Pieter DagnelieSacha Ruland
In Body
Written by Graziella Runchina Thursday, 06 December 2012 09:26
Malnutrition is common and a considerable health problem in hospital patients and elderly people. As a result, the topic has received a great deal of attention in recent years. Hospitals and healthcare institutions are supposed to keep a close eye on energy and protein deficiencies in the sick and elderly and supplement their diets as necessary. But how big this problem actually is and the extent to which supplementary nutrition helps remains unclear. Further research is needed to underpin the approach to malnutrition, as noted late last year by the Health Council in its report on malnutrition in the elderly.
“In the Epidemiology Department, we felt it would be useful to get involved in this research”, says Professor Pieter Dagnelie, who heads the Nutritional and Molecular Epidemiology programme. Together with Dr Nel Reijven of the Dietetics Department, he supervised the two recent PhDs on malnutrition in the hospital. Can extra nutritional care improve the recovery time for people with hip fractures? This was the key question in two recent studies on malnutrition in hospitals conducted by Maastricht University PhD candidates Caroline Wyers and Jose Breedveld-Peters.
Downward spiral
“Given that hip fractures are quite common – nearly 18,000 new cases are reported each year in the Netherlands alone – and that recovery can potentially be improved with better nutrition, we decided to study the effects of extra nutritional care in people with hip fractures”, Dagnelie explains. The research was conducted by UM’s Epidemiology Department in collaboration with the Maastricht academic hospital, the Atrium Medical Centre in Heerlen and the Orbis Medical Centre in Sittard. “As people age, they tend to exercise less”, says Dagnelie. “Less exercise means a reduced appetite and reduced energy requirements. Your physical fitness and muscle mass deteriorate but your need for essential nutrients stays the same. Because elderly people spend relatively little time outdoors, they tend to have low levels of vitamin D and accelerated bone loss. Many are also lack sufficient vitamin B12, which can lead to reduced concentration and coordination. Taken together, all these factors could force the elderly into a downward spiral and increase their risk of falling and bone fractures, such as broken hips.”
Intensive support
In the PhD research conducted by Wyers and Breedveld-Peters, patients received three months of intensive support from a dietician, who also recommended liquid nutritional supplements when necessary. “Looking at the effects of these nutritional supplements, we see that dietary intake improved in our participants during the three-month intervention period after the operation. We also found that participants in the intervention group gained more weight than those in the control group.” But these positive effects aside, no significant differences were found between the two groups in terms ofphysical limitations, concentration or quality of life. “The amount of time spent in the hospital and the recovery clinic was also the same for both groups, regardless of whether they received extra nutritional care”, says Dagnelie. “So as to whether enhanced nutritional care improves a patient’s recovery time after a hip fracture, the answer is no.”
Cause or effect?
“And this is exactly where the problem lies”, says Dagnelie, referring to the recent Health Council report, which concluded that the effectiveness of malnutrition care for the elderly remains unclear. “The current approach is based on the assumption that treating malnutrition is always useful. In other words: that malnutrition is the cause of their deterioration and slow recovery times. But we don’t know if that’s true. The downward spiral many old people experience makes it very hard to distinguish cause from effect. It’s the classic chicken-and-egg scenario. Is malnutrition causing their slow recovery or are there other causes, which also result in poor eating habits? If the latter is true, nutritional supplements may not improve their health or bring about a speedier recovery.”
Communication
Does this mean we shouldn’t concern ourselves with elderly people’s nutritional needs? “On the contrary”, says Dagnelie. “Most care facilities pay too little attention to diet and nutrition. That’s why the patients themselves valued our intervention so highly. The attention we paid to maintaining the continuity of nutritional care from the hospital to the recovery clinic to the home was viewed as a huge advantage. Unfortunately, nutrition is not a fixed point of attention for health care institutions. What our research does show is that healthcare providers not only struggle with time constraints, but also with a lack of knowledge in the field of nutritional care. They also reported that communication among institutions is lacking and it was unclear who was responsible for nutritional care.” To help alleviate this problem, Dagnelie believes that nutrition must play a bigger role in healthcare institutions. “For this, we need to pay more attention to the individual needs of our elderly patients, especially when it comes to nutrition. We also need better and faster malnutrition indicators. Given that malnutrition among the sick and elderly is a big problem in this country, this would no doubt be beneficial in terms of vitality and quality of life.”
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