A.L. Cawood

Local implementation of a pathway to manage malnourished COPD patients in the community

Background: Malnourished COPD patients have higher healthcare use and poorer outcomes than those not at risk. NICE (CG101, CG32) and the national “COPD pathway” (www.malnutritionpathway.co.uk/copd) highlight the importance of managing malnutrition in COPD but evaluations of the impact locally need investigation. Aim: To investigate the effect of locally implementing the “COPD pathway” on the nutritional status, well-being and health care use of malnourished COPD patients in the community. Methods: 19 patients (75±9.4y) identified at high risk of malnutrition (BMI 18.3±3.1kg/m2) were initiated on the pathway and received dietary advice plus low volume, high protein oral nutritional supplements (600kcal, 36g protein) and followed up at 6 and 12 weeks. Malnutrition risk, health care use, health rating (bad – great, 0-10 scale), COPD assessment test (CAT) (0-40 scale), compliance and satisfaction were recorded for 12 weeks before and after implementation. Results: Implementation of the pathway led to a significant reduction in malnutrition risk (19 high risk to 10 high, 4 medium, 5 low) (p Conclusion: This local pilot suggests appropriate management of malnourished COPD patients in the community improves nutritional status, health and CAT rating with associated reductions in health care use. A larger project to explore the clinical and economic effects is required.

PP022-SUN RANDOMIZED CONTROLLED TRIAL SHOWS GREATER TOTAL NUTRITIONAL INTAKES WITH LIQUID SUPPLEMENTS THAN DIETARY ADVICE IN CARE HOME RESIDENTS

was associated with a reduced risk (all-cause HR = 0.74 [95%CI, 0.55 0.97], P= 0.035; cardiovascular HR = 0.62 [95%CI, 0.42 0.91], P= 0.016). Conclusion: BMI is significantly associated with all-cause and cardiovascular mortality in institutionalised elderly. A value of 21 kg/m2 can be considered a useful trigger for nutritional support. These results support intending BMI as nutritional reserve in institutionalised elderly.

PP258 SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EFFECTS OF HIGH PROTEIN ORAL NUTRITIONAL SUPPLEMENTS (ONS) ON NUTRITIONAL STATUS AND INTAKE

many studies comparing outcome (prevalence), process (screening and treatment of malnutrition) and structure indicators of nutritional care in different countries, using the same methodology. Therefore we conducted a study in Germany (G) and the Netherlands (NL). Methods: A cross-sectional international prevalence study was performed in 151 nursing homes (NL n = 5848, G n = 4923). A standardized questionnaire (3 levels) was used: at institutional and ward level structure indicators of nutritional care were assessed, whereas at patient level demographic data, care dependency and nutritional screening and treatment interventions for malnutrition were measured. Malnutrition was measured by assessing BMI, undesired weight loss and nutritional intake. Results: Dutch residents were older, more often male, more care dependent, and have a lower BMI than German residents. Dutch residents were more at risk of malnutrition (NL = 31.7% and G = 29.1%, p = 0.03), but no significant difference was found in the prevalence of malnutrition between both countries. About half of the malnourished residents received a nutritional intervention. Structure indicators at institutional level were more often fulfilled in the NL, only education was given more often in G. Besides having a specialized person in malnutrition, all other indicators on ward level were more often fulfilled in G. Conclusion: Malnutrition is a problem in more than a quarter of nursing home residents in each of the countries. Despite the fact that nutritional screening is rather frequently performed, nutritional interventions are provided only in about 50% of the malnourished patients. Structure indicators at ward level are more fulfilled in G, whereas at institutional level they are more fulfilled in NL.

PP353 MALNUTRITION RISK VARIES ACCORDING TO NUTRITION INTERVENTION IN CARE HOMES

Rationale: There is little information about how the prevalence of malnutrition in care homes varies according to the type of nutritional support provided. This study aimed to examine the extent to which malnutrition in residents receiving oral nutritional supplements (ONS) and enteral tube feeding through a percutaneous endoscopic gastrostomy (PEG) differs from the general care home population, and whether dietetic input is provided. Methods: 1322 residents [mean age 86.7 y (SD 8.7), mean BMI 23.0 kg/m2 (SD 5.1)] from 51 care homes (24 nursing, 19 residential, 8 dual registered) participated. Malnutrition was assessed using ‘MUST’ (‘Malnutrition Universal Screening Tool‘) (1) and related to the use of ONS (in the 4 weeks prior to the survey), PEG feeding, as well as the provision of dietetic input. Results: 8% of the care home population received ONS and 2% PEG feeding. Those receiving ONS resided predominantly in nursing homes (61%), and to a lesser extent in residential (10%) and dual registered homes (29%). All residents with a PEG resided in nursing homes. Overall 37% of residents were at risk of malnutrition (13% medium risk, 24% high risk) but this varied according to the type of nutritional support provided. Dietetic input was provided to 0.3% of the population. Results according to ONS and PEG are shown in the table.