Introduction to Evidence Based Practice

This document provides an introduction to evidence based practice and its application in healthcare. It discusses the prevalence of malnutrition among the elderly, the causes behind it, and strategies to manage and prevent malnutrition. The document also highlights the importance of nutritional assessment tools and the role of healthcare professionals in providing proper care to older people.

Introduction to evidence Based Practice
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Contents
INTRODUCTION...........................................................................................................................3
LITERACTURE REVIEW/ SEARCH............................................................................................4
DISCUSSION..................................................................................................................................6
IMPLICATION FOR PRACTICES................................................................................................9
CONCLUSION..............................................................................................................................10
REFERENCES..............................................................................................................................11
APPENDIX....................................................................................................................................13
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INTRODUCTION
The Malnutrition is often overseen in elderly acute the medical patient which need for
simplest and robust screening tool. It is consider as huge public health problem which currently
effects on the millions of people in UK, with an aging the population. There are large number of
people aged 65 and also projected to increase by 40% in next 20 years (Juby and Mager, 2019).
This type of malnutrition problem that cannot be ignored. As per study, it has found that 1.2
million people over 60 living in the social community, 40% of people admitted within hospital
and also moved towards the hospital to identify risk of malnutrition (Ingstad, Uhrenfeldt and
Pedersen, 2019). Furthermore, Proactive efforts always needed to increase the malnutrition
profile and also improved the entire management system. It will be identified the treatment of
malnutrition which estimated to high potential and deliver cost saving due to effects of diseases,
health as well as well-being (Eriksson, Ferm and Rosengren, 2019). It is well known that many
elderly people who are suffering from malnutrition and admitted to hospital. Afterwards, it
should be used the simplest process of screening identify the current health status of elderly
population. The reliable screening and assessment tool for purpose of malnutrition in the elderly
which may include measurement such as body mass and recording other risk factors related
insufficient food intake, chronic diseases and weight loss. In order to measure the consequence
of poor nutrition through screening (Juby and Mager, 2019). Furthermore, Community care and
other setting are applicable for elderly whereas they can improve and stable the medical
condition.
The documentation will discuss about the definition and causes of malnutrition and current
national guidance to assess risk. The primary care nurse perform the specific role which will
identify the innovative approaches, strategies to implement the nutritional care in the community.
Therefore, imperative that representing the major issues that aged society will face problem,
among such issue which is widespread prevalence of malnutrition in the elderly. The hospitalized
patient have been reported that malnutrition among elder people, understand the risk which
affecting on the individuals. Malnutrition is mainly defined as having to include many nutrients
in the diet and refer to state of under-nutrition. It is commonly used in the practices and defined
by national institute for health and clinical excellence. The importance of nutritional assessment
tool which are adapted as appropriate to identify health condition or situation of elderly person.
In order to find out the instrument which have mentioned to validate for acute ill elderly hospital
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patient. As per consider, the primary aim is to test the validity through screening technique for
purpose of malnutrition in elderly patients.
LITERACTURE REVIEW/ SEARCH
As per Ali and Abdelaziz (2019) it is mainly indicating the nutritional intervention at the
time of hospitalisation which associated with the different health care resources. Multiple health
professional have been aware about the challenging issue of Malnutrition among elderly
population. It also exploring the workable strategies to minimise the economic cost of under
nutrition. Through research, it have been suggested that 22%-55% of patient at risk of
malnutrition. Sometimes, it is depending on the specific instrument whereas calculating the
overall patient population those are suffering from malnutrition. It is necessary steps for
preventing undernourishment which are screening the patient for malnutrition after
hospitalization and assessing patient identified at risk. An appropriate nutrition support for
elderly population and provide better quality of services. On regular basis, it also monitoring
their progress to make some appropriate change in term of nutritional intervention.
According to Aziz Teng and Zaman (2019) it has summarised that relevant of nutritional
problem was confirmed by the feeding and various type of hospital diet registered through
analysis. Almost 40% of patient are identified which mostly because of sever dysphagia. To
identify the various factors which mainly associated with the malnutrition and understand the
baseline characteristics of both non-malnourished as well as malnourished patient compare in
proper manner. It has identified the more frequently symptom among elderly population. It also
estimating the entire hospital mortality approximately 16.4% of difference in accurate outcome
generation. Through research, it become easier to identified risk of dying at the time of
hospitalization. It also higher from the malnourished patient which easily compare with non-
malnourished. In another way, it also understanding the relationship between the putative
nutrition variable and analysed by using regression for accessing relational with time to death. It
has been conducted to identify the putative nutrition variable which are significantly associated
with controlling process.
