Following the census in 2001 it was estimated that the population of England and Wales was over 52 million. Of these 52 million some 8 per cent are between the age of 65 and 74 years and further seven and a half per cent are over 75 years (Office of National Statistics (ONS) 2003). The statistics reflect the trend that our population is getting older. The number over the age of 65 has increased by 51 per cent since 1961 to 9.4 million in 2001. If current projections are correct, by 2025, there will be 1.6 million more people over the age of 65 (ONS 2003). This has policy implications for the government as the demand for health and social services increases. This is reflected in the production of documents such as the National Service Framework (NSF) (2001) for older people. The health needs of the older population are a large part of the district nurse caseload, playing a pivotal role in coordinating complex care. District nurses are therefore best placed to identify the future needs of the older population.
[...] The range of changes mentioned can contribute to malnutrition in the older person with dementia (Devlin 2000) and may therefore come to the point of the patient having to be spoon fed by the caregiver (McGillivray and Marland 1999) Van Ort and Phillips (1992) carried out a field study in a care facility to characterize and describe nursing activities, patient's behaviors and caregiver patient interactions during feeding. This was done to examine the effectiveness or otherwise, in increasing functional and decreasing non- functional behaviors at mealtimes. [...]
[...] District nurses have a key role in helping to detect older people at risk of undernutrition because they are more likely to come into contact with them and can work with them to identify the nutritional problems that they may face. In this way they can a significant contribution to the improvement of health protection/promotion of the older person. The practice of nutritional assessment is often done by observation and prior knowledge rather than formal nutritional screening using an appropriate tool. [...]
[...] A number of nutrition screening tools and guidelines already exist for use in a community setting to help detect and manage malnutrition, for example, the Mini Nutritional Assessment (MNA) and the Nutrition Assessment Checklist (Nutrition Advisory Group for the Elderly 1990). However, along with others the NHS Executive (1998) has developed criteria for the development of screening tools which these do not meet. These include, providing a grading system for the strength of recommendations, providing the source of scientific evidence and information and establishing the validity, reproductability and practicality of tools (NHS Executive 1998). [...]
[...] Many of the older people on a district nurse case load live in residential homes and often attend to their needs on a daily basis. Therefore district nurses are ideally placed to share their knowledge with members of staff within the residential homes which could also be taken into nursing homes. A small teaching session conducted by the district nurse could be carried out which could be considered as an update session. The update session will cover the aspect of meeting the nutritional needs of older people. [...]
[...] This is no way implying that district nurses are experts in nutrition, but the community dietician, if one is available cant possibly assess every older person and if district nurses have a little knowledge to share, then why not share it ? It has been ascertained through the findings that nutritional screening within the community setting, including residential and nursing homes is very poor with older peoples needs in this area may not being met. Additionally, undernutrition in the community is a significant public health problem. [...]
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