A Day in the life of a Community Nutrition and Wellbeing visitor
The UK’s largest charitable meals on wheels provider is also the only one to have a full-time nutrition and wellbeing service, offering intensive nutrition support and tailored meal plans for older residents across the county. Our newest recruit, Kolsum Jahan [pictured, right], reflects on her experiences helping some of Hertfordshire’s most vulnerable residents.
“From small beginnings with just one office and 200 clients in 2007, HILS has grown exponentially. At the time I joined in 2017, we were delivering a variety of independence-promoting services to over 13,000 elderly people living in the community. And we are certainly having an impact! Our annual client survey showed that 84% of our clients felt less lonely as a result of seeing our friendly meal delivery drivers and 97% of family members said they felt reassured knowing that their loved ones have a regular visit from our teams.
“For me, the most exciting part of HILS is our unique nutrition service. The team includes three community nutrition and wellbeing visitors (of which I am one), a dietitian and a registered nutritionist. Together, we go out to visit meals on wheels clients to identify people who are at risk of malnutrition. If they are underweight, or losing weight unintentionally, we offer them tailored advice and sometimes give them extra high energy food. This free service is hugely important in targeting malnutrition, which is particularly prevalent among older people living at home. The British Association for Parenteral and Enteral Nutrition (BAPEN) has estimated that malnutrition affects over 3 million people in the UK – of these, nearly 50% are over the age of 65.
“Losing weight is not a necessary part of ageing, in fact it can drastically reduce a person’s ability to fight infection, stay physically active and mobile, and induce lethargy and low mood. All of these symptoms can lead to frequent and avoidable hospitalisation.
“One particular client who has benefited from our support is Mrs Bunn [pictured, left], who lives at home and cares for her disabled daughter. When we first met, she had lost over 10% of her weight over a few months, and her BMI was just 18.7kg/m2. This is considered quite underweight; a healthy BMI for older adult ranges from 20 to 30. Together with the weight loss, this told us that she was at high risk of malnutrition, so we decided to act.
“Both Mrs Bunn and her daughter receive our hot lunches, but they prepare their own breakfast and supper. Mrs Bunn has always been slim with a small appetite and found it difficult to put on weight, so we devised an action plan to help her.
Firstly, we started providing Nutrition Boosts – these are a selection of additional snacks such as biscuits, cakes, drinks and fortified soups, delivered free alongside her daily lunchtime meals. Small, high calorie snacks can be easier for people with small appetites.
Secondly, we arranged a follow-up visit to be conducted every 3 months to monitor her weight and review the eating plan.
Thirdly, we gave ideas on how she can fortify her food, such as adding full fat cheese, butter or cream to meals, or enriching milky drinks with dried skimmed milk powder. These are simple ways to increase calorie intake without increasing portion sizes.
Finally, we introduced her to our range of Mini Meals - these are small but energy dense food portions designed for people with a reduced appetite.
“In just one year, Mrs Bunn now weighs 49.8KG, giving her a BMI of 20.7kg/m2! This may not seem like much for healthy adults, but for someone who struggles to even maintain a stable weight this is a huge success and will hopefully help her stay happy, healthy and independent for longer. Mrs Bunn is now considered to be at low risk of malnutrition, and is in a better health to continue caring for her daughter – and herself! We will continue visiting her every 6 months for the next year, just to monitor her weight and keep an eye on her, whilst our drivers will give her regular encouragement to keep eating for good health.
“It is a great privilege to be able to help people like Mrs Bunn. Many of the people we see don’t always think about food and drink as an important part of their overall wellbeing.”