THE BLOG

What the Dickens!: Left to Starve

05/11/2015 16:24 GMT | Updated 05/11/2016 09:12 GMT

It seems we're not as advanced a society as we thought. Last week we passed a remarkable popular cultural landmark - the famous day to which the characters in the film Back to the Future travelled. But in terms of health and well-being, we're in danger of going Back to the Past. A troubling and murky past at that.

Cases of Dickensian-like diseases which were rife in the Victorian era are now soaring, such as scurvy, scarlet fever, cholera and whooping cough and there has been a huge rise in malnutrition and dehydration among people in England.

Malnutrition is often seen as a condition which only affects people overseas, but latest figures published by the HSCIC (Health and Social Care Information Centre) recently have shown it to be a growing problem closer to home, with malnutrition rising by a third since 2010. Estimates suggest at least one million older people are malnourished or at risk of malnourishment in our communities. This is extremely disturbing, given that the condition is largely avoidable.

Malnutrition in older people is characterised by unintentional weight loss. Indicators can include jewellery slipping off, belts needing tightening and dentures becoming loose. Some less obvious signs may be tiredness, lethargy, dizziness, difficulty keeping warm, changes in mood and concentration as well as picking up frequent infections.

Being malnourished is a serious health issue for older people and will impede recovery from other conditions. It can also lead to increased use of health and care services, including more GP visits and a longer length of stay in hospital. Preventable malnutrition is estimated to cost the NHS billions of pounds. Despite this, continued cuts to the social care budget mean that older people are left to cope on their own without enough help around nutrition and hydration.

There are many reasons why an older person may become at risk of malnutrition. Someone with mobility problems may not be able to shop, stand unaided, cook for themselves or wash up afterwards. For someone in poor health, skipping a meal may appear a more attractive option than struggling to cook and clean.

Feeling sad and alone, perhaps after bereavement, may make people even more vulnerable. Poor oral health or badly fitting dentures can also reduce a person's appetite, whilst the sense of taste can lessen with age or be altered by medication. Many illnesses or diseases, including stroke, cancer, respiratory and gastrointestinal illnesses, can also lead to an older person requiring a bit of extra support with eating and drinking.

Lack of understanding of the causes of malnutrition may impact on the quality of the care and the help that is given to eat and drink; however, the fact that health professionals are so busy is probably the bigger factor here.

Some older people living in fuel poverty tell us that they face the stark choice between paying for heating or for food. Those who rely on formal carers with limited time slots may have to make a similarly tough call between receiving help to eat or being helped to have a wash.

Eating a meal together is an important social activity, and food can lose its appeal for an older person who has become depressed or isolated. It's not hard to understand why someone who suddenly finds themselves living alone, after many years of preparing hot meals for their loved ones, would lose interest in cooking. A little bit of assistance and encouragement to eat a healthy meal can go a long way. Equally, many may have relied on others to plan, cook, or shop for meals in the past and be perplexed by where to start without support or guidance.

This is why a volunteer with the time to support someone to eat, a lunch club that provides a hot, shared meal, or a friendly face arriving with a ready to eat dinner ("meals on wheels") can be such important lifelines. However, it is precisely these services which are being dramatically affected by Government funding cuts, even as the numbers of those at risk of preventable malnutrition continue to rise.

To address the problem of rising cases of malnutrition and dehydration it is necessary to raise awareness of the symptoms among health professionals in hospitals, care homes and the community as well as with older people themselves, their families and friends.

It is essential that older people's nutritional needs are appropriately assessed and taken into account in any care plan. Only when health staff and carers ensure that older people have access at all times to the right food and drink alongside the appropriate help and support they require to go with it, will we see a much needed drop in these startling figures.