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Malnourished seniors slip through healthcare system's cracks


By Sabriya Rice
Posted: August 13, 2014 - 3:15 pm ET
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With the number of Americans age 65 and over expected to surge by more than a third over the next decade, some experts are concerned that malnutrition among the elderly is too often overlooked, especially for those outside of assisted-living facilities.

Malnourished seniors take longer to heal, are more likely to re-enter the hospital and they experience more rapid functional and cognitive decline, say researchers in the field of geriatrics.

“This is a prevalent problem that is under-recognized,” said American Geriatrics Society fellow Dr. Chris Carpenter. Nutritional screening is more common for patients with dementia and among seniors in assisted-living residences, but it is not necessarily prevalent in the overall population, Carpenter said. Part of the issue is time. Physicians have to pick and choose what they are going to do in a 15- to 20-minute visit. “Nutrition screening might slip though the cracks,” he said.

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A new study finds that despite having malnutrition symptoms, three-quarters of patients age 65 and older who visited emergency departments in the University of North Carolina hospital system had not been diagnosed before their visit, even though 95% had a primary-care physician and nearly all were insured and living in a private residence. The study found 16% of the patients were malnourished and 60% were either malnourished or at risk for the problem. Of the patients with poor nutritional status, 77% did not recall having conversations with their primary-care physician about the issue.

Malnutrition was highest among patients with symptoms of depression, those residing in assisted-living facilities and those who have challenges getting groceries. It was also a problem among those who said they had difficulty eating, which was often attributed to dental pain, difficulty swallowing or dentures. Researchers surveyed 138 seniors and reviewed their medical records. The findings were published Wednesday in the Annals of Emergency Medicine.

Though the study was small, the data is consistent with other malnutrition research, according to Denise Houston, a registered dietician in the department of gerontology and geriatric medicine at Wake Forest Baptist Medical Center in Winston-Salem, N.C.

Even though nutritional assessments are available in hospitals, the assessments are not always done, which can negatively affect outcomes, she said. “Malnutrition puts people at risk for having longer hospital stays and greater complications,” Houston said. “Someone coming in with worse nutritional status is just not going to do as well as someone with good nutritional status.”

A report released today from the Alliance to Advance Patient Nutrition (PDF) points to a growing body of research correlating poor nutritional status with a range of complications, including surgical site infections, pressure ulcers, patient falls and deteriorating functional status across the continuum of care. The report recommends more education to ensure clinicians are able to recognize and diagnose malnutrition and offer evidence-based interventions, and that nutritional status be considered an essential part of the patient's condition.

Whether in a primary-care setting or the emergency room, there are simple ways to determine that nutrition might be a concern for an elderly patient, experts say.

“Look in the patient's mouth,” says Dr. Reid Blackwelder, president of the American Academy of Family Physicians. Dental disease can decrease one's ability to get adequate nutrition by making the act of chewing uncomfortable. A patient with medical insurance may not necessarily be covered for dental care, and the primary-care physician may have an opportunity to address the issue, he says.

Clinicians should ask patients if they've experienced recent, unexpected weight loss, advised Houston. A nutritional assessment might be in order if they report a 5% loss of body weight over a three-month period, 10% over a six-month period or a loss in appetite, she said.

The UNC study authors also recommend physicians be aware of interventional resources, like the Supplemental Nutrition Assistance Program, Meals on Wheels, congregate meal programs, and other community-based food charities, which they say are underused by older adults with limited food access.

“Malnutrition is likely something we're going to see as being critically important,” Blackwelder said. “It's a critical aspect of so many medical problems.”

Follow Sabriya Rice on Twitter: @MHSRice


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