3.10 Identify when referral to a health professional is necessary

This guide will help you answer 3.10 Identify when referral to a health professional is necessary.

Malnutrition is a serious health condition that occurs when a person’s diet does not provide adequate nutrients for their body to function properly. It can lead to significant physical, emotional, and cognitive problems, particularly for vulnerable individuals such as older adults, children, and those with chronic illnesses. As a care worker, recognising the signs of malnutrition and knowing when to refer someone to a health professional is an important part of your role in maintaining their health and wellbeing. This guidance will help you understand when referral is appropriate and what steps to take.

What is Malnutrition?

Malnutrition includes both undernutrition (lacking enough nutrients or calories) and overnutrition (excess calories, often with poor nutrient balance). In a care setting, undernutrition is of greater concern, particularly among individuals with limited mobility, chronic illnesses, or poor appetite.

Severe or prolonged malnutrition can cause problems such as:

• Muscle wasting
• Loss of strength
• Increased risk of infections
• Delayed wound healing
• Cognitive decline
• Reduced quality of life

Signs and Symptoms of Malnutrition

Identifying malnutrition early is critical. Look for these common signs and symptoms in someone you support:

• Unintentional weight loss – clothes or jewellery may appear looser.
• Loss of appetite, or difficulty eating or swallowing.
• Tiredness, irritability, or lethargy.
• Weakness or reduced muscle strength.
• Hollow cheeks or the appearance of bones under the skin.
• Skin that becomes dry or pale and may bruise easily.
• Hair loss or brittle nails.
• Frequent infections or poor wound healing.

In people with long-term conditions like dementia or cancer, malnutrition may develop gradually, making symptoms less obvious.

When Referral is Necessary

If you suspect someone is malnourished or at risk, it is important to act quickly. You might refer to a health professional in the following situations:

Significant Weight Loss

If a person has lost more than 5% of their body weight within 6-12 months without meaning to, this is a red flag. For someone who is underweight, any weight loss can be concerning. Notify a GP, nurse, or dietitian immediately.

Poor Appetite or Reduced Food Intake

If a person refuses meals, complains of feeling full quickly, or consistently eats very little, they may not be meeting their nutritional needs. This is especially concerning if it continues for more than a few days.

Difficulty Swallowing (Dysphagia)

If someone struggles to chew or swallow, they may avoid certain foods or eat less overall. Dysphagia can be dangerous and lead to malnutrition or choking. Referral to a speech and language therapist (SALT) or a dietitian is necessary.

Persistent Health Issues

Recurring illnesses, infections, or poor wound healing are signs the immune system may be weakened. Malnutrition could be a contributing factor, and a health professional should assess the individual.

Other Medical Conditions

If someone has a condition that makes eating or digesting food difficult – such as Crohn’s disease, coeliac disease, or cancer – they are at higher risk of malnutrition. Regular review by a healthcare team, including a dietitian, is important.

Emotional or Psychological Issues

Depression, anxiety, or grief can lead to significant loss of appetite. In these cases, both mental health and nutritional support may be required. Consider referring to a mental health professional and a dietitian.

Observations of Physical Symptoms

Signs such as muscle wasting, pronounced ribs, or loose skin can indicate a lack of nutrients. These physical changes need further assessment by a GP or dietitian.

Concerns About Dehydration

Although dehydration is different from malnutrition, the two are often linked. Dry mouth, reduced urination, or confusion can indicate dehydration, which should be addressed alongside nutritional concerns.

Who to Refer To

Deciding where to refer someone depends on their needs and the severity of their condition. Potential health professionals include:

GP (General Practitioner)

• Often the first point of contact for health concerns.
• Can assess malnutrition, conduct tests, and organise specialist referrals.

Dietitian

• A professional specialising in diet and nutrition.
• Will create a tailored eating plan to improve nutritional intake.
• Provides guidance on supplements, food fortification, or specialised diets for medical conditions.

Speech and Language Therapist (SALT)

• Assesses and supports individuals with swallowing difficulties.
• May recommend texture-modified diets, thickened drinks, or specific techniques to aid swallowing.

Specialist Nurses

• Nurses specialising in areas like diabetes or cancer often provide nutritional advice relevant to the condition.

Pharmacist

• May assist in sourcing and advising on nutritional supplements if prescribed.
• Can offer advice on medication side effects that cause nausea or loss of appetite.

Steps to Take Before Referral

Before making a referral, gather as much relevant information as possible. This helps the healthcare professional understand the situation fully. Follow these steps:

1. Monitor Dietary Intake
   Keep a food and fluid diary for 3-7 days. Record what the individual eats and drinks, the portion sizes, and any reasons they struggled (e.g., pain, nausea).
2. Check Weight
   Weigh the person regularly. Use the same scales each time and record the results. Note any weight changes.
3. Assess the Mid Upper Arm Circumference (MUAC)
   If the individual cannot stand for weighing, measure the circumference of their upper arm to estimate malnutrition risk.
4. Screen for Malnutrition
   Use tools like the Malnutrition Universal Screening Tool (MUST), which considers body mass index (BMI), weight loss, and acute illness affecting intake.
5. Discuss with the Individual
   Talk to them about their eating habits and how they feel. They may share reasons for not eating, such as pain or financial issues.
6. Communicate with Other Team Members
   Share concerns with colleagues or supervisors. They may provide insight or recommend the next steps based on their experience.

Providing Support After Referral

While waiting for an appointment or assessment, take steps to support the person’s nutritional needs:

• Offer small, nutritious meals or snacks frequently throughout the day.
• Fortify foods with extra calories and nutrients (e.g., adding cream, butter, or milk powder to dishes).
• Provide foods they enjoy, as this can help encourage eating.
• Ensure they remain hydrated, offering water, tea, or other preferred drinks.
• Avoid pressuring the individual, as this may reduce their appetite further.
• Offer emotional support if mental health issues contribute to the problem.

Legal and Organisational Responsibilities

As a care worker, you must follow your workplace’s policies about identifying and addressing malnutrition. These policies will align with UK legislation and guidelines, such as:

• The Care Act 2014 – emphasising the duty of care to meet individuals’ nutritional needs.
• NICE Guidelines (National Institute for Health and Care Excellence) – providing best practice advice on recognising and managing malnutrition.
• Food Safety Act 1990 – ensuring food provided is safe, nutritious, and suitable for the individual’s needs.

Failing to address malnutrition can lead to serious health complications and even death. It is your duty to act in the individual’s best interest and seek help when required.

Conclusion

Recognising the signs of malnutrition and knowing when to refer someone to a health professional is critical in a care setting. Malnutrition can significantly affect quality of life and lead to serious health problems if left unaddressed. Be observant, proactive, and thorough in your approach. Work in partnership with the individual, your colleagues, and healthcare providers to give them the best chance of recovery.