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Malnutrition May Be Hiding in Plain Sight

There are many misperceptions about malnutrition. For example, the idea that someone who is overweight can’t possibly be malnourished. Or that those living in countries like the U.S. have enough food to avoid this condition.

But the truth is, malnutrition is far more common than you might think. It can happen to people of any weight and to those in both developed and developing countries. And it occurs in various settings – some of which may never even have occurred to you.

Hospitals

It might seem counterintuitive that, in a facility designed to return patients to health, the risk of malnutrition is substantial. However, it is estimated that at least one-third of patients in developed countries are already malnourished upon admission to the hospital. It often continues to be under-diagnosed during stays and, if left untreated, approximately two-thirds of those patients will experience a further decline in their nutrition status during their hospitalization. Malnutrition also is associated with an increased risk of pressure ulcers and impaired wound healing, immune suppression and higher infection rates, higher treatment costs, and increased mortality. It leads to longer hospital stays and an increased risk of readmission. A statistical brief developed by ASPEN shows that, of the nearly 2 million hospital inpatient stays involving malnutrition in 2013, a significant percentage occurred among seniors, particularly those who were 85 years or older.1

Nursing homes

Seniors living in long-term care facilities are particularly vulnerable to malnutrition due to a variety of factors. Poor dental health can make it difficult for some residents to chew comfortably and, therefore, it’s harder to eat. In addition, some residents may require a caregiver to help feed them, while others may need a feeding tube to receive adequate nutrition.

The community

For seniors in the broader community, malnutrition can compromise independence and quality of life. Some older adults may experience a loss of appetite, while others face feelings of isolation and depression. These factors limit their desire to eat. Further, those with decreased mobility may struggle to shop for groceries, finding themselves unable to stock their own pantries. Those who are older and malnourished are also more likely to require health and social services and experience more hospitalizations.

Identifying and preventing malnutrition

The prevalence of malnutrition, particularly among an aging population, is deeply concerning. Adding to the challenge, many of the most common symptoms of malnutrition — such as unplanned weight loss, ability to eat only in small amounts, weakness, fatigue, and fluid accumulation — mirror the “normal” signs of aging.

So, what can be done to prevent, identify, and treat malnutrition across the various settings in which it might occur?

  • First and foremost, careful monitoring is required to identify the condition. Older adults and those who care for them must be aware of the potential risks, ask their health care provider about their nutrition status, and actively advocate for optimal care.
  • Health care teams must be vigilant in promptly diagnosing and treating malnourished patients in the hospital setting to expedite healing. It is equally important, however, for patients and their families to be knowledgeable and speak up when they feel something is amiss.
  • Hospitals should also, in short order, offer on-site nutrition interventions and education and provide a plan for ongoing nutritional support for patients after they are discharged.
  • The establishment of a nutrition quality measure would help to promote optimal nutrition care in the U.S. Such a measure, combined with a series of specific actions to address disease-related malnutrition, has the potential to improve patient outcomes by reducing readmissions, morbidity, mortality, and costs.

Understanding that awareness is the first step, the American Society for Parenteral and Enteral Nutrition (ASPEN) is hosting its annual Malnutrition Awareness Week™ Sept. 18-22, to help educate both providers and consumers to achieve improved health outcomes. For more information, visit nutritioncare.org/maw. And follow the hashtag #MAW2017 to join the conversation.

1hcup-us.ahrq.gov/reports/statbriefs/sb210-Malnutrition-Hospital-Stays-2013.jsp

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About Peggi Guenter

Peggi Guenter, PhD, RN, FAAN, is ASPEN’s Senior Director of Clinical Practice, Quality, and Advocacy.

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