Exploring the views and dietary practices of older people at risk of malnutrition and their carers: the Nutrition in Later Life Study

Conference: 
SAPC ASM 2018 - London
Talk Code: 
P1.11
Presenter: 
Christina Avgerinou
Co-authors: 
Christina Avgerinou1, Cini Bhanu1, Kate Walters1, Jennifer Rea1, Yehudit Bauernfreund1, Helen Croker2, Kalpa Kharicha1
Author institutions: 
1Department of Primary Care and Population Health, University College London 2Health Behaviour Research Centre, University College London

Problem

Malnutrition is an important cause of morbidity and mortality in older people. Estimates suggest that 1.3 million people over 65 in the UK are malnourished. Malnutrition is commonly under-recognised in general practice, due to limitations in consultation time and lack of appropriate training. We have little evidence on the views and perceptions of older people and their carers regarding the management of this condition in the community setting.Aims1. To explore the views and dietary practices of older people at risk of malnutrition and their informal carers on the management of malnutrition in later life 2. To identify the gaps in knowledge, barriers and facilitators to healthy eating in later life for older people at risk of malnutrition3. To explore potential interventions for malnutrition in later life

Approach

Design: Qualitative study using semi-structured interviews.Setting: Three GP practices in London (Camden, Islington and Barnet). Study population and sampling: Community-dwelling older people aged ≥75 years, identified as malnourished or at risk of malnutrition, and their informal carers who support them with shopping or meal preparation. We are interviewing up to 40 people in total.Data collection and analysis: Interviews are audio-recorded and transcribed verbatim. Data collection will continue until saturation of key themes. Thematic analysis is being used to identify key emergent themes and their meaning, with input from the entire research team including lay members.

Findings

Early interview findings (n=18) suggest that ‘healthy eating’ beliefs established in earlier life are maintained in later life. Little awareness of the effect of age related malnutrition is reported. Some participants were aware of recent weight loss, reduced appetite or eating smaller portions, although they were not always able to understand why. Some reported having a smaller appetite and low energy is part of normal ageing and may be a result of decreased physical activity. Amongst people who could pinpoint when and why they started losing weight, reasons reported were acute illness, incomplete recovery following discharge from hospital, mental health issues and other health conditions. Few had discussed weight loss with their GP, but the majority thought that the doctor would not have time to deal with their reduced appetite. People liked the idea of a nutritional intervention delivered in primary care. Some felt that the doctor was best placed to provide that support, whereas others would welcome advice from a nurse, dietitian or other trained professional.

Consequences

Older people with reduced appetite and weight loss are open to advice and support with their nutrition, which is currently lacking. Interventions to help people improve nutrition and increase/maintain their weight are needed to provide this type of support in the community setting.

Submitted by: 
Christina Avgerinou
Funding acknowledgement: 
This is a summary of independent research funded by the National Institute for Health Research (NIHR)’s School for Primary Care Research, Funding round (FR) 13. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.