrointestinal disease (43%) and neurological disease (33%) versus cardiovascular (21%) and musculoskeletal conditions (18%)).A low body mass index (BMI <20 kg/m 2 ) contributed to a 'MUST' score in 4 out of 10 'malnourished' patients. 2.5Most hospitals reported that they had a screening policy (89%), but weighing on all wards was carried out in less than half (less than a quarter of patients involved in the survey were in hospitals where weighing was carried out on all wards).This suggests that much malnutrition continues to be under-recognised and under-treated. Care homes3.1 Of 1610 residents screened 30% were 'malnourished' (20% high risk, 10% medium risk). 3.2The prevalence of 'malnutrition' was greater in residents admitted from hospitals (35%) and other care homes (30%) than in those admitted from their own homes (24%).The prevalence was also greater in nursing homes (35%) than residential homes (22%). 3.3'Malnutrition'was more prevalent in care homes that had a screening policy (31%) (these care homes accounted for 82% of the residents in the survey) than in those that did not (23%). 3.4A low BMI (<20 kg/m 2 ) contributed to the 'MUST' score in about 9 out of 10 'malnourished' residents.Underweight was 2-to 3-fold more common than obesity.The subjects in care homes were older than those in hospitals and mental health units, half of them being 85 years and over.The prevalence of 'malnutrition' tended to increase with age (26% in those <70 years, 29% in those 70-84 years and 32% in those 85 years) and duration of stay (up to 6 months), but neither of these were statistically significant. 3.5Women were older and had a greater prevalence of 'malnutrition' than men (32% v 27%). 3.6Half the residents had neurological conditions with an associated 'malnutrition' prevalence that was intermediate (33%) between those found in respiratory (43%) and musculoskeletal conditions (21%), which accounted for only 5% and 9% of all those screened respectively. General subject characteristicsGender: There were 1095 women and 515 men (total N = 1610) Ratio of women to men, 2.1:1.0. Age:The mean age was 83.3 (sd 9.5) years (median 85.0 years; inter-quartile range 79-89 years) (N = 1570).Women (N =1066) were older than men (N = 504) (mean 84.4 (sd 8.7) v 81.0 (sd 10.6) years; median 86 v 83 years; P < 0.001).96% of the residents were 65 years and over.In the figure of age distribution, frequency refers to the number of residents in each age group, which is represented by the individual bars of the histogram.