Food. We literally can’t live without it! And for most of us, we wouldn’t want to either – the pleasure food brings us and the way food brings people together, is a building block of society.
There are a number of reasons why people may not achieve their daily nutritional requirements and as a result become malnourished. For example, it could be due to difficulty swallowing, a loss of interest in food, disease or illness, pain, or even simply a lack of knowledge around appropriate nutrition.
The national picture
There’s not a huge amount of research out there that tells us how many people are malnourished (undernourished) in New Zealand. But some new research hot off the press in May this year has identified malnutrition in 22.8% of those newly admitted to hospital and in 47.2% of older people admitted to residential care . It is obvious that this warrants immediate attention.
The prevalence of nutrition risk in community dwelling older people has also previously been studied in Christchurch. The researchers found 23% of the participants were at risk of poor nutrition with a whopping 31% considered to be at high risk .
This is happening in our country. These older people could be you, your parents, your neighbours or your grandparents. It’s clear that it’s time to make a change and there is no reason why that can’t happen!
The ultimate effect
The British Association of Parenteral and Enteral Nutrition (BAPEN) described malnutrition as ‘often under-recognised and under-treated to the detriment and cost of individuals, the health and social care services and society as a whole’ .
Now, we know malnutrition has an impact on the individuals in question, but the huge impacts on society, including the health care system are also undeniable. Malnutrition cost the health and social care system in the UK over £19 billion (NZ $34 billion) in 2011 - 2012 .
Malnutrition inevitably affects the body’s ability to fight infections and can have a significant impact on both clinical and economic outcomes such as, prolonged hospital stays, higher treatment costs, increased risk of pressure injuries, and increased mortality rates [5, 6]. Given all of these factors, it once again highlights the need for a change not only for people who are malnourished but also for international health care systems.
A review of nine different studies in Europe found that the associated costs of malnutrition in ‘institutionalised and community-dwelling older adults were considerably higher than those of well-nourished ones’ . Also, it has been suggested than an estimated resource saving of £71,800 (NZ $130,000) per 100,000 people can be achieved, simply by using screening tools to earlier identify malnutrition . This, combined with other simple nutritional strategies, such as use of oral supplements in preventing worsening malnutrition, represented such a cost effective model that the National Institute for Health and Clinical Excellence (NICE) identified nutrition as the fourth largest potential cost saving to the National Health Service (NHS) .
Nutritional supplements are a very effective way to ensure adequate nutrition in those that need it. They should be used to complement dietary food intake but not as substitutes to nutritious meals . Dietary modifications are essential in the prevention and treatment of malnutrition. Ensuring appropriate texture of foods, having enough energy and protein (‘fortifying’ your food if needed), and eating the right number of meals per day are simple, yet effective strategies .
Malnutrition can cause infection, poor healing, pressure injuries and prolonged hospital admissions. Our British counterparts also show a clear connection between malnutrition and a rise in economic cost on their health care system. Nutrition screening and appropriate nutrition interventions may seem like an obvious place to start, but it’s a case of simple changes that will have long lasting benefits for both the individual and our own nation’s health service.References
- Wham, C., et al., Malnutrition risk of older people across district health board community, hospital and residential care settings in New Zealand. Australasian Journal on Ageing, 2017: p. 1-7.
- Watson, S., Z. Zhang, and T.J. Wilkinson, Nutrition risk screening in community‐ living older people attending medical or falls prevention services. Nutrition & Dietetics, 2010. 67(2): p. 84-89.
- BAPEN Quality Group, Malnutrition Matters - Meeting Quality Standards in Nutritional Care: A Toolkit for Commissioners and Providers in England, 2010.
- Elia, M., The cost of malnutrition in England and potential cost savings from nutritional interventions (full report), 2015, BAPEN.
- Barker, L.A., B.S. Gout, and T.C. Crowe, Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. International journal of environmental research and public health, 2011. 8(2): p. 514-527.
- KPMG, The case for investment in: A quality improvement programme to reduce pressure injuries in New Zealand, 2015.
- Abizanda, P., et al., Costs of Malnutrition in Institutionalized and Community-Dwelling Older Adults: A Systematic Review. Journal of the American Medical Directors Association, 2016. 17(1): p. 17-23.
- National Institute for Health and Clinical Excellence, Implementation Programme: NICE support for commissioners and others using the quality standard on nutrition support in adults, 2012. p. 1-24.
- Avelino-Silva, T.J. and O. Jaluul, Malnutrition in Hospitalized Older Patients: Management Strategies to Improve Patient Care and Clinical Outcomes. International Journal of Gerontology, 2017: p. 1-6.