Understanding Malnutrition

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Malnutrition in Ireland

Quick facts

  • Malnutrition affects ~145 000 adults at any time in Ireland.
  • Affects people with an underlying disease, illness or chronic health problem.
  • Although> 95% of malnourished are community based, highest concentration in hospitals (1 in 3 )
  • Untreated malnutrition/weight loss increases risk of infection, pressure sores, falls and poorer outcome
  • Healthcare costs are 3 times higher in malnourished patients

What is malnutrition?

Malnutrition here refers to undernutrition, typically due to appetite loss and inadequate intake in someone who has an underlying illness or inflammatory condition.  Malnutrition may develop rapidly (eg. in acute illness) or more gradually, depending on the factors at play, highlighting the importance of nutrition screening to detect those at risk.

How many patients are affected

On any given day in Ireland, an estimated 145,000 community and hospital patients are malnourished or at risk of becoming malnourished (4% of the total population) without appropriate nutritional care or nutrition support. Unfortunately, some will fail to have their needs identified or properly addressed due to low awareness of the problem amongst the public and health professionals.

Who is at most at risk

The condition termed ‘disease-related malnutrition’ affects those with diseases or conditions that reduce appetite or otherwise make eating or utilising food difficult or impossible.  These include:

  • Older people, particularly those living alone and coping in poor social circumstances or have recently been admitted to nursing home or hospital.
  • People with diseases like cancer, COPD and progressive conditions like dementia or neurological diseases (eg. multiple sclerosis, motor neuron disease, cva)
  • People with conditions like cystic fibrosis, crohn’s disease and any other diseases that affect digestion/absorption.

Why malnutrition matters: risks for patient

Weight loss and malnutrition increase a patient’s risk of serious but potentially avoidable complications.
Community patients (representing over 95% of those affected on any day):

  • Have more GP and outpatient visits
  • More likely to be admitted to hospital

Once admitted to hospital, patients identified as ‘at risk’ of malnutrition were found to have:

  • 3 x greater risk of surgical site infection
  • 5 x risk of catheter associated urinary tract infection
  • 2 – 3.8 times risk of developing pressure ulcers
  • Higher risk of readmission to hospital within 45 days
  • 2 – 3 x greater risk of dying (according to age)

Cost to patients, the health service and society

Because malnourished patients have higher rates of complications, more hospitalisations and greater care needs than normally nourished patients, their costs have been found to be up to 3 times greater than normally nourished patients.  The annual healthcare costs associated with malnutrition are enormous, estimated at over €1.4billion in Ireland and €170billion across Europe, exceeding that of obesity.  (See Health Economics section for more details)

Weight loss as a sign of developing malnutrition

Malnutrition can often be difficult to recognise, particularly in patients who are overweight or obese. In an older person living at home, malnutrition can develop quite gradually, making it difficult to spot. However, loss of appetite and unintentional weight loss are signs that an individual has an inadequate intake of energy, protein and other nutrients and should not be ignored, even if the patient is overweight.   Nutrition screening takes less than 5 minutes and can identify those at risk.

Malnutrition is largely preventable / treatable

Far from being inevitable, most malnutrition is relatively simple and inexpensive to treat, especially if detected early.  Research has shown that effective hospital nutrition programmes and raising awareness of the issue of patient nutrition leads to better patient outcomes.

The key elements to ensuring good nutritional care are:

1) Create an institutional culture in which good nutritional care is central to quality care

2) Routine nutrition screening on admission to identify malnourished patients and those at risk

3) Rapidly implement nutrition interventions / actions according to agreed treatment pathway.

4) Communicate nutrition care plans to all staff involved in care and patient

5) Develop a comprehensive discharge nutrition care and education plan

Explanation of Clinical Nutrition from ESPEN