It’s malnutrition week. I support it wholeheartedly. Malnutrition is silent and subtle. It causes people to have poorer quality of life. People who are malnourished get ill more easily with more complications and poorer recovery.

We think of malnutrition as something that is for hospitals and care homes. But more than 90% of malnutrition is in the community.

The message for Malnutrition Week is Ask! Look! Listen!

I want to write about it this week more than ever. Someone very close to me has just come out of critical care after 44 days. Nutrition is going to be so important and it is an example of how someone is often likely to arrive in hospital already malnourished.

He was losing weight and the family were concerned. They were encouraging him to eat and creating more opportunities for nutritious snacks – he had lost his appetite. There was no pain or other symptoms – or at least none that were highlighted. At least the family had noticed and were watching but regardless he was probably undernourished – other people in the same situation may well have been worse off if they lived alone or their weight change and appetite changes hadn’t been noticed. These things are gradual and often subtle.

Suddenly, the reason became clear as he suddenly took very ill and needed an operation on his bowel but there was a lung infection on top that resulted in this long stay in critical care being tube fed directly into the stomach.

After so long in critical care, he has lost a lot of muscle, gained a stoma bag and is still on oxygen. To recover he has higher nutritional requirements but his appetite is still quite small.

He is on a ward now and was presented with soft food that in the words of the auxiliary who gave it to him looked like a poo and brains. Not exactly appetising! I know hospitals try their best and it is so challenging. There are so many attempts to make hospital food better but on this one day and this one meal things weren’t looking great for feeding up this patient.

The dietitian tells him that the food won’t be enough to meet his needs and asked if it would be ok if he would have a nutritional supplement. He wasn’t given an example or had any real explanation of the benefits of the supplements. There are a range of nutritional supplements but it is unlikely that the dietitian will have time to drill down to find out which are most acceptable so in the end his patient wants to just have more milk! Nutritional supplements only help if they are consumed.

His nutrition support will need to continue when he is home so that he can get strong again. The risk of malnutrition or undernutrition back home after a spell in hospital stay like this is high. It is important that he and his wife find out tips and tricks to ensure that he will get enough to support his needs – it may not look like what or how he ate before hospital.

The battle against malnutrition is back in the community again.

If we want to beat malnutrition (which is so often preventable) then it is not just doctors, nurses and dietitians who need to understand or have access to information. It’s not just hospital and care home staff. In fact, given the percentage of malnutrition that is in the community, they can only do so much. It is patients and families that need to be educated and supported most of all. In fact everyone can be more aware of malnutrition and who might be affected. How we can all play a part in tackling something that has a huge cost – both financially for the health services and on quality of life.

Malnutrition is an issue for the community.

Ask!

Look!

Listen!

Here are some top tips from the Malnutrition Task Force as well as plenty more links and resources.