Malnutrition as a Multifactorial Health Problem - Essay Example

Institution : xxxxxxxxxxx Title : xxxxxxxxxxx Tutor : xxxxxxxxxxx Course : xxxxxxxxxxx @2013 Introduction Malnutrition, which encompasses both low and high levels of particular nutrients in the body, is a significant concern globally. It includes under-nutrition and over-nutrition where the levels of micronutrients and macronutrients such as calories, vitamins, minerals and proteins are significantly low or high in the body. In Australia alone, a study conducted by Bolin et al in 2010, showed that up to 80 percent of people aged 65 and over admitted in hospitals were suffering or at risk of malnutrition. With 15.1 percent of the population of the country’s 22.5 million made up of those aged 65 years and above, there is definitely the need to treat malnutrition seriously and offer necessary assistance (AGPC, 2011; Charlton, 2010). Malnutrition One of the basic and inalienable human rights is access to adequate food. The adequacy of a given food is defined by its consistency, nutritional value and amount. Therefore, adequate food needed for daily and healthy sustenance must have calories, vitamins, proteins, minerals and other micronutrients needed for optimal body functions. In Australia, the right to access to adequate food is a critical social, health, political and economic issue with nearly 40 percent of the population hospitalised having malnutrition problems (Charlton, 2010; Barker et al, 2011). The Dietitians Association of Australia notes that about 8 to 30 percent of Australians living within the community suffer from malnutrition. The association further notes that about 40 to 70 percent elderly Australians in residential aged care facilities (RACF) suffer from malnutrition. This is despite the fact that during the 2009 – 2010 budgetary period, the Australian government spent a staggering $11 billion in caring for the over one million elderly; 14% of its population. Over $7 billion of this budgetary allocation was set aside for expenditure by the RACFs (AGPC, 2011). The high number of people including those hospitalised, in elderly care facilities or within the Australian community grappling with the problem of malnutrition is a manifestation of its complex nature. One of the major contributory factors to malnutrition is associated with limited mobility and loss of sensory functions, especially smell and taste, affects food acquisition and appetite respectively. Other factors such as inability to chew and/or swallow food due to dental and gastrointestinal and cancerous diseases also lead to high malnutrition cases. Age is also definitely among malnutrition’s major contributory factors. The disparities in the prevalence of malnutrition in RACFs and the community give an indication that age is an important factor in causing malnutrition. In a research study published in 2010, a group of researchers found that at least 80 percent of the elderly admitted to hospitals suffer from malnutrition. The elderly are predisposed because of their inability to acquire or access adequate food. Moreover, their failing health and body organs and systems including digestive system restrict the type of food they consume. Another significant cause is related to the Psychiatric problems such as apathy, neurological and other medical problems, which are also highly prevalent amongst the elderly. Such factors play an integral in undermining adequate food acquisition, intake and digestion (Bolin et al, 2010). Similarly, inability to buy or even cook food owing to time, limited mobility, poverty and lack of support contributes significantly to malnutrition. It is an important consideration that, as a group more prone to diseases requiring extensive and intensive treatment such as surgery and drug therapies, the elderly are more unlikely to access adequate food. Likewise, treatment procedures such as ventilation and drain tubes also restrict the kind and amount of food that may be consumed thereby significantly contributing to the high number of hospitalization due to malnutrition (Kubrack & Jensen, 2007). At organisational level, malnutrition is primarily caused by poor screening and assessment protocols, lack of awareness and little emphasis laid on the importance of nutrition. Therefore, most health and care facilities lack adequate personnel to take care of the nutritional needs of people, especially the elderly. The few personnel are not well trained. Generally, organisations including the government have not fully appreciated the fact that malnutrition is a problem in Australia (Kubrack & Jensen, 2007). There is therefore no single factor than can be pinned down as the cause of malnutrition: it is a manifestation of interplay between multiple factors both at organizational and individual level. One of the most significant effects of malnutrition is that it increases the mortality risk, especially among the elderly. It also exposes people to either obesity or abnormal weight loss that can lead to other fatal diseases and conditions such as cardiac arrest and frailty (Middleton et al, 2001). It makes them vulnerable to extended hospitalisation due to apathy and falls which can lead to institutionlisation and sometimes death. Additionally, malnitrition also affects the physiologic systems while also impairing the homeostatic functions of the body which lead to diminished cognitive capabilities and impaired physical performance. This forces people, more so the elderly, to be too dependent on support of care givers and family members. They are thus incapable of enjoying life and their basic human rights; a situation that pushes them further into depression and a further vicious cycle of health problems. All these also increase the cost of providing social and health services. It increases the burden on the individual, family, society and the government (Adams et al, 2008). Management of Malnutrition An integrated approach towards management of malnutrition requires an evidence-based assessment approach that will ensure all the risk factors are taken into account. Therefore, an ideal screening and assessment tool must identify the risk factors and diagnose the cause of malnutrition with a particular group or individual under consideration (Raja et al. 2008). The Dietitians Association of Australia and the National Health and Medical Research Council (NHMRC) have provided comprehensive, detailed yet simple to use nutrition screening and assessment tools and guidelines including: Mini Nutrition Assessment (MNA) Short Nutrition Assessment Questionnaire (SNAQ) Malnutrition Screening tool (MST) Subjective Global Assessment (SGA) Short-form MNA (MNA-SF) Nutritional Risk Screening (NRS-2002) Malnutrition Universal Screening Tool (MUST) (Barker et al, 2011). These tools assess key areas including body mass index (BMI), developmental and weight loss history and background of individuals. They also have a validation and scoring system for drawing conclusions and making recommendations (Barker et al, 2011). Supplementary and specially formulated foods have shown significant efficacy in dealing with malnutrition. These special ready-to-use foods with therapeutic value must however be given gradually to avoid cases of refeeding syndrome. They can also be fortified with special micronutrients such zinc, potassium and vitamins among others. This can also include giving water, sugar and oral rehydration solution (ORS) intravenously to restore energy and body fluids. The World Health Organisation (WHO) also notes that empowering cash-handouts are also efficacious in dealing with malnutrition across all age groups. Conclusion Malnutrition is a multifactorial health, social, political and economic problem that cuts across many age groups and societies. It increases the cost of healthcare and social service provision due to extended hospitalisation and treatment cost. It can also lead to deaths, low morbidity, psychological and physical problems. Effective malnutrition management therefore requires a multifaceted approach that takes into account all the variables at play. Bibliography Adams, N.E., Bowie, A.J., Simmance, N., Murrary, M., & Crowe, T., 2008, “Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients.” Nutrition and Dietetics 65: 144-150. AGPC, 2011, “Caring for Older Australians.” Productivity Commission Inquiry Report Overview, No 53, 28 June 2011. http://www.pc.gov.au/__data/assets/pdf_file/0016/110932/aged-care-overview-booklet.pdf Barker, L. A. Gout, B. S. & Crowe, T. C., 2011, “Hospital Malnutrition: Prevalence, identification and impact on patients and the healthcare system”, Int J Environ Res Public Health 8(2): 514–527. Bolin, T., et al.,2010, "Malabsorption may contribute to malnutrition in the elderly", Nutrition 26 (7–8): 852–853. Charlton, K., 2010, “Nutrition screening: Time to address the skeletons in the bedroom closet as well as those in hospitals.” Nutrition & Dietetics 67: 209–212 Kubrack, C. & Jensen, L., 2007, “Malnutrition in acute care patients. Int. J. 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