Dent, Hoogendijk and Wright (2019) While reducing the incidence of malnutrition which
often occurs at the time of hospitalization and give more priority to nurse care profession. in
some situation, there are lack of staff member so that patient unable to admit. The key factors in
the prevalence of elder people which mainly representing with malnourishment. At that time, it
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must be considering the change management ongoing process that will implement the suitable
facilities and services. The malnutrition is the most common issue which require for professional
to provide better care as possible. In order to consideration of major requirement for survival so
that elder people can live healthy life and also intake appropriate nutritious diet. It suitable for
patient to use conventional method and artificial measurement for patient current condition of
health. As per Di Bella and Et.al. (2019) hospital malnutrition mainly show that five out of eight
elderly individual admitted to the hospital which already malnourished. The health care system
will be developed the improvement plan with the help of standards which easily deals with the
incidence of malnutrition within hospital.
Eriksson, Ferm and Rosengren (2019) has found that constantly interruptions occurs from
clinical activities, rounds and lack of nursing staff members. They can able to understand the
current situation which encounter the malnutrition level of patient. It is the responsibility of each
elderly people trust to health care service provider because they can implement an efficient
managerial change, policies and procedures. It must ensure that they are monitored, improved
and evaluated to give best care as possible. The evidence has been suggested that analysed the
problem of malnutrition. Many professionals are considered the holistic approach to acquire
opinion of individuals on certain practices, regimes and other care deliverance.
Finocchiaro, Fanni and Bo (2019) argue that Malnourishment can be identified and
managed effectively among elderly population by using screening tool. It must be included
during treatment whereas nursing staff provide the facilities and services. So that tool or platform
to assess elder patient but it may be required a proper trained staff to understand finding of
assessment. It is willing to involved other health nurse, professional and staff in care of elder
patient. Multi-disciplinary approach use to tackle the problem and reduce the risk of
malnutrition. It allows for assessment in the different areas to understand the mental health issues
among people which directly affects on the nutritional intake by individuals.
According to report, it also analysed the affects and involve different staff members within
hospital. It including different areas of clinical practices where individual require proper
nutritional intake not only for patient but provide those who are suffering problem due to
malnutrition. Furthermore, it can be monitored the activities after applying change management
process. It has identified that successful achieve the specific goal and objective. Many
professional staff referred to successful implement the protection movement and provide the
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better benefits for elderly people. On the other hand, it is important that applied nutritional tool
which adopted appropriate manner. In order to set up the instrument that automatically validate
for acute ill elderly peoples.
As consider by Fitall and et.al (2019) the Mini nutrition assessment which promising
instrument in order to perform test and validate the accurate result or outcome. One problem in
related the false positive in screening that can be shown unnecessary anxiety. However, in case
screening is mainly followed the immediate action through assessment and get advice to intake
proper sufficient nutrition. Another problem is that when identified the elderly people by
screening. It also performed by nurse in the hospital in order to full requirement of individual. As
per identification, it is mainly focused on the treatment of malnutrition which can easily
estimating the high risk of malnutrition. In order to control the high potential risk and deliver
cost saving due to effects of diseases, health as well as well-being.
DISCUSSION
Elderly and Malnutrition
It can be identified the various type of diseases due to malnutrition such as heart diseases,
morbid condition, cancer and dementia. It has found that have a relationship with the current
nutritional status of elderly aged over 65 years. Aging is a process that causes of malnutrition
which are generally affecting the nutritional status among elders (Hipskind and et.al., 2019). As
per definition, the malnutrition can be referred as a condition of undernourished. So as
prevalence of nutrition among people in developing nation which adversely increasing the
development and also change the eating habit of elderly. Still, it is consider as major problem
which require to focus towards improvement (Eriksson, Ferm and Rosengren, 2019).
It is mainly used the qualitative method for collecting and gathering large amount of
information related the malnutrition among elderly population. It can be identified the suitable
Screening tool which support for calculating the accurate result or outcome. So as helping for
professional staff members to adapt in their treatment which providing the better health care after
performing test approach through screening (Juby and Mager, 2019). Qualitative method is based
on the pre-existing theories which already discussed in previous studies. It useful for providing
brief idea about the concept and also reduce risk malnutrition. It has been discussed in the case
study.
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Prevalence of Malnourished hospitalised elderly
In globally, the prevalence of malnutrition even applicable in the development nation
which mainly including united states. It show as increasing the current trend according to the
time, However, it has found that 17%-18% of hospitalised elderly become faced problem of
malnourishment The percentage range is similar to other nation such as UK (Eriksson, Ferm and
Rosengren, 2019). In regards of Malaysia, The prevalence of malnutrition among elderly large
population which is similar to other nations. According to study, it has been identified that
Malaysia showed 55.3% of people malnourishment of which 17% (Ingstad, Uhrenfeldt and
Pedersen, 2019). In this way, it become easier to understand the difference in the prevalence of
malnutrition in global world. According to survey, it has found that hospitalised elderly continue
increases in regular basis. Thus, it is considered as malnutrition which are underestimated,
undertreated and underdiagnosed in both internally as well as locally (Juby and Mager, 2019). In
order to formulate by using health care system which provide better protection to the elder
people. In this way, it help for protecting against risk of poor health as well as malnutrition. On
the basis of evidence, it should be gathered lot of information on their nutrition status which
indeed important.
