DR CLARE CORISH

ASSOCIATE PROFESSOR

UCD SCHOOL OF PUBLIC HEALTH, PHYSIOTHERAPY AND SPORTS SCIENCE

Managing Malnutrition in Older Adults

Approximately 145,000 people in Ireland are malnourished or at risk of malnutrition, many of whom are older adults. Malnutrition has negative implications for health and quality of life and is estimated to cost 10% of the irish healthcare budget.

With the projected increase in the older population, this is a key research area. Associate Professor Clare Corish and her team are collaborating nationally and internationally to provide better understanding of the prevalence and causes of malnutrition, as well as policy, education and clinical practice requirements for its screening and management.

Malnutrition is associated with poorer quality of life and health outcomes. Maintaining good nutritional status reduces the effects of chronic disease, improves quality of life, energy, ability to participate in activities and reduces cost and resource strains on the health service.

In the video below, Dr Clare Corish speaks about her work in this area.

MaNuEL

Associate Professor Corish has worked with national and international collaborators on the international Malnutrition in the Elderly Knowledge Hub (MaNuEL) project.

MaNuEL has strengthened evidence-based practice in the management of malnutrition in older persons, built a network of malnutrition experts and harmonised research and clinical practice across six European countries and New Zealand. Project funding in Ireland came from the Department of Agriculture, Food and the Marine and the Health Research Board (HRB).

ONSPres

Further research into the management of malnutrition and prescription of oral nutritional support (ONSPres study) in the primary care/community setting in Ireland has been funded by the HRB. Prof Corishs' colleague Dr Patricia Dominguez Castro presented a piece on ONSPres at the 13th European Nutrition Conference 2019.

General practitioners are the first point of contact and the main prescribers of oral nutritional supplements for individuals in the community who are malnourished or at risk of malnutrition.

Considering the demand for GP visits is projected to increase by up to 27% by 2030, Professor Corish and her team are focusing their research on GPs, community nurses’, dietitians’ and pharmacists’ experiences of malnutrition and its management within the community setting.

This data provides insight into the complexity of managing malnutrition and oral nutritional supplement prescribing and the support GPs and other healthcare practitioners need to effectively tackle malnutrition within the community.

Malnutrition impacts significantly on quality of life, particularly in older people. The ability to participate in daily activities, socialise, exercise and engage in hobbies and family life requires adequate nutrition to provide energy, protein and other nutrients.

The MaNuEL study has identified appropriate malnutrition screening tools for healthcare settings to assist healthcare professionals in assessing and treating those at risk.

The ONSPres project will support better management of those at risk of malnutrition in the community, aiming to improve quality of life and health outcomes.

This research has also highlighted that community resources are scarce and that oral nutritional supplement prescription may be the only option when community meals-on-wheels services are limited and home care packages do not include meal preparation.

Professor Corishs' and colleagues research acknowledges the environment in which primary care healthcare professionals including GPs and community nurses, work. 

GPs strongly support the need for multidisciplinary primary care teams, emphasising that resource allocation and referral pathways with long waiting lists are significant issues that need to be addressed, particularly in light of the ageing population. These findings are being discussed with the HSE to address the issue of malnutrition.

The annual cost associated with adult malnourished patients in Ireland is estimated at over €1.4 billion with hospitalisation due to malnutrition contributing the highest cost. Of this €1.4 billion, the cost of oral nutritional supplements is only approximately 3%.

Professor Corishs' research seeks to improve identification and management of people at risk of malnutrition in the community, aiming to reduce or prevent hospitalisation and lessen healthcare costs.

RESEARCH FINDINGS

MaNuEL has identified that nutrition teaching is deficient in nursing and medical education curricula across Europe. These healthcare professionals are inadequately prepared to assess and intervene to prevent and treat malnutrition.

Professor Corish and her team are currently developing online training for GPs and other healthcare professionals that will provide continuous professional development credits.

The recommendations from the MaNuEL study have contributed to the new National Clinical Guideline on nutrition screening and the use of oral nutritional supplements for adults in the acute care setting.

This guideline has been approved by the Department of Health National Clinical Effectiveness Committee. the MaNuEL study results have also contributed to the Health Service Executive prescribing pathway for uncomplicated malnutrition.

Internationally, policy makers in Europe are examining their nutrition screening and management policies.

The ONSPres study results were recently presented to the HSE and Health Research Board Research Collaborative in Quality and Patient Safety decision-makers, highlighting the need for better identification of malnutrition, more resource allocation to community care and the cultural issues that occur within the community setting.

