Author: Siobhan McKenna

INTRODUCE the training and how long it will be, with some interactive elements for them to get involved with and contribute ideas to.
READ the bullet points. These are the three main aims of the programme and the training

Maslow’s triangle highlights the most basic of needs being food, water, warmth & rest. Without these no-one can thrive but it is more important the older you get.
Eating & drinking is fundamental for an older
person’s OVERALL health and well-being.
READ the bullet points.
HIGHLIGHT eating & drinking as one of the TOP 4 PRIORITIES for GM Ageing Hub / GM Food Cell.

READ the slide

DEFINE malnutrition and consider the two different extremes – obesity / malnutrition.
This training concentrates on UNDERNUTRITION in relation to OVER 65s.
READ the slide (animations can be removed if they are distracting).
The PAPERWEIGHT ARMBAND has been developed to indicate a BMI of 20 if it fits around the mid-part of the upper non-dominant arm and 18.5 if it is lose / slips up and down this part of the arm.

READ the slide (animations can be removed if they are distracting).
HIGHLIGHT that most people (93%) live at home and may not come into regular contact with different services / agencies / groups, so any malnutrition may be hidden or missed.
The people living in care homes or staying in hospital will have more regular contact with nurses, doctors, auxiliary staff, care workers and managers. Even with lots of contact with professionals, 5% & 2% will still become malnourished.
Are these figures surprising?
What implications do they have for your work?

It’s a hidden problem.
It’s all around us - A third of recent arrivals to hospitals and care homes are already malnourished (or at risk).
The consequences - For every 10 days a person over the age of 80 is in hospital they lose 10% of muscle mass, they have slower healing wounds, a longer recovery time and generally become sick more often.
It is preventable – Losing weight is not a natural part of growing old.
It’s expensive – Malnutrition costs the health and social care system around £19-20bn per year – relate this to longer stays in hospital, higher costs of treatment and being admitted more often. A&E presentation for older people for a fall has huge costs attached.
It affects vulnerable people most – The older you are, the more likely you will be at risk.

USE the animation to show the title first, asking the question WHICH COSTS MORE TO THE NHS? – in the context of malnutrition and obesity, then the next animation to show the scales
DISCUSS the issue about obesity being everywhere, with many different campaigns about reducing the obesity figures BUT malnutrition is largely ignored, even though the costs are DOUBLE!
This may be due to obesity being more VISIBLE and malnutrition being INVISIBLE.

OPTIONAL SLIDE
ADD local stats. This will need to be adapted to reflect the population within the area the training is being delivered – local data may be on Gov.uk website or in a local JSNA through the council or public health department.

READ the slide giving examples where possible – my partner used to do all the cooking but they are in hospital / my partner always drove me to the shops and I don’t know which bus to catch on my own / I can’t be bothered cooking just for me, so I just have a slice of toast / I find it difficult to stand for long periods of time, so I can’t prepare a meal… Offer some solutions, such as food deliveries, ready meals, batch cooking, lunch clubs etc.
OUTLINE that it only takes 2-3 days to become malnourished – so if they are seen on a Thursday by workers or family and then not seen again until the following Monday, they could become
malnourished.
HIGHLIGHT that in many cases, it is PREVENTABLE AND TREATABLE and NOT a natural consequence of getting older!

DIFFERENT ways to check – verbal or visual or BOTH.
READ the writing on the picture and EMPHASISE that it can be simple things that indicate there is a concern.

READ the slide
HIGHLIGHT that a reduced sense of thirst due to age or a condition, may mean that prompts to drink are needed.
DRAW attention to the many different signs & symptoms of dehydration – these will have some baring if the case study ‘Emily’s story’ is used at slide 15.
Is dehydration currently considered as a cause of these symptoms?
Can you think of occasions when dehydration might have been missed?

READ the slide
HIGHLIGHT the number of drinks needed in a day and how dehydration can lead to hospital admissions – this can be referred back to the costs mentioned in SLIDES 6 & 7.

READ the slide EMPHASISE greater independence, which most older people want to keep for as long as they can.
NOTE – the reductions are all things that have a cost to health services as well as the older people themselves.
Animations can be removed if they are distracting
STOP AND REVIEW
Are there any questions or comments on the slides and information given so far?

READ the slide – use the animation to remind people to consider a FOOD FIRST approach before referring to a GP (last statement in red).
Discussion points:
WHY might a person display these symptoms?
What are some of the UNDERLYING CAUSES?
How LIKELY are you to notice any of these symptoms?
What would you DO if you noticed any of these symptoms?

OPTIONAL SLIDE
Depending on the group being trained, use one of the 3 optional stories or miss this slide out of the presentation. The text of these are in separate files within the package
Emily’s story – see notes
Hidden Hunger: In pairs or groups spend 2 minutes reading the story / Read out to the rest of the group & discuss.
What are the barriers to the people in those scenarios? What could you suggest / do to support those individuals? What services would be available locally to signpost to?
Grandad’s story – watch the short 4-minute clip and discuss how things can go wrong and how to find solutions for these.
The information for trainers gives more information about each of these three options

INFORMATION:
An independent evaluation by the University of Manchester has shown that 80.6% of those at risk of malnutrition have had a positive outcome (compared to an initial CBA assumption of 30%). Frailty levels of the participants are a significant factor in how they respond to the intervention (correlation between level of frailty and likelihood of positive impact). This strengthens the evidence base around the importance of early intervention. A reduction in malnutrition can stop and even reverse a person’s frailty. Full report link is at the bottom of the slide. READ the slide & EMPHASISE the 3 points.

