MEDIA PRESS
UNDER-NOURISHED PATIENTS MORE LIKELY TO DIE, YET PROBLEM STILL
OVERLOOKED OR IGNORED – CONFERENCE TOLD
Patient Groups & International Nutrition Experts Call on Irish Government to take action
to prevent old and chronically ill become malnourished
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Patient Organisations attending Dublin conference on the impact of malnutrition join in call for
Government to implement key actions to prevent malnutrition in the Irish healthcare system
Malnutrition is avoidable and easy to treat, yet over 140,000 are put at risk every year
Malnourished patients are between two and three times more likely to die within six months
Less than 10% of hospitals in Ireland are routinely screening for malnutrition despite Department
of Health guidelines issued 4 years ago
It is a health crisis that costs state €1.42 billion every year
Dublin, 24th May 2013: Delegates attending a conference in Dublin this morning, organised under the
auspices of European Presidency, were told that many under-nourished patients within the Irish
healthcare system continue to be overlooked and are not receiving adequate nutritional care, despite
being three times more likely to develop infections and at least twice as likely to die as normally nourished
patients with a similar diagnosis.
The comments were made at the launch of a call to action document, Every Patient Deserves Good
Nutritional Care, which outlines five key recommendations designed to eliminate avoidable malnutrition
in older and chronically sick patients - a problem that affects as many as 140,000 Irish hospital and
community patients.
The report, which has been drawn up by the Irish Society for Clinical Nutrition and Metabolism (IRSPEN)
with partners the Irish Nutrition and Dietetic Institute and European Nutrition for Health Alliance has the
backing of a number of the Irish Cancer Society and many other patient organisations whose members
are at higher risk of malnutrition and more likely to need specialised nutrition support.
Launching the ‘call to action’, Dr. Orla Crosbie, Consultant Gastroenterologist and Director of
IRSPEN, explained that, for patients with an underlying disease process, nutritional intake becomes
incredibly important:
“Patients who come into hospital in a poor nutritional state are at a major disadvantage, and medical or
surgical procedures can make matters worse. This makes it imperative to have systems in place to
identify patients at risk, ideally in the community so that malnutrition can be prevented,and certainly as
soon as they arrive in hospital”.
Most malnutrition is preventable; nearly all is treatable. Despite this, the low priority given to ensuring
good nutritional care for all patients within our healthcare system every day in Ireland means many older
and chronically ill patients are put at avoidable risk by. Across Europe, there is general consensus on the
solutions – it is simply now a matter of putting them into practice.
The key actions contained in the call to action document launched today include making nutrition risk
screening mandatory in hospitals and long term care facilities and introducing nutrition training for all
healthcare professionals. The report also calls for the new Quality Standards for the nutritional care that
patients should receive, with which hospitals and other healthcare settings would have to comply.
Finally, the report highlights the very serious deficits in the support available to patients on home
nutritional support (i.e. patients being fed by tube or intravenously), many of whom are left largely to their
own devices once discharged from the hospital.
IRSPEN Chairman, Professor John Reynolds, who is also head of Surgery in St. James’ Hospital,
renewed an earlier plea to the Minister for Health to fully recognise malnutrition as a critical health priority:
“Unfortunately, I find myself once again calling on the government to give malnutrition the attention that it
deserves. Every patient has a basic human right to have their nutritional and care needs met and to
receive the support required in order to ensure malnutrition is prevented. Incredibly, for such a serious
condition, combating malnutrition within our healthcare system still languishes as a low priority compared
to other conditions and diseases which have far less human and financial costs. This needs to change”.
International expert, Professor Olle Ljungqvist of the European Nutrition for Health Alliance who
was also speaking at the conference, also urged the Minister James Reilly, as holder of the EU
Presidency, to take action on malnutrition and urge other EU health ministries to do the same:
“Governments must ask themselves if the cost of continued inaction is affordable. Recent studies show
that a malnourished patient incurs around twice the healthcare costs of a well-nourished
patient. Undernourished patients are around 60% more likely to be hospitalised and will have a 30%
longer length of stay once there. In Europe, these healthcare costs add up to around €170 billion per
year, whereas in Ireland, the costs may be as high as around 10% of your total healthcare budget –
€1.4billion”
IrSPEN Director Dr. Crosbie also announced their intention to use the conference and call to action report
as an opportunity to establish a ‘malnutrition alliance’, working with partners INDI and patient
organisations. The alliance would aim to advance better standards of nutritional care within the healthcare
system. The intention is to broaden the network of alliance members to other professional and patient
groups and to work with policy makers, within the Department of Health and the HSE, to improve nutrition
knowledge amongst healthcare professionals and the standards of nutritional care that patients receive.
Groups supporting the call to action include: MS Ireland, the Cystic Fibrosis Association, the Carers
Association, Third Age, the Irish Cancer Society, the Irish Patients’ Association and the Irish Nutrition and
Dietetics Institute (INDI).
