January 23rd-27th marks the National Patient Safety Agency’s (NPSA) Nutrition and Hydration week. The week aims to ‘reinforce and focus energy, activity and engagement on nutrition and hydration as part of patient safety improvement’.
As is often the case poor nutrition and hydration has once again hit the headlines this week, but unfortunately not to support the NPSA’s excellent campaign. The Daily Mail asked the Office of National Statistics to provide figures for the number of deaths in both NHS and privately run hospitals where malnutrition and dehydration was reported as a ‘direct cause’ or a ‘contributory factor’.
The figures show that in 2010, 1,316 deaths, an increase of 24 on the previous year, were linked to or directly caused by dehydration and malnutrition. These figures are higher than in 2000, when 862 deaths were recorded. There is no doubt that these figures will be shocking to many. The prospect of any deaths being related to the basic requirements to human life of food and drink is appalling. The article notes that a further 812 patients died with dehydration and another 301 with malnutrition, although this did not directly cause their death.
However, these figures only tell us part of the story and raise the question of whether increased awareness of nutrition and hydration issues in hospitals has led to better recording, or if we are failing in our efforts to address the fundamentals of care. In some circumstances patients at end of life refuse food and drink making care a difficulty. Patients with Alzheimer’s or advanced forms of cancer can really struggle to eat and drink. More importantly the figures also do not take into account the large numbers of people experiencing malnutrition and dehydration in their own home.
As a result we do not get a full picture of what is really happening. It is likely that the figure is in fact a gross underestimate of the extent of malnutrition and hydration.
Those living unnecessarily with malnutrition/dehydration who remain at risk of preventable illness and death need our support. The figures on dehydration are less clear; there are no exact figures on the hydration status of the general UK population, but research into malnutrition suggests 1 in 10 people aged over 65 are malnourished and living in their own homes (ENHA, BAPEN, ILC-UK; 2006). Hydration and nutrition are individual issues and must be treated as such, but are in turn inextricably linked, both to each other and the overall health of the individual. Integrated care is key to ensuring the best possible care opportunities are met for all.
Clearly, anything that highlights the importance of hydration and nutrition can only be a good thing, but we need to then follow the numbers up with demonstrations of what good policy and practice can and do achieve. There are many examples of areas where local solutions have transformed the patient experience (as seen in Cornwall, Dorset, West Midlands and Harrogate, to name a few) and where national policy makers should be taking note to ensure this issue remains a priority area.
Clear, firm and relevant national nutrition and hydration policies need to be put in place to ensure that all patients have universal access to the most appropriate care for their needs. Many organisations are already able and willing to support this development are stuck waiting for policy makers to take this step. Developing policy around integrated care would be one step towards the whole person approach which is sorely needed. Policy makers need to learn from the positive outcomes in successful areas and better understand the basic need to enshrine good nutrition and hydration practices in care.
For more information on Hydration, visit the Hydration for Health Initiative website: http://www.h4hinitiative.com/