Dietitians are keen to bring you the latest food and nutrition information on topics that we know you care about. Nutrition views are based on the latest science. It’s our way of ensuring that the most reliable information is available to you and that people are aware of nutrition initiatives that focus on getting better nutritional healthcare for all people in Ireland.
Malnutrition/Undernutrition - a modern day phenomenon
Many Irish hospitals and several nursing homes took part in Nutrition Screening Week in 2010 and 2011.6 The purpose of these surveys was to establish the malnutrition risk of patients on admission to hospital and of residents in longer term care. Results showed that:
- One in three to four of all patients admitted to Irish hospitals were considered to be at risk of malnutrition, with 75% of these considered to be at high risk
- A quarter to a third of residents in Irish nursing homes were considered to be at malnutrition risk
- The highest risk of disease-related malnutrition was associated with gastrointestinal conditions (45% and 48% respectively), with significant risk being associated with respiratory disease (30% and 33% respectively).
In Ireland, it is considered that at any one time there are 140,000 adults at high to medium risk of disease-related malnutrition, of which over 50% are aged 65 or over. People aged 65 and over are five times more likely to be malnourished, compared to younger adults. The annual cost of disease-related malnutrition to Ireland is estimated to be 1.5 billion euro, representing over 10% of the total annual health and social care budget.
What are the consequences of unrecognised or untreated malnutrition?
Malnutrition in the community is an independent predictor of mortality regardless of age. The consequences of malnutrition are well documented, and
- Depletion of body protein, glycogen, minerals and micronutrients
- Increased hospital length of stay
- Increased hospital mortality
- Increased complications: increased infections, delayed wound healing, increased surgical complications
- Delayed rehabilitation and convalescence
- Reduced quality of life
- Increased GP visits
- Increased readmissions to hospital
- High social cost
- Higher healthcare costs.
Many patients and their carers are struggling to battle their conditions due to lack of access to good nutritional care.
How do we prevent and treat malnutrition?
Strategies to tackle malnutrition should be focused on primary care settings as well as hospital settings. From UK data, 93% of malnourished patients were living in the community. This highlights the importance of screening and assessment for malnutrition in the community. An increasing evidence ase shows that the appropriate use of nutrition support (oral nutritional support, enteral tube feeding and parenteral nutrition) can improve outcome and reduce costs. Despite this knowledge, nutrition support remains a very small percentage of national prescribing costs, typically <2% in the UK. utrition support is often not used frequently enough or early enough to prevent or treat disease-related malnutrition. Nutrition support should be seen as an integral part of the optimal management of malnourished patients. Other aspects of care must also be given due consideration, which may involve other therapies,such as appropriate physiotherapy.
The first line of treatment in the community is oral nutrition support. This is used when the patient can swallow safely and the gastrointestinal tract is functional. This can take the form of:
- Assistance with eating
- Food fortification
- Oral nutritional supplement (ONS) use.
Oral nutrition support is discontinued when the person can demonstrate an adequate intake persistently from diet. In a hospital setting enteral and parenteral feeding are other nutrition support tools that can be used to treat or prevent malnutrition. Enteral tube feeding is used for malnourished patients or those at risk, who have a functioning gut, but who cannot meet their needs with oral nutrition support alone, or where oral diet is considered unsafe. Parenteral or intravenous nutrition is reserved for those who have an inadequate or non-functioning gut, where the gut is inaccessible, or when tube feeding is unsafe or unlikely to be effective. Increasing numbers of patients need to continue these therapies at home.
Who can help?
Avoidable malnutrition must be eliminated from our healthcare system. This involves an integrated approach by all medical, nursing and health and social care professionals working in our communities, our hospitals and other healthcare facilities. Patient groups also have a key role to play in this process.