Estimating the costs associated with malnutrition in Dutch nursing homes

Summary

Backgrounds & aims

Malnutrition in western health care involves a tremendous burden of illness. In this study the economic implications of malnutrition in Dutch nursing homes are investigated as part of the Health and Economic Impact of Malnutrition in Europe Study from the European Nutrition for Health Alliance.

Methods

A questionnaire was developed, focussing on the additional time and resources spent to execute all relevant nutritional activities in nursing home patients with at risk of malnutrition or malnourished. Results were extrapolated on national level, based on the prevalence rates gathered within the national Prevalence Measurement of Care Problems 2009.

Results

The normal nutritional costs are 319 million Euro per year. The total additional costs of managing the problem of malnutrition in Dutch nursing homes involve 279 million Euro per year and are related to extra efforts in nutritional screening, monitoring and treatment. The extra costs for managing nursing home residents at risk of malnutrition are 8000 euro per patient and 10000 euro for malnourished patients.

Conclusions

The extra costs related to malnutrition are a considerable burden for the nursing home sector and urge for preventive measures.

Introduction

A large number of patients in European healthcare organizations are malnourished.1, 2, 3, 4, 5, 6, 7 Therefore since 2005, the European Nutrition for Health Alliance has raised awareness of malnutrition as a significant public health problem that is extensively under-recognized and under-treated.¹ Malnutrition (meaning undernutrition) is a serious burden, leading to increased mortality, longer hospital stays, more GP visits, more intensive nursing care, increased requirement of nursing home care, decreased quality of life and increased complication rates.3, 4, 5, 6, 7, 8 Both in terms of its impact on individuals’ health status and their increased needs for care and social services, malnutrition is a tremendous burden of illness in western societies, leading to costs of billions of euro’s every year.⁹

Quantifying this burden is a critical step in improving and completing our understanding of how malnutrition manifests itself amongst people of different age groups and clinical conditions. A small number of studies have assessed the economic implications of malnutrition related to hospital stay, residential care and community care. A UK study found that malnutrition costs £7.3 billion each year, more than double the projected £3.5 billion cost of obesity.¹⁰ The bulk of these costs arises from the treatment of malnourished patients in hospital (£3.8 billion) and in long-term care facilities (£2.6 billion). Other associated costs arise from GP visits (£0.49 billion), outpatient visits (£0.36 billion), and enteral and parenteral nutrition, tube feeding and oral nutritional supplementation in the community (£0.15 billion).¹⁰ The Erasmus MC University Medical Centre Rotterdam assessed the total additional health care costs of disease related malnutrition in the Netherlands roughly at 1.7million euro, using the prevalence of malnutrition as an indicator for calculating costs.¹¹ This is equal to 2.8% of the total care costs in the Netherlands and 5.8% of the total costs in hospitals, care homes and home care.¹² Despite this, no published studies exist, involving more precise economic implications of malnutrition in Dutch care homes.

In the Netherlands, long-term institutional care can be divided into residential homes and nursing homes. Residential homes (n = 1000) mainly offer assisted living (a safe living environment) to older people who are still able to do a considerable part of their ADLs themselves. In our study we focus on nursing homes. There are about 345 nursing homes in the country. Disabled persons with chronic somatic (i.e., physical) diseases or with progressive dementia, mainly elderly who are not able to do their ADLs and who need plural, more complex continuing care and monitoring, which are beyond the range of home care services or the service in residential homes, are often admitted to a nursing home. The nursing home sector has more than 60,000 beds. 27,000 beds in somatic wards, primarily for patients with physical diseases (e.g. stroke, other neurologic disorders like Parkinsonism and multiple sclerosis, problems affecting mobility and malignancies) and 36,000 in psychogeriatric wards for patients with dementia. Approximately 60,000 new patients (mean age 80 years) are admitted every year. Most of the somatic patients are admitted from the hospital (65%) or by their family physician (26%); psychogeriatric patients primarily come from their own home (53%), from a residential home (23%), or from a hospital (20%). Nursing homes employ their own multidisciplinary staff and this team consists, next to physicians and nurses, of physiotherapists, occupational therapists, speech therapists, dietitians, psychologists, social workers, pastoral workers, and recreational therapists.¹³

This study aims to determine the economic implications of malnutrition more precisely in nursing homes in the Netherlands, using the ‘bottom-up’ approach, in which costs of individual treatments, use of resources and the time spent on nutritional screening, monitoring and treatment of malnutrition are taken into account.