Identifying and treating older patients with malnutrition in primary care: the MUST screening tool.

Abstract

Malnutrition means ‘poor nutrition’ when there is a deficiency of energy and nutrients in the diet that causes a measurable clinical outcome or impact on body composition or function.1 As such, malnutrition can refer to people who are overweight but the term is more often used to apply to people who are underweight. Malnutrition (as undernutrition) affects an estimated 3 million people in the UK (those either malnourished or at risk), the majority of whom are living in the community (93%).2 It can be a cause and consequence of illness, and is a common clinical and public health problem that has largely been ignored in primary care.3,4 This may be because the reverse problems of overeating, and obesity, have been the focus of attention in regard to weight management and nutritional status. Malnutrition can have a profound detrimental impact on disease risk, progression, and prognosis, as well as increasing complications after injury and delaying recovery from illness. It results in greater healthcare needs in the community, including more frequent access to GP services and increased needs at home. Recent estimates suggest that the health and social care cost of malnutrition in both adults and children in England alone exceeds £19 billion, and half of this expenditure is due to people >65 years.3 Overall, the cost of treating a malnourished patient is over three times more than treating a non-malnourished patient. It is only set to increase with an ageing population and the rising cost of health and social care services.