Malnutrition Common Among Elderly in Emergency Departments

Marcia Frellick

August 14, 2014

Sixty percent of adults aged 65 years and older who visited an emergency department (ED) were either malnourished or at risk for malnutrition, according to a single-center study published online August 13 in the Annals of Emergency Medicine. In addition, the researchers note that only about 1 in 4 of those patients had received a previous diagnosis of malnutrition.

Greg F. Pereira, BSPH, from the Department of Nutrition, University of North Carolina Gillings School of Global Public Health, Chapel Hill, and colleagues found that of the 16% (95% confidence interval [CI], 11% - 23%) of the 138 patients enrolled in the study who were malnourished, 77% of them said they had not been diagnosed as such. All of the participants were cognitively intact ED patients aged 65 years or older who were seen at a single academic center in the southeastern United States. The researchers randomly selected participants, excluding those who were critically ill, had moderate or severe cognitive impairment, or lived in nursing facilities.

Malnutrition was most common among patients who were depressed (52%); resided in assisted living (44%); reported difficulty eating from denture problems, pain, or trouble swallowing (38%); or had difficulty buying groceries (33%).

However, lack of diagnosis was not tied to lack of access to healthcare providers. Nearly all the patients (95%) had a primary care physician, and 96% had insurance.

Meals Programs May Help

Although the authors cannot say what caused the malnutrition, their data suggest multiple intervention strategies may be necessary. For example, for those who report difficulty buying groceries, referrals to the Supplemental Nutrition Assistance Programs (previously known as the Food Stamps Program), Meals on Wheels, Congregate Meal Programs, or community-based food charities may help. Because there is a higher rate among those with depression, interventions that target both depression and malnutrition may be appropriate.

In addition, because studies have shown a link between poor dental health and malnutrition among older adults, the authors suggest that all Medicare plans should include dental coverage for all seniors.

"Given that seniors visit [EDs] more than 20 million times a year in the U.S., emergency physicians have an opportunity to screen and intervene in ways that may be very helpful without being very costly," lead author Timothy Platts-Mills, MD, said in a journal news release.

The researchers defined malnutrition as lacking "adequate calories, protein, or other nutrients needed for tissue maintenance and repair." They assessed nutrition levels using the Mini Nutritional Assessment Short-Form (0 - 14 scale); malnutrition was defined as a score of 7 or less, and being at risk for malnutrition was defined as a score of 8 to 11.

Malnutrition was identified in 22 patients, with an overall prevalence of 15.9% (95% CI, 10.8% - 23.0%). "Of these 22 patients, only 5 (23%) had received a previous diagnosis of malnutrition. The combined prevalence of malnutrition or at risk for malnutrition was 60.1% (95% CI 51.8% to 67.9%)," the authors write.

As the numbers of elderly swell, intervention to identify malnourished patients and those at risk will become increasingly important, the authors conclude.

"The growing role of the [ED] as community health resource makes it an essential place for identifying and addressing unmet needs of older adults," Dr. Platts-Mills said. "Implementation of oral nutritional supplementation is inexpensive and may reduce overall costs by accelerating recovery from illness and reducing readmissions."

This study was supported by National Institute on Aging and the University of North Carolina's Summer Undergraduate Research Fellowship. The authors have disclosed no relevant financial relationships.

Ann Emerg Med. Published online August 12, 2014. Full text

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