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This chapter will take into consideration the background and relevant issues relating to Malnutrition Universal Screening Tool (MUST), focusing on the importance and significance of malnutrition assessment among individuals living with dementia in care or residential nursing homes to contemporary nursing. The aim of this research appraisal is to critically analyse and synthesise the accuracy and consistency of MUST in identifying malnutrition among people living with dementia. The research question will be: To what extent is MUST effective for identification of malnutrition among individuals with dementia in care or nursing homes?
According to Murphy et al (2018), more than 3 million people in the United Kingdom are malnourished or at risk of malnutrition, of these 93% are living in the community. The cost of malnutrition in England is estimated to be 19.6 billion pounds per year and about half of this is spent on people over the age of 65 (Murphy et al, 2018). Research has indicated that, the cost of treating care home residents who have been diagnosed with malnutrition is twice that of screening and monitoring the general care home population.
Risk assessment serves as an indicator for nursing care, MUST seeks to help minimise or prevent the prevalence of malnutrition in vulnerable adults (Chauhan et al., 2007). The Malnutrition Universal Screening Tool is a tool devised to identify whether adult patients are malnourished or at risk of malnutrition. It comes with management guidelines which can be used to formulate a care plan (BAPEN, 2003).
According to Care Quality Commission (CQC, 2012), five hundred care homes were inspected for quality of nutritional care and found 1 in 6 care homes did not meet the required standard. Malnutrition affects the physical and psychological function (Murphy et al., 2018) and impairs patients’ recovery from diseases and injuries, consequently increasing level of morbidity and mortality (NHS, 2015). Age UK (2016), reported that, malnourished patients stay on average 5 to 10 days longer in hospital.
Malnutrition is set to increase with an ageing population and the rising cost of health and social care services (Murphy et al, 2018). Thus early identification and treatment can significantly minimise the clinical risk including vulnerability to sickness, clinical complications and mortality (Stratton et al, 2018). Stratton et al (2018), have reiterated that, evidence-based assessment tool is required for good practice that will complement clinical judgement to facilitate effective assessment and monitoring.
Dementia widely refers to a syndrome that arises as a result of a group of brain disorders caused by loss of cognitive functioning that is severe and progressive (Elahi and Miller, 2017). In United Kingdom, there are an estimated 850,000 people living with dementia and more than half of this figure has Alzheimer’s disease with approximately 670,000 friends and families acting as informal carers (Alzheimer’s Society, 2014). The cost of dementia to the UK government is estimated to be 19 billion pounds per year. Alzheimer’s disease is the most common type of dementia which accounts for 62% of all dementia cases, Vascular 17%, Lewy body 4%, Frontotemporal 2%, Parkinson’s 2% and other subtype 3% respectively (Prince et al, 2013).
Problems associated with nutrition are inevitable in all stages of dementia, and are more pronounced in the middle and later stages (Alzheimer’s Society, 2014). These problems act as major contributing factors to malnutrition and other behavioural symptoms (Roque et al., 2013). Poor nutrition, in these cases, may also cause weight loss.
Dementia among the older population is, therefore, a major public health issue in UK because of the increasing ageing population (Mole et al., 2019). It is one of the biggest challenges facing both the NHS and our society.
1.3 key definitions
Definitions of key relevant terminologies that will be used in this literature review will be provided in the appendix.
This introduction chapter has presented a descriptive background of the MUST, malnutrition and epidemiology of dementia, focusing on the relevance of the MUST to the contemporary nursing. The rationale for the review has been justified. In analysing the extent to which MUST is effective in identifying malnutrition among patients in care and nursing homes, the researcher adopts a systematic literature review. The methodology and research method that will be used to conduct this literature search will be explored in the subsequent chapter 2. The thematic areas and analysis will follow in chapter three, presented as part of the results, then the discussion, and eventually the conclusion and possible recommendations from the research.
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