How can we better support older people at risk of malnutrition living in the community? A qualitative study exploring the views and practices of older people, carers, primary care and community health professionals
Malnutrition is associated with increased morbidity and mortality and is estimated to affect 1.3 million people >65 in the UK. However, we know little about the views of older people, carers and health professionals on current management of weight/appetite loss in community-dwelling frail older adults. The aims of this study were to a) explore the views and practices of older people at risk of malnutrition, their carers, primary care and community professionals on how malnutrition is currently managed, b) identify gaps in knowledge, facilitators and barriers to healthy eating in later life, c) identify the elements of potential primary care based interventions for frail older people at risk of malnutrition.
We conducted a qualitative study using a) semi-structured interviews with community-dwelling people aged ≥75, malnourished/at risk of malnutrition, recruited from four GP practices, their carers, b) a carers’ focus group in London, and c) Seven focus groups with primary care and community health professionals (multi-disciplinary (MDT) and dietitians) in London and Hertfordshire. Data were analysed using thematic analysis.
We interviewed 93 participants in total (24 older people, 9 informal carers, 60 health professionals). Most older people did not consider their low weight to be a problem. ‘Healthy eating’ perceptions focused on fruit and vegetable intake and low-fat diet. Older people rarely asked their GP about diet and none had received advice about increasing protein intake or gaining weight. Carers held different perspectives and most expressed concern about weight loss in the older person they cared for, although they were not provided with any guidance on how to help meet the older person’s dietary needs. Most older people and carers were open to advice, and did not have a strong view about the professional background of the person delivering such a service (doctor, nurse, dietitian, other trained professionals), although the majority felt they would follow advice recommended by a clinician. Health professionals perceived malnutrition as a multi-faceted problem. Overall, a lack of ownership of the problem was a main barrier to management. From the primary care professionals’ perspective, hindering factors were time constraints and lack of training in nutrition. GPs generally felt overwhelmed by workload and saw nutrition as low priority and not necessarily within their remit. Some suggested public health interventions delivered in other community settings. MDT professionals reported screening for malnutrition during initial assessment of frail people and referral to dietitians but thought that this was often not enough, especially for people with unmet social care needs.
There is currently a gap in the care provided for older people at risk of malnutrition in the community. Future interventions should include a multi-faceted approach with education of individuals and healthcare professionals and a tailored approach according to need and context.