Cuts to social care triggering rise in malnutrition


The number of adults being admitted to A&E with a primary or secondary diagnosis of malnutrition has more than tripled over the decade.

According to new data from NHS Digital, admissions related to a primary diagnosis of malnutrition almost doubled from 348 in 2008/09 to 735 in 2017/18. Meanwhile, admissions due to a secondary diagnosis of malnutrition have more than trebled from 2,545 to 7,802.

Overall, malnutrition cases treated by the NHS have risen from 2,893 in 2008/09 to 8,537 in 2017/18.

Malnutrition, or undernutrition, occurs when the food that a person eats fails to provide the body with the correct balance of fats, carbohydrate, proteins, vitamins, minerals and water that it needs to function efficiently. This can be due to a long-term health condition which prevents the body from absorbing vital nutrients or a poor diet.

A patient usually receives a primary diagnosis of malnutrition as a result of unintended and unexpected weight loss, and a secondary diagnosis when they’ve been admitted to hospital with an injury caused by an accident such as a fall. Further investigation often reveals that the fall was a result of poor nutrition.

The British Association for Parenteral and Enteral Nutrition (BAPEN) has attributed the rise in the numbers of malnutrition-related admissions to A&E to a lack of awareness of the condition among older people by primary healthcare professionals. It said awareness of the early signs of malnutrition in vulnerable groups was paramount.

“We need to see improved knowledge of malnutrition risk amongst primary care professionals,” said Dr Trevor Smith, BAPEN president. “We need to be identifying people at risk of malnutrition earlier than hospital admittance, to provide them with better care and give them a better outcome, as well as relieve pressure on the NHS.

“We need to make [nutritional] screening routine in all health and social care settings, in GP surgeries and care homes as well as in hospitals. We hope that government plans to fix the social care system will incorporate a focus on embedding nutritional screening and care planning in care and residential homes.”

Campaigners have linked the increases in the condition to austerity polices, the lack of public services and rising poverty. Very few people are unaware that the UK’s pensioners are experiencing a social care crisis of epic proportions. Not only are a million seniors persistently lonely, in part due to widespread closures of the day centres and lunch clubs that offered them the validating friendships that kept them healthy by shoring up their emotional resilience.

But many more are now coming to terms with the brutal realisation that at a time when they need good-quality, timely compassionate care and attention, cuts in health and social care services mean they have to fight to access the services that will keep them well, despite having paid into the system throughout their working lives.

Austerity and rising risk of the condition

Historically, pensioners have always had to watch their spending if they wished to live within their means. But nine years of austerity and public spending cuts, coupled with rising rents, mean seniors now realise that if they are not even more careful with their money, they risk becoming homeless.

In October 2017, the Local Government Association (LGA) reported a 130% rise in the numbers of older people presenting themselves to councils as homeless since 2009.

The rise had been driven by a mix of complex heath conditions and other issues, such as alcohol abuse and gambling addiction, the body which represents councils in England and Wales said.

Bereavements, divorce and separations, homes falling into disrepair, rising rents and flat incomes were also contributing to the increase in older people’s homelessness. The LGA said that based on current trends, it expected the figure to double by 2025.

So it’s little wonder that when it comes to deciding where to allocate their hard-pressed cash, many older people will simply stop eating regular meals. A consequence of making such a heartbreaking decision is that malnutrition, a condition many people assumed had been relegated to the past, is making a comeback.

BAPEN estimates that 1.3 million people aged 65 or over are either malnourished or at risk of malnutrition, that 93% live within the community and that older people are disproportionately represented in malnourished groups.

Risk factors for malnutrition

Malnutrition among pensioners can be caused by many things, such as loss of appetite in response to taking medication to manage a health condition. Elderly people can also become under nourished if they have dysphagia, a condition that makes swallowing certain foods or liquids difficult, making it harder for them to maintain their optimal nutritional intake.

Other risk factors include having dementia, which may mean a person forgets to eat; or an older person may be depressed or feeling lonely and isolated, and so may feel less inclined to prepare nutritious meals for themselves.

