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Sample Research Proposal on Analysis and Prevention of Malnutrition among elders in the United Kingdom


            A large number of elderly patients admitted in nursing homes are at risk of being malnourished. In an inspection conducted there were over 2000 care homes that did not reach the minimum standards.[1] (Hope, 2005) Malnutrition according to wikipedia[2] (2006) is a common medical state due to not suitable and inadequate diet. Almost one third of elderly admitted in home care facilities are malnourished. (Hope, 2005) The quality of care given to elderly in the United Kingdom must be of high standards and the mortality rate of elderly due to malnutrition must be diminished. Implementing registration schemes to regulate workers that do not have the technical skills in taking care of elderly patients and proper training are some of the measures the government has done to improve the quality of care among the patients. CNN also reported simple measures in alleviating malnourishment on elderly. Malnourishment among elderly is a relevant issue that must be addressed urgently.




            According to Koh [3](2005), malnutrition is a condition as a consequence of lack and excessive nutrients or energy in connection to the metabolic and tissue needs. It can be divided into over nutrition and under nutrition or malnutrition. Osmani (1992) discussed that under nutrition occurs widely on populations that are socially and economically impoverished. Malnutrition among the elderly in the United Kingdom as well as around the world is at risk of being malnourished. There are a lot of reasons in which elderly are undernourished; it may be physiological, psychological or physical. But as a first world nation, the elders in our society must receive the basic necessities on the nursing homes whether it is private or state owned. An alarming rise of death due to malnutrition in nursing homes must be addressed right away by the government.


Objective of the Study

            The main objectives of this study are to identify the major causes of malnutrition among the elders and the prevention of undernourishment.


Significance of the Study

            This study will be an effective tool in identifying the causes and prevention of malnutrition among elderly patients based on different literatures. This study is a big help in giving suggestions on ways malnutrition can be reduced in nursing homes.

Scope and Limitations

            This scope of this study focuses on the causes of malnutrition and prevention on elderly patients. Other factors of malnutrition and concerns of elderly patients will not be discussed in this study. This study will use the qualitative method in discussing the results from related literatures.




Review of Related Literature

            Undernutrition composes a lot of factors according to Osmani[4] (1992), the major factors that attributes to malnutrition are (a) low income levels that are not enough in meeting the basic necessities such as shelter, food and clothing (b) quantitative and qualitatively poor diets (c) impoverished surroundings, poor access in potable water and poor sanitation (d) lack of access in the health care system and (e) high levels of illiteracy. In addition, the nutritional status has two broad factors; (a) diet, in which the food that the body intakes must provide the required nutrients and (b) factors that condition the requirement, absorption, assimilation and utilization of the nutrients.

            According to CNN[5] (2005) malnutrition lessens the strength of the immune system, it increases the risk of elderly in acquiring infections and pneumonia, malnutrition also adds in mental disorganization which contributes to malnutrition.

            Wikipedia (2006) identifies the common froms of malnutritions which includes protein energy malnutrition (PEM) which is the inadequacy of absorption of proteins and energy in the body and the micronutrient malnutrition which is the inadequacy of important and essential nutrients like vitamins and trace elements that the body needs.

            In the article of d'Arcy[6] (2001) stated that around 40 percent of patients admitted in the hospitals and almost fifth of the elderly staying in nursing homes are experiencing malnutrition. And because of malnutrition elders are more likely to undergo major complications and four times most likely to die.

            According to Hope (2005) the officials in the UK government found out that more than 2,000 nursing homes that cater for the elders have failed to meet the nutrition requirements needed. More than 250 nursing homes last 2004 failed by a significant degree on the mandatory standards and 1,842 care homes unable to obtain the standards needed. On 2005 a research by the British Association for Parenteral and Enteral Nutrition (BAPEN) estimated that one in three elderly living in care homes are "clinically malnourished." Malnutrition includes poor food quality and eating little, and because of being undernourished elderly loses their strength which affects their mood, anxiety and wellbeing.  

            Furthermore, Thorne[7] (1998) discussed that if elderly acquired serious illness malnutrition can occur rapidly as the patient eats food little by little. Malnutrition in elderly has many causes; it includes (a) side effects of medications (b) variations in taste and digestion (c) emotional and psychological issues such as depression, paranoia, and dementia (d) physical issues like swallowing disorders, and chewing ability (e) medical issues like physical illnesses and (f) financially insufficient.

            According to CNN (2005) in aging persons a process of difficulties triggers malnutrition and these are: (a) chronic illness- diseases and illnesses such as Alzheimer's disease and Dementia affects the mental functions of an elderly which could also affect the person's appetite. (b) hospitalization- Illness and surgery can take a great amount on the health of senior citizens; the common outcomes are loss of appetite, weakness and weight loss. (c) Depression- although it is not usually recognized and mostly underreported among the elderly it affects many, in the United States alone six million senior Americans aged 65 years old up experience undernourishment due to depression. (d) Alcoholism- Alcoholism is the primary contributor in undernourishment of seniors because it decreases appetite, destroys the important nutrients and it is usually used as a substitute for meals. (e) Malabsorption- As the body ages it undergoes physiological changes which affects the absorption of the nutrients, a number of older adults reduces the production of enzymes that are needed in the absorption of vitamins. (f) Medications- A lot of older people takes medications that affect the capacity of the body to eat and digest the nutrients inside the food.