The awareness among the hospitalised elderly which become crucial to provide the better
health care. In additional, it must be adapted the nutritional care policies or procedures which
always helping for improve the burden to the population (Juby and Mager, 2019). Moreover, it
will require the proper health facilities and services which can determine if proper data available
in order to assess the effectiveness of current situation.
Causes of Malnutrition
The aging process is consider to be one of most common cause of malnutrition which
eventually affects on the current status of elderly people. It also believed that associated with the
physiological, social and health changes that occurs with aging in the cause. On the other hand, it
also identified the unintentional weight loss in older person because of food intake, increased the
requirement for nutrients (Juby and Mager, 2019). The ability is to absorb to add enough amount
nutrient in people diets. So that malnutrition can be going slow which occurring over month or
week. It also including the indicator of malnutrition such as heart failure, weight loss, poor
wound healing, increased tendency and loss of appetite.
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Afterwards, it can be implemented the best practices nutrition care which mainly involves
the significant principle. It will be increasing the awareness among elder people so that they can
prevent and treat malnutrition. Professional team has been developed an effective plan to provide
better care services to individuals. In order to monitor and evaluate the process which is
positively impact on the elderly population. It is important to identify the various risk of
malnutrition through reporting and weighting of changes (Juby and Mager, 2019). Sometimes, it
is also validating the malnutrition by using screening tool which is widely used within hospitals,
health care homes.
Managing Malnutrition among older people
Once if an individual has been determined the risk of malnutrition in order to established
the goal immediately. It should be involved the contribution towards individual care through
family and nurses (Eriksson, Ferm and Rosengren, 2019). When individual experience as setting
like community, hospital and care homes. Furthermore, it can be identified the range of health
status, condition and communication across different settings. It enabled the significant goal to
meet expectation level. The professional management is mainly focused on the availability of
food, social issues and other type of environmental activities (Nepple and et.al., 2019). The oral
based nutrition supplements are considered as most useful when healthy food intake in proper
manner. In this way, it can easily integrated with the care pathway. There are various available
on prescription and evidence which strongly supported with combined approach which may
increase weight gain among older people.
As per analysis, it has found that there is becoming lack of expertise and other protocols for
malnutrition. So that it is required to use an appropriate amount of supplement to provide better
services. It can be addressed the intervention which mainly influencing different factors
(Eriksson, Ferm and Rosengren, 2019). The comfortable supportive culture or environment
which always encouraging independence, including the specific drinking, eating and other food
preparation platform. Training is another important management technique that will support for
staff members and ensure that understanding the screening, Person-centred as well as dignified
nutrition health care. There are various food related activities performed which may increase
anticipation of meals. It assists the enzymes to do work and increase appetite (Ingstad,
Uhrenfeldt and Pedersen, 2019). Various activities can promote the sense of purpose which
belonging, independence and wellbeing. In this way, it is positively impact on the drink and food
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consumption. By using disciplinary team, primacy care support for identifying the risk factors
which directly associated with malnutrition. Hence, it become easier to maintain the better
position through screening technique. To screen elderly medical patient while identifying the
current risk of malnutrition. The screening method always support for maintaining high
sensitivity, reproducibility and inter-observer agreement when used by professional nurses.
IMPLICATION FOR PRACTICES
Even though it has been determined that it should provide the protein energy malnutrition
which compromise clinical outcome of hospitalized patient. It has been performed the screening,
assessment to identify the nutritional status of people but this approach is not actively used in
regular basis (Ingstad, Uhrenfeldt and Pedersen, 2019). Consequently, it become difficult for
identifying the reliable data on the malnutrition among elderly population. It is very important
gap in the knowledge of stimulated clinical nutrition unit within hospital. In order to implement
the improvement practices that always support for applying the suitable action. The primary aim
is to gather reliable information in regards of risk due to malnutrition. It must be used the
screening tool which has subsequently, diagnosis of malnutrition and performed in step by step
manner. The screening must be estimated that 28% of elderly people suffering from high risk of
malnutrition. 88% suffered from chronic diseases. Unfortunately, The result may be consider on
the basis malnutrition prevalence. Sometimes, it is difficult because of different screening and
other assessment tool (Ingstad, Uhrenfeldt and Pedersen, 2019). As signinficantly, it become
higher rate of risk due to malnutrition. It is quietly investigated through current report. In this
way, it showed a strong correlation between the hospital mortality as well as malnutrition. With
increasing 68% high probability of malnourished elderly population whereas they are dying at
the time of hospitalization. It is important to analyse about malnutrition which predicting the
factor of mortality. During study, it has identified the limitation. It is mainly focused on the
malnutrition but it is well known about the frequency which occurs during hospitalization. It
mainly including the patient who are not risk on the admission but consideration overall
performance of professional staff whereas they can deal with patient. In additional, it should
have been assessed during food intake by elder people (Ingstad, Uhrenfeldt and Pedersen, 2019).
