Calls for nutrition screening at flu vaccine appointment

People over the age of 70 who are receiving their flu vaccine this winter should undergo nutrition screening at the same time, experts have recommended.

As part of its 2022 pre-Budget submission, the Irish Society for Clinical Nutrition and Metabolism (IrSPEN) has called for a pilot scheme, which would see the integration of a five-minute nutrition screening for over-70s as part of their winter flu vaccine appointment.

The call is supported by the Irish Nutrition and Dietetic Institute (INDI).

IrSPEN estimates that such a pilot scheme would cost €150,000.

The pre-Budget submission also recommends that nutrition screening should be extended to the 58,000 people in receipt of home care support. This screening would be performed by care staff once each quarter at an annual cost of €700,000. Most of these costs would be spent on training staff.

According to IrSPEN director, Niamh Rice, the prevalence of malnutrition is estimated to be at least 15% in those over the age of 70 “and is likely to be even higher in those presenting for flu vaccination”. As a result, the potential to identify those at risk is high.

“Screening while waiting for vaccination, or in the 15-minute wait post vaccination, offers a low-cost but highly cost-effective means of ensuring that patients at nutritional risk can be identified at a convenient point with the primary healthcare team, with minimal additional staffing costs other than training and initial piloting,” she explained.

She pointed out that the 58,000 older people receiving home care support “are likely to be particularly vulnerable to malnutrition with an estimated prevalence of up to 30%”.

“Integrating a five-minute nutritional screening every three months into their care has the potential to avert costly hospital admissions, decrease healthcare usage and improve quality of life and independence,” she said.

Ms Rice highlighted that the cost of treating a malnourished patient is three times higher than that of a nourished patient “and so it makes economic sense to identify any risk of malnutrition and treat it early”.

“There is potential for lower healthcare utilisation, reduced burden on our GP services as well as improving the wellbeing and independence of many people,” she added.

IrSPEN’s pre-Budget submission has also called for improved early access to nutritional care for cancer patients. It recommends an investment of €1.7 million per year, which would fund 19 full-time dietitians to address gaps in dietetic services and allow an estimated 9,000 assessments and follow-up reviews for chemotherapy patients. This would cover up to 30% of chemotherapy patients annually.

“The impact would be to reduce cancer waiting times overall, to reduce avoidable side-effects of treatments and to ensure more effective interventions to protect nutritional status,” commented IrSPEN president and oncology surgeon, Prof John Reynolds.

The pre-Budget submission has also called for the establishment of a specialist intestinal rehabilitation unit for adult patients in Ireland at a cost of €1.8 million in 2022 and €4 million per annum from 2023 onwards.

Patients with intestinal failure (IF) have highly complex healthcare needs and as a result, specialist care in a high-volume unit is critically important. 

The submission recommends establishing a dedicated unit at St James’s Hospital in Dublin, with units in Cork and Galway also.

Initially, eight acute beds would serve a caseload of up to 50 patients with IF every year, which is equivalent to an estimated 50% of the needs based on new patients, allowing for a phased development over three-to-five years. 

According to IrSPEN director and consultant gastroenterologist, Dr Cara Dunne, this service is urgently needed.

“It’s now eight years since IrSPEN first issued its report highlighting our inability to manage these patients safely within non-specialist centres. Each year, we estimate that there are at least 12 avoidable deaths that could be saved if they were treated within a specialist unit, similar to that in the UK and the vast majority of European countries,” she commented.

IrSPEN’s full pre-Budget submission can be viewed here.