Recommendations for research
The guideline committee has made the following recommendations for research.
Further research is needed to ascertain whether an educational intervention (for example, three 1‑week modular courses, over 6 months) for all healthcare professionals, in particular medical and nursing staff including those who work with people with dementia, would have an effect on patient care (that is, effect on nutritional status, length of hospital stay, frequency of GP visits, complications and quality of life) compared with no formal education.
It is known that healthcare professionals in both the hospital and community setting have a poor knowledge of nutrition. This is partly due to receiving a minimal amount of education in nutrition during their undergraduate or basic training. It is therefore essential to determine whether an organised nutrition support education programme to healthcare professionals would improve the choice made about nutrition support and the consequent care of patients prescribed nutrition support.
What are the benefits to patients of a nutritional screening programme (using a simple tool such as the Malnutrition Universal Screening Tool [MUST]) compared with not screening people in: a) primary care (attending GP clinics); b) care homes; c) hospital inpatients; d) hospital outpatients; e) patients with dementia in terms of determining the number of people at risk of malnutrition, complications, survival, hospital admission rates, length of stay, quality of life and cost effectiveness?
There is no clear evidence available as to whether screening is really beneficial or how it should be carried out. With the lack of evidence, the committee have considered in detail this problem and have instead carefully developed consensus statements to support recommendations for screening. As a priority, it is important that we determine the need for screening and intervention − in particular, primary care and the wider community.
Further research is needed to identify which components of nutrition monitoring are clinically and cost effective.
There is no clear evidence available regarding the long- and short-term benefits of clinical monitoring in terms of prevention of complications and survival. With the lack of evidence, the committee have considered in detail this problem and have instead carefully developed the guidance for monitoring by expert clinical practice and consensus opinion.
What are the benefits of patients (in hospital or the community, including older people) identified as at high risk of malnutrition by a screening tool such as MUST being offered either oral nutritional supplements compared with: a) dietary modification and/or food fortification; or b) dietary modification and/or food fortification together with dietary counselling, in terms of determining complications, survival, length of hospital stay, quality of life and cost effectiveness?
This is an essential recommendation for research since there is insufficient evidence on the benefits of intervention used for oral nutrition support – in particular, the benefits of often first line treatment, for example food fortification and/or dietary counselling. It is essential to know this so that the indications on how to treat can be further supported.
What are the benefits of enteral tube feeding to patients compared with no enteral tube feeding in people with dysphagia and early- to mid-stage dementia in terms of reduced complications associated with swallowing, improved nutritional status, delayed onset of advanced stage dementia, hospital admissions, cost effectiveness and survival?
Much of the research tends to focus or concentrate on tube feeding people with advanced dementia or those who may be in terminal stages of the disease. Depending on the type of dementia, swallowing disorders may occur at an earlier stage in the disease, for example vascular dementia. The benefits and complications of tube feeding may be quite different in people in the earlier stages than those who are in the advanced stage of dementia.