ONSPres is the first to define appropriate prescribing of oral nutritional supplements which will significantly influence future research in this area. MaNuEL has provided data on the prevalence of malnutrition and the risk of malnutrition across Europe.

It has also has led to the formation of international collaborations with Austria, France, Germany, Spain, the Netherlands and New Zealand. These collaborations will enrich research, policies and processes across Europe.

About the Researcher

Professor Clare Corish has a background in human nutrition and dietetics and worked for over 15 years in dietetic practice in Ireland, the UK and Saudi Arabia. She has extensive teaching and research experience in clinical nutrition and dietetics as lecturer in human nutrition and dietetics and programme director on the joint Dublin Institute of Technology/Trinity College Dublin undergraduate programme in human nutrition and dietetics.

Professor Corish was appointed as associate professor in clinical nutrition and dietetics at University College Dublin where she has established a professional graduate programme in clinical nutrition and dietetics, the first such programme in the Republic of Ireland.

Professor Corish has a long-standing commitment to nutrition research activities, particularly in disease-related malnutrition/malnutrition in the older person, nutrition in early childhood and recently, nutrition and lifestyle among shift workers. Research funding has come from the Irish Health Service Executive, the Food Safety Promotion Board, safefood, the Department of Agriculture, Food and the Marine, and the Health Research Board.

Professor Corish has previously (2013-2016) represented dietetics education on the Irish regulatory body for dietitians (Dietitians Registration Board; CORU) and currently represents dietetics education on the Education Steering Group of the Irish Nutrition and Dietetic Institute, the professional body for dietitians in Ireland.

She is also a member of the Food Safety Authority of Ireland Public Health Nutrition sub-committee and has served on a number of expert committees over many years. She is a member of the Editorial board of Nutrition Today and Nutrition and Dietetics as well as being peer reviewer for many high impact nutrition journals. She is an active member of the Irish Nutrition and Dietetic Institute and the Nutrition Society holding several leadership roles in the past including INDI president. She is currently Chair of the Nutrition Society Irish Section.

Associated References

IRSPEN Understanding Malnutrition

Rice, N. and Normand, C., 2012. The cost associated with disease-related malnutrition in Ireland. Public health nutrition15(10), pp.1966-1972.Click here

Wren, M.A., Keegan, C., Walsh, B.M., Bergin, A., Eighan, J., Brick, A., Connolly, S., Watson, D. and Banks, J., 2017. Projections of demand for healthcare in Ireland, 2015-2030: First report from the Hippocrates Model. Economic and Social Research Institute. Click here

Streicher, M., van Zwienen‐Pot, J., Bardon, L., Nagel, G., Teh, R., Meisinger, C., Colombo, M., Torbahn, G., Kiesswetter, E., Flechtner‐Mors, M. and Denkinger, M., 2018. Determinants of Incident Malnutrition in Community‐Dwelling Older Adults: A MaNuEL Multicohort Meta‐Analysis. Journal of the American Geriatrics Society66(12), pp.2335-2343.Click here

Power, L., de van der Schueren, M.A., Leij-Halfwerk, S., Bauer, J., Clarke, M., Visser, M., Volkert, D., Bardon, L., Gibney, E., Corish, C.A. and MaNuEL Consortium, 2019. Development and application of a scoring system to rate malnutrition screening tools used in older adults in community and healthcare settings–A MaNuEL study. Clinical Nutrition38(4), pp.1807-1819. Click here

Leij-Halfwerk, S., Verwijs, M.H., van Houdt, S., Borkent, J.W., Guaitoli, P.R., Pelgrim, T., Heymans, M.W., Power, L., Visser, M., Corish, C.A. and de van der Schueren, M.A., 2019. Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults≥ 65 years: A systematic review and meta-analysis. MaturitasClick here

Cadogan, C.A., Dharamshi, R., Fitzgerald, S., Corish, C.A., Castro, P.D. and Ryan, C., 2019. A systematic scoping review of interventions to improve appropriate prescribing of oral nutritional supplements in primary care. Clinical NutritionClick here

HSE Supplement Prescribing Pathway

 

Research team:

About Clare Corish

Clare Corish on Twitter

About Celine Murrin

About Carla Perrotta

About Gerard Bury

About Eileen Gibney

Dr Patricia Dominguez Castro, Dr Ciara Reynolds UCD

PhD Candidate Laura Bardon on ResearchGate