One-third of patients identified as malnourished on arrival to hospitals in Ireland

Carried out in November 2023 with data from 3,662 patients across 26 public hospitals in Ireland, the report shed light on an increase in hospital admission malnutrition by 34%, compared to previous surveys in 2011 (32%) and 2010 (28%). However, the survey also details a significantly reduced rate of malnutrition in patients in long stay or rehabilitation wards. This translates as 21% compared to 36% on all other wards, and additionally in those admitted from other hospitals rather than from home at 26% compared to 35%.

It aims to highlight the efficacy of mandatory national screening and treatment protocols which were introduced in public hospitals in 2020.

The launch of the National Malnutrition Screening Survey 2023 has prompted calls from the IrSPEN for the expansion of screenings to other clinical settings including daycare and primary care facilities.

The organisation includes details of recommendations in its 2025 pre-budget submission to reiterate the need for funding in the areas of additional malnutrition interventions.

Report co-author and IrSPEN director Niamh Rice said the survey identified two major reasons for the rise in patients with risk factors for malnutrition.

“The first is an increase in the age demographic of patients presenting at hospitals, with older people more likely to be malnourished and secondly a higher incidence of cancer, resulting in more cancer patients within the general hospital population (22% in November 2023 versus 16% in 2011), with this patient cohort also more likely to suffer nutritional problems resulting in malnutrition,” she said.

She expressed concern about the situation adding: 

The level of malnutrition presenting at our public hospitals remains too high and some is preventable if we pay more attention to improving the nutritional status of patients in the community. 

“We need to expand screening and treatment for malnutrition to all settings where cancer patients receive care, particularly in day wards where they receive systemic anti-cancer therapy (SACT), to facilitate rapid access to specialist cancer dietitians, of whom we have just a handful across the country.” 

Ms Rice also referred to other recommendations.

“A secondary recommendation is to resource an expansion of targeted malnutrition screening and treatment for older people living with frailty, particularly those living alone and requiring home care support,” she said. 

“These patients typically present to their GP and to hospital emergency departments more frequently, and at significant cost to the healthcare system, due to falls and an increasing need for care. In many cases, loss of muscle due to increased nutritional requirements or poor dietary intake – malnutrition – is a key factor resulting in poorer quality of life, increasing frailty, and an increased healthcare costs.” 

Co-author and King’s College London lecturer and cancer research dietitian Dr Erin Stella Sullivan RD, said there is a lot of confusion around the meaning of malnourishment, which she knows first-hand from supporting patients with cancer.

“It is often incorrectly thought of as meaning being underweight or ‘skinny,’” she said. “However, if patients are not eating what they need during illness, muscle is broken down in an attempt to keep the tissues supplied with the protein building blocks needed to keep everything functioning normally. This happens even if patients have higher BMI and can even be hidden in those cases.” 

She proposed solutions adding: “The effect of a screening and treatment programme is that patients who are losing weight or failing to eat sufficient protein, energy or other nutrients, which are typically required in higher amounts during illness – are identified early, so that appropriate nutritional supplementation or support can be provided. The impact of an improved nutritional status is significant health gain for these patients – improving their resilience, ability to complete treatment courses and enhancing their quality of life. There are also benefits to the healthcare system as healthier, stronger patients, have fewer complications and better outcomes.”