Background:

What is malnutrition?

(Elsevier, 2024)

“Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization” (WHO, 2024).

 

Malnutrition increases the risk of health issues, negative quality of life and mortality. Literature has linked malnutrition with extended hospital stays, placing a larger burden on the health care system (Roberts et al., 2019) The impact of malnutrition on health and health care costs was estimated to cost £7.3 billion per year in 2006 (Hungry to be heard, 2006), with BAPEN indicating this has risen to £20 billion currently

Malnutrition affects around 3 million people in the UK and 33 million around Europe. Adults suffering with malnutrition, account for 30% of hospital admissions, 35% of care home admissions, 15% of outpatient clinic appointments and 10% of GP appointments (BAPEN, 2017).

Malnutrition in health and social care is not new

Hungry in Hospital (Community Health Council 1997) and Hungry to be heard (Age UK 2010) by Age UK identified nutritional inadequacies in hospital patients. These reports were produced to raise awareness for the elderly who were being ‘starved’ in hospitals.

The Hungry to be heard report has introduced 7 steps to reduce malnutrition in hospitals:

1. Hospital staff must listen to older people, their relatives and carers and act on what they say.
2. All ward staff must become ‘food aware’.
3. Hospital staff must follow their own professional codes and guidance from other bodies.
4. Older people must be assessed for the signs or danger of malnourishment on admission and at regular intervals during their stay.
5. Introduce ‘protected mealtimes’.
6. Implement a ‘red tray’ system and ensure that it works in practice.
7. Use volunteers where appropriate.
8. However, to overcome malnutrition in hospitals and improve the food consumption of hospital patients, interventions have been implemented in health care settings

Since then the Malnutrition Taskforce in 2017 in their report  ‘State of the Nation‘ identified that as our populations ages so does the risk of malnutrition with as many as 60% of older people and their carers being worried about food availability. Regular surveys in health care by the British Association for Parenteral and Enteral Nutrition (BAPEN) have consistently reported the level of malnutrition in responding NHS trusts. In 2022 45% of patients across all settings were at risk of disease related malnutrition.  More recently, post pandemic issues related to food insecurity influenced by the economic crisis, planetary and climate concerns including extreme weather events, and growing populations has increased the extent of malnutrition in all its forms.  No longer can we think about malnutrition simply as a result of the absence of food as it encompasses people who are overweight or obese, and that have micro nutrient deficiencies (WHO, 2018). There are many factors behind the cause of malnutrition in adults, when unwell.  These include; poor nutrient intake, illness-related loss of appetite, drug-related side effects, poor management of patient nutrition and reduced nutrient bioavailability (Ostrowksa et al., 2021). Literature has found that in‐patients experienced hunger and difficulty accessing food due to the lack of staff noticing and the patients being reluctant to request assistance (Naithani et al., 2008).