Implementing a nutrition care pathway for identifying and capacity building older people at nutritional risk using multidisciplinary, restorative care

Chadia Bastin1Shanayde Daly2, Carol Ho3, Denise Leyden4,Tenealle Nicholson5

1Gateway Health, PO Box 224 Wangaratta VIC 3676, chadia,bastin@gatewayhealth.org.au
2Albury Wodonga Health, PO Box 326 Albury NSW 2640, shanayde.daly@awh.org.au
3Gateway Health, PO Box 224 Wangaratta VIC 3676, carol.ho@gatewayhealth.org.au
4Goulburn Valley Health, 121-135 Corio St Shepparton VIC 3630, denise.leyden@gvhealth.org.au
5Goulburn Valley Health, 121-135 Corio St Shepparton VIC 3630, tenealle.nicholson@gvhealth.org.au

Background

Identification of malnutrition and subsequent intervention is generally poor across all health settings despite associated high rates of morbidity and mortality. The prevalence rate in community settings is as high as 30% and solutions which tend to create dependency are over-prescribed. In acute and residential aged care settings, nutrition screening and referral pathways are used.

Aim

To develop and implement a nutrition care pathway for older people at nutritional risk living in the community to improve identification rates and increase referrals for restorative care.

Method

Analysis of nutrition risk screening and assessment practices amongst community services via interviews and file audits was conducted along with a literature review of tools successfully used in community settings. A pathway for screening and investigating capacity to access nutrition was drafted, introduced at regional training and its impact evaluated using questionnaires and repeat file audits.

Results

Barriers to timely identification include lack of awareness of consequences of malnutrition, use of inadequate screening methods, poor acceptance of referrals to Dietitians and misconceptions about their roles. Insufficient assessment of functional capacity around food access and care planning leads to blanket, routine interventions such as meal provision and shopping services.

Discussion

The draft nutrition care pathway improved identification of malnutrition risk however the decision support function required refining to support more referrals for multidisciplinary, capacity building interventions. The re-developed pathway has been incorporated into a training toolkit for Dietitians and disseminated state-wide.

Recommendations

Further evaluation is required to determine effectiveness in increasing restorative approaches to care.

Biography

Chadia Bastin is a Senior Dietitian and Early Intervention in Chronic Disease Coordinator at Gateway Health in Wangaratta, Northeast Victoria. Since graduating from Deakin University with a Master of Nutrition and Dietetics, she has worked as a Dietitian in rural areas for the past 18years, specializing in community aged care. She has a passion for delivering education and training to service providers on the nutrition needs of older people and how to support independence in the home and community environments through appropriate screening and capacity building, restorative care approaches.