To overcome certain limitation so as needed to change the procedures and applied better
practices. It has been already used approach to handle critical situation or condition in proper
manner.
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CONCLUSION
From above discussion, it concluded that Malnutrition is the most common problem or
issue occurs among elder people. It can be determined various treatment of malnutrition which
estimated to high potential and deliver cost saving due to effects of diseases, health as well as
well-being. The documentation is mainly focused on the definition and causes of malnutrition,
current national guidance to assess risk. The primary care nurse perform the specific role which
help for identifying the innovative approaches, strategies to implement the nutritional care in the
community. It has summarised the prevalence of malnutrition among elderly population in
which increasing problem across the world. However, it can be identified the malnutrition by
using screening and other assessment tool. It always support for examining the current health
condition of elder people. A wide variety of tools which are available and become reliable to use
easily. As a result, it could help for staff members to reduce the time spend on the different
nutrition assessment process. Thus, as implementing the nutrition intervention which provided as
possible to affect elderly populations.
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REFERENCES
Book and Journals
Ali, A.Y. and Abdelaziz, N.E., 2019. Short Nutritional Assessment Questionnaire as a
Malnutrition Screening Tool for Hospitalized Patients. Pakistan Journal of
Nutrition. 18(7). pp.650-656.
Aziz, N.A.S.A., Teng, N.I.M.F. and Zaman, M.K., 2019. Geriatric Nutrition Risk Index is
comparable to the mini nutritional assessment for assessing nutritional status in elderly
hospitalized patients. Clinical nutrition ESPEN. 29. pp.77-85.
Dent, E., Hoogendijk, E.O., Visvanathan, R. and Wright, O.R.L., 2019. Malnutrition screening
and assessment in hospitalised older people: a review. The journal of nutrition, health &
aging. 23(5). pp.431-441.
Di Bella, A. and et.al., 2019. Assessing the Concurrent Validity and Interrater Reliability of
Patient-Led Screening Using the Malnutrition Screening Tool in the Ambulatory Cancer
Care Outpatient Setting. Journal of the Academy of Nutrition and Dietetics.
Eriksson, E., Ferm, V. and Rosengren, K., 2019. Working through Others-A Qualitative Content
Analysis of Nursing Students’ Experiences with Malnutrition at One Hospital in
Vietnam. Int Arch Nurs Health Care. 5. p.134.
Finocchiaro, C., Fanni, G. and Bo, S., 2019. Risk, prevalence, and impact of hospital
malnutrition in a Tertiary Care Referral University Hospital: a cross-sectional
study. Internal and emergency medicine. 14(1). pp.7-9.
Fitall, E. and et.al., 2019. Improving malnutrition in hospitalized older adults: The development,
optimization, and use of a supportive toolkit. Journal of the Academy of Nutrition and
Dietetics. 119(9). pp.S25-S31.
Hipskind, P. and et.al., 2019. Correlation of New Criteria for Malnutrition Assessment in
Hospitalized Patients: AND-ASPEN Versus SGA. Journal of the American College of
Nutrition. pp.1-10.
Ingstad, K., Uhrenfeldt, L. C. and Pedersen, P.U., 2019. Scoping review protocol: effectiveness
of individualised nutritional care plans to reduce malnutrition during hospitalisation and
up to 3 months after discharge. BMJ open. 9(9). p.e032615.
Juby, A.G. and Mager, D.R., 2019. A review of nutrition screening tools used to assess the
malnutrition-sarcopenia syndrome (MSS) in the older adult. Clinical nutrition ESPEN.
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Nepple, K.G. and et.al., 2019. Enhancing identification and management of hospitalized patients
who are malnourished: A pilot evaluation of electronic quality improvement
measures. Journal of the Academy of Nutrition and Dietetics. 119(9). pp.S32-S39.
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APPENDIX
Database searched Date Search
strategy
Limit No result
Correlation of
New Criteria for
Malnutrition
Assessment in
Hospitalized
Patients
16-4-2020 Malnutrition
MAN
Article
prevalence, and
impact of hospital
malnutrition
18-4-2020 Risk,
prevalence
Article
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