Malnutrition is underestimated in the Netherlands, WHO CARES?
Malnutrition in elderly people living at home
Recently, I visited an 87 year old single lady, who lives independently in a small village. Her memory has deteriorated and walking is becoming more difficult for her. She stays inside and gets few visitors. She is thin. Recently, home care has been arranged and her family does her shopping for her. She is waiting for a place in a nursing home. A 2 person room is available, but that is too big a step for her.
Loneliness, as well as reduced physical abilities are factors that increase the risk of malnutrition and an emergency situation. Although the doctor has visited her frequently in the past few weeks, there is no policy in place for malnutrition and preventing loneliness. I realise that this is not the only example. Newspapers regularly devote attention to this issue. The headline of an article in De STEM of April 2014, for instance, reads: “Malnutrition in the elderly is an underestimated problem.” The percentage of malnourished elderly people living at home is estimated at 35%. This percentage is expected to increase enormously in the coming years.
Malnutrition not only in hospitals and healthcare institutions
But this issue concerns not only elderly people who live at home – in hospitals and care facilities, fairly high rates of malnutrition occur as well. The 2014 National Prevalence figures of the Care sector (Dutch LPZ) reported that 10% of the elderly in general hospitals and 16.7% of the elderly living in nursing homes are malnourished. Malnutrition increases as people get older, have more illnesses and are more dependent on care. In 2010, the Dutch Journal of Medicine reported that 19% of the children who visited the hospital were malnourished. On 9 September 2014, the NRC published that every day, a death caused by malnutrition occurs in the Netherlands. Malnutrition seems to occur in both the young and the old in the Netherlands. And this is not surprising, because what, how and when we eat has changed considerably the past few decades.
Economic consequences of malnutrition in the Netherlands
The effects of malnutrition, which are recognised worldwide, are significant. These include reduced resistance, the development of illnesses and a lower quality of life. This leads to an increased use of medicines, prolonged hospital stays and more complex care. The LPZ report states that an amount of 279 million in additional costs is caused by malnutrition in the WZW. The Cater with Care project mentions an estimated amount of 1.9 billion Euros per year, of which 1.5 billion is attributed to malnutrition in adults of 60 years and older.
Underexposed value of GOOD and WHOLE-FOOD BASED nutrition
In the Netherlands and Europe, the value of good and whole-food based nutrition is underestimated in mainstream care. This, in spite of the fact that Hippocrates stated: “Let food be thy medicine, thy medicine shall be thy food”. Little or no attention is devoted to nutrition in medical training programmes for nurses and doctors. Even within care organisations, there is little knowledge about the effects of good and whole-food based nutrition on people´s health. This is shown by the food choices available in kiosks, restaurants and vending machines of care organisations. This food is not appropriate for sick, old and malnourished people whose exercise is limited. In addition, I often hear people complain about the quality of the food in hospitals and care organisations. I know people who bring home-cooked food to people who are in hospital. To me, choosing foods such as croquettes, frankfurters or pastry do not seem the best foods to recover on. Fortunately, the topic “Good care requires good nutrition” is currently receiving attention in the Second Chamber (De STEM, 3 January 2015). All in all, it is clear that in Dutch healthcare, the effect of nutrition on health has not received sufficient attention up until now.
Initiatives of care organisations in the area of nutrition
In recent years, several initiatives were started to reduce malnutrition. One of these is the Cater with Care alliance, in which Wageningen University and the hospital Gelderse Valleiziekenhuis, and the food industry are developing new, tasty, high quality products for the elderly. One of the products of Cater with Care is Carezzo bread, which is enriched with protein. Positive results are also achieved by letting patients eat what and when they want. The Cater with Care project assumes that the percentage of malnourished elderly people in hospitals and nursing homes is much higher than the LPZ 2014 figures, namely 40-50%. The hospital Gelderse Valleiziekenhuis is one of the few hospitals in the Netherlands that specialises in and showcases the nutrition it provides. Currently, experiments are conducted with protein-rich diets and their effects on the recovery process. Another initiative is the innovation network Foodsquad of Hutten. The purpose of this network is to achieve food innovations that really matter. The network focuses on three pillars; sustainable chains, an active lifestyle and specialty foods. In 2007, several hospitals launched an initiative to detect and address malnutrition at an early stage through the “Faster Better” programme.
However, besides these good initiatives, more attention is needed for the growing problem of malnutrition. The LPZ report of 2014 reports a slight increase in malnutrition. Interventions to prevent malnutrition are still not used often enough.
The main questions that remain are: who and where is malnutrition identified, and has action been taken? “Malnutrition in nursing homes due to high workload” is a headline in Skip on 29 November 2014. GPs do not have enough time. People with vague symptoms are told such things as: “We all feel a bit poorly sometimes, you eat healthy don´t you?”. In my opinion, malnutrition in the Netherlands is a much bigger problem than might be thought. People with a low BMI or spontaneous weight loss who come into contact with a hospital or healthcare institution are the tip of the iceberg. When malnutrition is established because people have a low BMI or have inexplicably lost a lot of weight in a short time, the malnutrition process is already at an advanced stage. Possibly the result of years of poor nutrition.
A shortened version was published in a Dutch Healthcare magazine SKIPR online
© dr.ir. Carla Peeters