Stephen McMahon CEO of the Irish Patients’ Association (IPA) welcomed the call to action report and
saying that the Irish Patients’ Association fully supported the initiative and are delighted to be working
with IrSPEN and other patient groups.
“Patients’ needs must be at the centre of any successful healthcare system – none more important than
the basic need for good nutritional care and adequate hydration. The actions outlined in this document
are all critical to each of the Governments stated objectives of better patient safety, better patient care
and better value for money so there can be no arguments for continued inaction on their part. He added
‘it is completely unacceptable for patients to become malnourished within our healthcare system, and yet
it is happening every day”.
-ENDS-
For further details please contact
Andrew Shaw or Helen McCormack of First Medical Communications on 01 6145102 / 0877525445
(AS) / 0863743378 (HMcC) or ashaw@firstmedical.ie and Hmccormack@firstmedical.ie
Notes for Editor:
Summary of the 5 action points
IrSPEN and the Malnutrition Alliance are calling on the Minister for Health, Dr James Reilly, to implement
five key actions to combat malnutrition:
1. Public awareness and education
Effective educational campaigns need to make the public aware of malnutrition and its risk, targeting
older people, those with chronic illness, their families and carers.
2.
Mandatory nutrition screening
Nutrition Risk Screening must become mandatory in all hospitals and long stay care facilities,
underpinned by protocols and adequate resources for follow up assessment and appropriate
management of those identified as ‘at risk’. A national screening policy should be immediately developed
for primary care services targeting high risk groups. This will ensure that nutrition support is targeted
effectively and at an early enough stage to prevent serious and costly complications.
3 Nutrition training of health professionals
Nutrition education should be a requirement on the curriculum of medical, nursing professions (including
primary care), pharmacists, and other healthcare workers. All healthcare professionals should receive, as
a minimum, training on how to identify the signs of malnutrition and the components of good nutritional
care.
4 Quality standards for nutritional care
National Quality standards should be immediately established for healthcare providers, outlining their
obligations in ensuring that patients are offered the best nutrition and nutritional care possible, including
hydration, and that any specialised needs identified through screening are addressed at the earliest
opportunity.
5. Equitable access to safe, effective home nutrition support
No patient should have to remain in hospital or care home solely to receive nutritional support. Adequate
resources must be provided at community level so that all patients have equal access to required nutrition
support at home, irrespective of location or ability to pay. All patients on home artificial nutrition support
must have regular access to a community-based dietitian to ensure safe, effective care. In this way,
patients who require artificial nutrition support have the best opportunity to live independent, fulfilling lives.
IrSPEN
The Irish Society for Clinical Nutrition and Metabolism (IrSPEN) is a multi-profession society that was set
up in 2010 with support from the Irish Society of Gastroenterology, Irish Nutrition and Dietetic Institute
and the Nutrition Society. IrSPEN is committed to addressing malnutrition and improving nutritional
treatment of ‘at risk’ patients in hospital and the community.
What is malnutrition?
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Malnutrition is a common clinical and public health problem which has adverse effects on every
system of the body and on physical and psychological function. Malnutrition is both a cause and
consequence of disease, delaying recovery from illness and increasing the risk of complications.
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Malnutrition in this context refers to under-nutrition that affects a person’s health, wellbeing and
ability to work. It can result from underlying disease that suppresses appetite or because the body
cannot use food properly, resulting in weight loss and nutritional deficiencies.
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The degree to which a patient is malnourished or at risk of malnutrition is determined by their
taking a number of factors into account. These include BMI (<20kg/M2 or less), significant recent
unplanned weight loss, or the presence of an active disease process.
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Those over 65 years of age are at far higher risk (approx x 5) than younger adults, since this
group is more likely to suffer from chronic illnesses that affect appetite or intake although social
isolation and depression are also key factors.
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Studies show that patients with malnutrition on average have 65% more GP visits, are about 80%
more likely to be admitted to hospital, have between 30% and 70% longer hospital stays once
there, and are far less likely to be discharged to their own home than a well-nourished, age
matched patients with a similar diagnosis.
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Malnourished patients are also three times more likely to die within six months of discharge from
a hospital.
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Malnutrition is treatable with nutritional interventions having been shown to be associated with
improved clinical outcomes and functional benefits in both hospital and community patients.
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Oral nutritional supplements (ONS) have been shown to be highly effective for patients that are
unable to meet their nutritional needs from food alone, and their use has been shown to improve
nutritional status, reduce rates of complications and reduce healthcare utilisation (e.g. LOS).
Malnutrition risk is particularly high in older people, affecting at least 70,000 adults over 65 years
of age. It is also a huge risk for patients with chronic illnesses, such as cancer, multiple sclerosis
(MS), Crohn’s disease, cystic fibrosis and motor neurone disease. These patients are at higher
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risk of nutritional problems (unable to eat properly or they can’t absorb nutrients) as a result of
their conditions and many require nutritional support or a carefully tailored diet.