STREAM programme

About 10-15% of people over the age of 65 living at home are at risk of malnutrition. In particular poor appetite is an important risk factor for malnutrition and for weight loss, and a risk factor for the development of infections, hospital admissions and even longer term mortality. This may be because they are not getting enough to eat, or because they are not eating enough of the right food.

We have developed an approach (‘intervention’) to help doctors and nurses in general practice to check if older adults who live at home are at risk of malnutrition. They can then offer support to those who need it. Our intervention, called ‘Eat well, feel well, stay well’, includes booklets and other materials for older adults, and support for health professionals. The support for health professionals includes guidance about when to see patients, and for those more severely at risk when to use oral nutritional supplements.

The intervention was developed by experts who looked at previous literature to find what helps or hinders older adults eating well, and what is likely to work best in general practice. The intervention was improved after feedback from people aged over 65 years, patients and healthcare professionals. We then tested the feasibility and acceptability of the intervention in 22 general practices and made necessary adjustments to it.

In the ongoing RCT, we aim to assess the effectiveness of the intervention. All patients get a brief intervention with patient booklets and follow-up, but individuals who are at much greater risk will have the brief intervention plus oral nutritional supplements (ONS) for short spells when they are unwell. For comparison we will follow a group of patients who have the usual care that is provided by their doctors’ surgery. We will assess outcomes including the number of infections people get, change in eating patterns, weight and quality of life. We will also compare patients and health professionals’ experiences of being in these different groups.

Contact: stream@southampton.ac.uk