Nutritional Care of the Older Patient with Fragility Fracture: Opportunities for Systematised, Interdisciplinary Approaches Across Acute Care, Rehabilitation and Secondary Prevention Settings

Abstract

Nutritional care of the older patient with fragility fracture is complex. Diagnostic difficulties, multi-morbidities and interdependencies and social complexities all contribute to the wicked problem of malnutrition. Whilst many settings have attempted to address malnutrition through highly specialised care, increasing evidence supports the role of systematised, interdisciplinary approaches across acute care, rehabilitation and secondary prevention settings. Consequently, this chapter is devoted to highlighting why a SIMPLE approach to malnutrition should underpin the nutritional care of the older patient with fragility fracture, regardless of setting or healthcare provider.S Screen for nutrition riskI Interdisciplinary assessmentM Make the diagnosis (es)P Plan with the patientL impLement interventionsE Evaluate ongoing care requirements

Dietitian assistant opportunities within the nutrition care process for patients with or at risk of malnutrition: a systematic review

“…Similarly, for mealtime assistance or monitoring, whether a dietitian assistant, foodservice worker, interdisciplinary professional healthcare worker or volunteer will be highly dependent on context, and individual requirements, revealing the lack of clarity that surrounds which tasks fit best under which roles 50,55,61 . Furthermore, involving the interdisciplinary team and enabling them to undertake elements of the NCP is vital to consider when developing local models 10,31,32 . This supports the “adapt to fit” concept as essential to developing delegated models of care and facilitating full scope dietitian assistant roles 10,19,34,62,63 …”

“…However, the lack of studies exploring delegation of nutrition care activities to dietitian assistants in the last 5 years suggests this is not being given adequate attention, or where delegation to dietitian assistants is occurring, practice implications have not been published. While skill sharing opportunities, for example by nursing staff, is also worthy of particular attention, this was beyond the scope of this systematic review 27,31,32 …”

“…Working to full scope, or even expanded scope, for all roles across the interdisciplinary team is a key consideration in this process 54 . Again, consideration needs to be given to contextual factors when determining what is full scope, expanded scope or beyond scope of appropriateness of tasks for delegation; factors include governance, infrastructure, healthcare setting, available resources, employer, workforce capability and attributes 13,25,29‐33,35 . Recent programs in Australia and Canada have explored interdisciplinary team involvement across all elements of the NCP 10,18,50 .…”

“…Screening for nutrition risk sits outside the NCP, as it is used to identify patients to be referred into the process 28 . Although the interdisciplinary team is paramount to the provision of nutrition care, the focus of this review is limited to components of the NCP that may be undertaken by dietitian assistants 31,32 …”

Delegation Opportunities for Malnutrition Care Activities to Dietitian Assistants—Findings of a Multi-Site Survey

“…For example, nutrition risk screening and consequent referral by nursing staff to the dietitian service [ 39 ] has been shown to be implementable and improved practice. This step may be an untapped opportunity for nursing staff or the broader multidisciplinary team to take on other nutrition care strategies that do not require specialised dietetic input [ 13 , 37 , 40 ]. Interestingly, results from this survey highlighted that dietitians were more confident to delegate to dietitian assistants, rather than students, nursing, non-dietetic allied health professionals or the medical team.…”