(g) Difficulty chewing and swallowing- Dental problems can also affect in the food intake and appetite of older patients, even if the elderly ate nutritious foods they will have difficulty in digestion. (h) Diminished taste and smell- Taste and smell decreases as the person grows older, making the elderly lose their appetite (i) Restricted diets- Dietary restrictions among elderly such as limitations on fats and salts makes the food bland and unappealing to elderly that they stop eating. (j) Limited income- Senior citizens who are financially limited often go hungry particularly if they are taking expensive medications. (k) Loneliness and isolation- Older adults that are living in a solitary life are often malnourished.

            Moreover, BBC[8] (1999) reported that dental and oral problems that were undiagnosed are the leading cause of malnutrition in elderly. In a study conducted on elderly people living in Nursing Homes in West Hertfordshire, researchers found out that older adults have high levels of tooth decay and plaque retention. On the sample population 250 had difficulty in eating, 206 had taste problems, 261 had difficulty in caring for their mouth and 343 elderly needed assistance in cleaning their teeth and dentures.

            Another cause of malnutrition according to Irwin Mitchell[9] (2006) is neglect; nurses do not have enough time in feeding the elderly which leads in undernourishment of older patients in the hospitals. In a survey of 500 nurses conducted, the results were nine out of ten did not have the time to help patients in basic functions like eating and drinking. This is the consequence of understaffing hospital wards.

            There is the saying "Prevention is better than cure." Preventive measures must be taken in order to keep malnutrition among elders from happening. In the article of Hope (2005) a spokesman in the Department of Health said that. "Improving health and social care for older people is a priority area and we have invested in better services for older people." And the Commission for Social care Inspection must regulate the nursing homes and make sure that those homes delivers the basic necessities of the elderly and must be concern on the welfare of its residents.

            Furthermore, in the article of Doughty [10](2006) the government announced that there would be a national registration scheme among persons working in the elderly health sector. Care services minister Liam Byrne stated that the new scheme will be a great help in stopping violations of dignity among elderly. By having registration the employers are permitted to turn away health workers that are not registered and qualified and remove those who do not reach the professional standards.

            In d' Arcy's (2001) article the Southampton team hopes to establish a study on the initial care and care homes to find out if amending the nutritional diet of elderly could diminish hospital admission, the team also wants to examine if the use of dietary supplements would be beneficial for nutrient-deficient patients.

            Thorne (1998) suggested that the use of "concentrated calorie programs" approach prevents weight loss among elders in which low-calorie items are substituted to more nutritious choices.

            Furthermore, CNN (2005), suggested simple solutions for malnutrition among elderly: Enrich Spartan diets, Restore life to bland foods, plan between-meal snacks, use nutritional supplements, consider outside help, engage doctors, make meals social events and encourage regular exercise.   

            In combating malnutrition problems Irwin Mitchell (2006), stated that the National Health Service (NHS) introduced new steps, like prioritizing meal times, in which the nurses and caregivers concentrate on patients' eating habits.



Search Strategy     

Different related literatures will be gathered through electronic databases like Google, MSN, and Mywebsearch, using the keyword, "malnutrition on elders" and "prevention of malnutrition." The search will give different articles on journal and magazines. The articles will be read one by one and then sorted out from relevant studies to those that are not so relevant in the chosen topic. The articles were read again to get the significant data and information, after obtaining significant pieces of information this thesis proposal is created.

            A literature review is a vital part in the process of creating a research because there are a large number of literature reviews that shows basis and grounds in supporting a point of view and argument. There are numerous related literatures created in order to give a background on various researches and studies. Some literatures persuade and convince the readers to accept and agree with the modifications and some studies just state a concept and idea in order for readers to fully understand the study.


Critique the Articles

            From the pool of articles collected eight articles will be chosen to be reviewed and criticized using a simple but efficient tool which is the Critiquing Framework by Bray and Ree[11] (1995), this tool uses twelve questions in examining the articles.



            The alarming rise of death among elders in nursing homes due to malnutrition must be addressed by the health sector right away. The care given to our elders is of poor standards which is a huge contributor of malnutrition among elders. Health workers pays little attention to elderly due to understaffing on hospitals, the nursing homes are not regulated by the health sector, therefore the quality of care delivered to the elders are poor. Therefore in order to prevent malnutrition to the elders, the initial step must come from the health sector, a set of nutritional standards must be established in nursing homes to ensure the family members of the elderly receives adequate nutrition. The caregivers must be properly and well-trained to provide quality care to patients, the nurses must be fully equipped with knowledge regarding the health and nutritional needs of elderly. And family members must always check upon their elderly to avoid the feeling of isolation and depression which can contribute to the undernourishment of elderly patients.













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