But malnutrition can also be caused because some older and vulnerable people do not have access to the support services to help them shop, cook and eat nutritionally balanced meals. It is now widely accepted that welfare reform and austerity policies have had a detrimental impact on an older person’s ability to eat well.

Almost a quarter (22%) of Britons aged 60-plus have skipped meals in order to reduce their food costs, the older people’s charity Age UK has said.

The lack of funds with which to buy nutritious, wholesome food is a serious cause for concern, because malnutrition in older people can lead to an increased risk of falls, heightened susceptibility to disease and slower recovery times. This puts further pressure on the NHS, already struggling to meet rising demand for its services.

According to the findings of a study published in the journal Clinical Nutrition in August 2011, people who are malnourished are twice as likely to visit their GPs, have three times the number of hospital admissions and stay three days longer in hospital than their adequately nourished peers. They are also more likely to be re-admitted to hospital once they have been discharged.

A hospital stay is estimated to cost £400 per day, according to the Department of Health and Social Care’s (DHSC) calculations. A BAPEN analysis of the consequences of malnutrition found it costs two to three times more to treat a malnourished person than to treat a well-nourished individual.

More malnutrition cases for NHS

As austerity extended its vice-like grip and older people have started to prioritise meeting their housing and heating costs over buying food, incidences of malnutrition have risen. Between 2011 and 2012, treating malnutrition cost the UK economy £19.6 billion compared to £13bn in 2008, according to NHS statistics.

The Malnutrition Task Force, set up to raise awareness of and tackle malnutrition and dehydration in older people, believes that unless action is taken now, the incidences and costs of treating malnutrition-related illnesses will continue to soar. It is urging councils to reinstate their Meals on Wheels (MoW) provision.

It said data shows large rises in hospital admissions for malnutrition-related illnesses occurred at the same time that councils were either axing or scaling back MoW services in response to cuts to their social care budgets – a move the Taskforce describes as a “terrible false economy”.

Around 65% of MoW services have either been closed or restricted to the most needy individuals only since 2010. This is despite the fact that studies show MoW services help prevent malnutrition, as the hot meals improve both the quality and nutritional intake of food consumed by clients, the Taskforce said.

It additionally argues that MoW staff delivering the meals provide essential social contact to vulnerable, socially isolated individuals. This helps prevent, decrease or delay loneliness and isolation – and their related illnesses – that can afflict those who are largely housebound.

MoW also offer a vital preventative service to older and vulnerable people, because MoW staff can monitor their physical and mental wellbeing and raise any concerns they may have about a client’s health or their ability to cope at home, before they descend into crisis.

Because of the benefits MoW provide, the National Association of Care Catering (NACC), which represents professionals providing catering to the care industry, is seeking extra protection for the service.

It has called on the government to make MoW a statutory service, since under-investment in MoW services puts vulnerable people at risk and places unnecessary pressure on the NHS. Should this happen, councils will be obliged by law to deliver a MoW service to their vulnerable residents.

In response to the call, local authorities have said that as their funding has been cut by 40% on average since 2010, some are so cash strapped they can only afford to deliver services they are required to do so by law. Currently, less than half (48%) of all UK councils provide a subsidised MoW service to their elderly and vulnerable residents, the most recent figures published by the NACC show.

In London, just nine out of 33 boroughs provide a MoW service, according to the results of a survey contained in a report called Beyond the Food Bank, by the charity Sustain. Given the fact the government has yet to ditch austerity, this state of affairs looks unlikely to change any time soon, despite the recent rise in malnutrition cases.

How to spot the signs of malnutrition

According to the Malnutrition Taskforce, the most obvious sign of malnutrition is unexpected weight loss. This may be gradual or sudden, as a result of an illness, or just unexplained. There are other more subtle signs such as loose clothing, dentures and jewellery. Other warning signs include:

  • Ill health or a recent medical diagnosis

  • A recent hospital stay

  • Problems with oral health or dentures

  • Difficulties in swallowing

  • Practical difficulties with cooking or shopping

  • Change in personal circumstance due to bereavement

  • Depression leading to loss of appetite

  • Loneliness and social isolation leading to lack of interest in food

  • Eating a restricted diet or even not eating.