Dramatic increase in malnutrition in Ireland due to aging population

Hospital inpatient malnutrition a major cost to health service

A new analysis released today shows a dramatic increase in malnutrition among patients in Ireland, with over 222,000 having serious nutritional issues due to the effects of diseases such as cancer, or multiple chronic diseases that affect many older people.

Conducted by the Irish Society for Clinical Nutrition and Metabolism (IrSPEN), the study identified a dramatic 59% increase in the numbers of patients of all ages with or at significant risk of malnutrition (up from 140,000) and a doubling of annual cost to the health system (to €2.8billion) – since a previous study published in 2012.*

IrSPEN Director and Consultant Nutritionist Niamh Rice, the lead author of the research, said that although the highest concentration of patients with malnutrition is found in those arriving in hospital, most people suffering from the effects of ‘disease related’ malnutrition reside in the community, with one in 20 of Irish adults (5.1%) affected at any time.

“Identifying patients struggling to maintain nutritional intake is critically important, since the effects of undernutrition has a relatively rapid and detrimental impact on the underlying disease.

“Patients with malnutrition cost approximately three times more per annum, since they are more likely to be hospitalised, have a 30% longer average length of stay and a higher risk of complications, particularly infections, and far more use of community healthcare resources.

“The health and economic analysis released today titled The Prevalence and Costs of Malnutrition in an Aging Ireland found the cost of malnutrition to have doubled to €2.8billion per annum, since IrSPEN’s previous and similar study in 2012.” (This figure is calculated by identifying the overall health and social care costs of those with malnutrition.)

Ms Rice said these significant increases were driven principally by demographic changes.

“Since the 2012 study, the percentage of the population over 65 has increased from 11% to 16%, now standing at 833,000 and older people are five times more likely to develop malnutrition than younger adults.

“Although most of this can be explained by higher rates of serious illness in older people, being older also means people are less able to cope with the added stressor of inadequate dietary intake when ill. Also, an older population increases cancer prevalence, and cancer patients are the most likely category of patients to experience malnutrition while in hospital.”

The malnutrition findings were presented as part of IrSPEN’s bi-annual conference taking place at the Aviva stadium today (Tuesday April 8^th). Expert speakers also covered topics on nutrition relating to obesity, cancer and frailty. The conference is titled Nutrition Interventions for Health Gain: New Approaches for Better Outcomes and more information can be found at www.irspen.ie. 

Ms Rice called for a greater awareness of the medical fact that ‘malnutrition worsens disease’.

“Being malnourished makes medical treatment less effective, delays recovery and increases the risk of complications, such as infections and poor wound healing. Older patients are particularly vulnerable, since many have had poor dietary intake for social as well as health reasons. They also generally have less muscle to lose and have higher requirements for nutrients like protein. If patients are malnourished coming into hospital, they are significantly more expensive to treat compared to a normally nourished patient.” 

In terms of recommendations stemming from the findings Ms Rice said: “We remain chronically short of Dietitians to initiate the right nutrition support at the earliest possible sign that a patient is failing to maintain a good nutritional intake. Greater resourcing is needed of nutritional care for those at highest risk – and this needs to be expanded beyond hospitals and into home and community care settings. We need to integrate screening and access to dietetic care for the 60,000 patients receiving home care support, since this is a key group that is at higher risk of malnutrition.” 

Research published by IrSPEN in collaboration with University College Cork in 2019 found that nearly 1 in 2 (45%) of cancer patients reported significant nutritional and eating problems during treatment and that one in three with weight loss received no nutritional care. 

Ms Rice continued: “Cancer patients have the highest rate and severity of malnutrition of any patient group – and poor nutritional intake and weight loss in cancer is associated with higher risks of complications, poorer response to treatments like chemotherapy – and even reduced survival.“More specialist Oncology Dietitians are needed for patients with cancer so that we don’t wait until they arrive in hospital to deal with nutritional problems. All patients with invasive cancer should be continually monitored and have access to specialist Oncology Dietitians.” 

Ms Rice concluded by saying that nutrition also needs to be given higher priority in medical education and in patient care generally. “It’s time to apply research findings on the impact of malnutrition into medical practice. Our health service cannot claim to be providing high quality medical care if patients’ nutritional status is not being screened and treated as necessary.”

Further information
Ronan Cavanagh, Cavanagh Communications: (086) 317 9731.

Summary of Recommendations in Response to the Study

• Good nutritional status including prevention of weight loss and preservation of muscle during treatment must become an integrated part of inpatient hospital care
• Nutrition screening and treatments should be expanded outside of public hospitals to home and community settings for higher risk groups patients (particularly older or frail people) – and to all care settings for cancer patients
• There is an ongoing shortage of Dietitians in the country, as well as too few specialist Oncology Dietitians.

* The study presented today was a health and economic analysis using multiple sources including 2022/3 healthcare activity statistics, costing and population data from the Central Statistics Office and data on hospital malnutrition prevalence from a national malnutrition screening survey conducted by IrSPEN and the Irish Nutrition and Dietetic Institute (INDI) in November and December 2023.

A previous and similar health and economic analysis of the prevalence and costs associated with malnutrition was published by IrSPEN in 2012 (Rice, Normand, Public health nutrition).