SHOW the PAPERWEIGHT ARMBAND but demonstrate how to use it in slide 22

READ the slide
Conversation, Check and Care are the three principles of the intervention for both nutrition and hydration

READ the slide and discuss.

READ the slide
HIGHLIGHT the questions BUT ensure that they use them in a way that will benefit the older person, so a chat covering weight, appetite and any changes they may have noticed or be experiencing is probably the better way to approach this.
SHOW the Eat, Drink, Live Well booklet as the main resource, if you are concerned about an older person’s eating & drinking.

IMPORTANT
The RED FLAG questions are used to check if the older person’s weight loss, swallowing issues, stomach pain or change in their bowels, have an underlying cause, which will REQUIRE a referral to a GP or Dentist.
If your mouth or teeth are sore, this can prevent an older person from eating, drinking, taking medication and breathing properly.

DEMONSTRATE the PWAB on self or each other.
READ the slide.
DISCUSS – do they think the older people they are in contact with, will be willing to use the PWAB, if not use the VERBAL or VISUAL cues mentioned in SLIDE 10.
Eat, Drink, Live Well: Using the PaperWeight Armband - YouTube

SHOW the E,D,LW Booklet and highlight a couple of sections that may be pertinent to the group.
EXPLAIN about the additional resources: see SLIDE 33.

Eat little and often – some people may be over faced by a big meal so they should try having smaller portion sizes, if they do this, they will need to have snacks between their meals. 6 small meals or snacks are as good as 3 big meals. Page 7 of the booklet has some ideas.
Add cream, butter, cheese and milk powder to meals and snacks. This helps to increase energy without increasing portion size. Page 8 has some ideas for this.
Adding skimmed milk powder to food and drinks can be a very easy way to get extra calories and nutrients. There is a recipe for fortified milk on page 11. This doesn’t make it any thicker and should not change the taste.
Protein can help keep us strong, eggs, beans, lentils, meat and fish can all help.
Eating with others may be difficult at this time, people are being creative about how they can do this – talking to friends and family about what they eat, having video calls while eating their lunch, watching their favourite programme.
Ready meals and pre-prepared sauces can help to make meal preparation easier. There are lots of meal delivery services, some are listed on Page 12 of the booklet. Also, tinned and frozen fruit and veg is just as good as fresh.
STOP AND REFLECT
How could you use this information in your work?

EXPLAIN what a FORTIFIED DIET is and HOW they can boost the calorific value of a meal, without increasing the size, especially important if the older person doesn’t have much of an appetite.
Animations can be removed if they are distracting.
How can you make sure other carers, family members and the older person know how to fortify food?

DISCUSS each bullet point and why an older person might not be drinking enough, with some solutions.

READ the slide and DISCUSS how they can monitor an older person’s food / fluid intake and oral hygiene, if applicable.
This simple visual chart can be displayed on a fridge or cupboard door and filled in by the older person or carer or family member.
This chart is only one example – use any example from your local organisations or other ways, if a chart isn’t a feasible method.

READ the slide and EXPLORE different methods of encouraging older people to drink more, in a person-centred approach, looking at what works for the individual.

READ the slide and stress that ‘if it isn’t written down, it didn’t happen’
If you have nutrition and hydration recorded, then you can report it wider to show how your organisation is making a difference.
It may also help to sustain funding or justifying
future funding.
It demonstrates that an holistic approach is being used and eating & drinking will not remain
invisible.

READ the slide and ensure they feel comfortable with the information this training has given them.
ENSURE the key questions form part of every contact they have with an older person, where relevant.
Answer any questions.

READ the slide.

READ the slide
Go through each bullet point
DISCUSS what they can do and any good practice examples they may have.
SHARE messages with senior managers and encourage them to include nutrition and hydration as a priority, in any strategic planning for your local area.
What will participants take away that will change the way they work or share their existing good practice?

READ the slide – the resource descriptions in RED are only to be given to older people, if there is a concern (undernourished / poor appetite / losing weight), they are NOT to be given to older people of an average / above average weight. The other resources are for all older people over 65.
All RESOURCES are available at:
https://www.ageuk.org.uk/salford/about-us/improving-nutrition-and-hydration/our-resources/

PASS on a contact number / details, so workers can ask any follow up questions, order any resources or ask for other teams to receive this training.
Thanks everyone for taking part, complete any evaluations and hand out certificates.

Unintentional weight loss, especially if rapid weight loss usually reflects loss of muscle mass, which may be particularly relevant for people recovering after a period of intensive care.
Malnutrition can increase a person’s risk of infection as well as slow down their recovery.
Weight loss, especially if rapid weight loss usually reflects loss of muscle mass, which may be particularly relevant for people recovering after a period of intensive care.
In turn this slows their recovery and may consequently result in readmission to hospital and further complications.