clinical focus
Eat for life
Hospital patients are more likely to die within 30 days of admission if they eat less than a quarter of the food they are offered or are already malnourished.
This is one of the key findings of recent research that looked at more than 3000 patients in 56 hospitals in Australia and New Zealand.
Dr Ekta Agarwal, from Queensland University of Technology’ s Institute of Health and Biomedical Innovation, says the study shows that poor food intake is associated with a high risk of in-hospital death, regardless of the patients’ age, nutritional status, and type and severity of disease.
Agarwal sits down with Aged Care Insite to unpack the findings and discuss what should be done based on the data.
ACI: You found that 1 in 3 malnourished patients ate less than 25 per cent of their offered food. What was the risk of death among the malnourished patients, within 30 days and beyond? EA: The malnourished patients had a 30 per cent increased risk of death within 30 days of hospital admission, in comparison with well-nourished patients. We also found that, when we evaluated the risk of death within 90 days of admission, malnourished patients had twice the risk of death as well-nourished patients.
Malnutrition is related to increased risk of death for nearly all groups; healthcare must acknowledge how formidable this threat is.
Ekta Agarwal interviewed by Dallas Bastian
You’ ve found that 1 in 5 patients classified as well-nourished also ate less than 25 per cent of the food offered. What effect did this have on their health and risk of death? If we just look at food intake, per say, we found that patients who ate 25 per cent or less of the offered food during the course of the study had the risk of death within 30 days of hospital admission increase – by as much as 2.6 times. The risk of death doubles within 90 days of admission. It didn’ t quite matter whether they were well nourished or malnourished, if they were young or old, if they were male or female. The type of disease that they had, or the severity of the disease that they had also did not matter.
In a nut shell, just eating poorly during hospital admission was an independent risk factor for an increased chance of death. When we look at wellnourished patients who were also found to be eating poorly during hospitalisation, it’ s important to consider that when well-nourished patients have a prolonged poor intake during hospitalisation, they can become malnourished, and then experience the same risks that malnourished patients face, in terms of extended length of stay, frequency of admission, and increased risk of mortality.
What might be contributing to the number of patients failing, or declining, to eat the food on offer? In this particular study, which is referred to as the Australasian Nutrition Care Day Survey, we found that two out of three patients did not eat all the offered food during hospital admission. This means that eating less is quite common in hospital patients. There is evidence to indicate that eating less could be due to a loss of appetite. This loss of appetite could be associated with a range of factors, which are patient related.
Examples of these patient related factors could include the illness itself that the patients have, or the disease condition they’ ve been admitted with. It could have issues in terms of experiencing early satiety. They may have a lack of flavour perception. They may be suffering from a depressed mood. They may be unfamiliar with the hospital’ s food system, or the foods that are being offered to them, which is why their intake may reduce. They may also be suffering from swallowing or chewing difficulty.
Apart from patient related factors, there are also certain organisational factors that may impact a patient’ s ability to eat food during their admission. These include issues such as the timing of meals. Most hospitals would offer breakfast, lunch, and dinner at particular times, and may not offer snacks in between these main meals. There is evidence to suggest that patients do usually get hungry between those meals, and by not offering them the opportunity to eat, this is actually a lost opportunity for the patient to eat. It is also quite common for patients to be interrupted at mealtime. For medical rounds, or diagnostic tests or procedures, which can impact their food intake.
Another issue is, quite often, patients who are frail or have a diminished capacity to feed themselves, may not get the assistance that they need at mealtime. This assistance may be lacking from hospital staff, or they may not have family members visiting them at mealtimes to assist them with food intake.
These are some of the complicating factors which could potentially lead to patients not eating adequately during hospitalisation.
How is the prevalence of malnutrition in hospitals affecting the health system overall? The Australasian Nutrition Care Day Survey, along with other studies, now confirm
30 agedcareinsite. com. au