Enhancing patient-professional discussion of malnutrition risk in a screen and treat intervention for older adults delivered in primary care

Payne, Liz, Harris, P, Slodkowska-Barabasz, Joanna, Ghio, D, Grey, Elisabeth, Little, Paul, Yardley, Lucy and Morrison, Lianne (2021) Enhancing patient-professional discussion of malnutrition risk in a screen and treat intervention for older adults delivered in primary care. In UKSBM Annual Scientific Meeting 2021, 13/01/21.

Abstract

Background: In the UK, around 13% of community-dwelling adults over 65 are at risk of malnutrition but challenges to eating and worsening nutrition may go unnoticed. Screening older adults and treating those at risk in primary care can help to reduce malnutrition risk, infections and healthcare use, and improve quality of life. Methods: Using the Person-based Approach (PBA) we developed and tested an online tool to support malnutrition screen and treat in primary care. ‘Think aloud’ focus groups with thirty healthcare professionals (HCPs) were carried out alongside iterative improvements to the support tool. A further nine interviews were carried out during feasibility testing in twenty-two practices, after which we made final adjustments to the support tool. A series of patient booklets to address barriers to eating were developed for use alongside the support tool. Results: HCPs were aware of malnutrition risk, but saw malnutrition as the jurisdiction of district nurses and proactive care teams, applicable to very unwell or underweight patients, rather than to those with low appetite or common eating difficulties. Some found it difficult to discuss eating habits with patients. We therefore outlined risk factors for reduced appetite and eating, gave a rationale for early intervention, encouraged HCPs to read the booklets and involve patients in choosing relevant booklets, and provided example wording to encourage and support discussion of nutritional needs and lifestyle changes. Conclusions and implications: The PBA and iterative qualitative methods allowed us to identify that HCPs did not always prioritise malnutrition risk assessment until obvious signs of deterioration were observed, and needed support to understand and discuss nutritional needs with older adults. Had we not explored HCPs’ perspectives and addressed these issues, the tool would have been insufficiently persuasive and relevant, with HCPs potentially being less engaged with the intervention, and less able to deliver the intervention optimally to patients.

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Contributors

Author: Liz Payne

Author: Paul Little

Author: Lucy Yardley

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