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.
Malnutrition in 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 20-50% of older adults are malnourished before hospital admission.1 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.
In one study, nearly 68% of older patients did not realize that they were malnourished.2 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. In fact, previously hospitalized older adults who exhibit symptoms of malnutrition and depression were likely to be readmitted within 30 days.3
Malnutrition in ursing homes and other long-term care settings
Older adults 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.
Malnutrition in the community
For older adults 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.
Sources
1. Bellanti, et al. Malnutrition in Hospitalized Old Patients: Screening and Diagnosis; Clinical Outcomes and Management. Nutrients. Feb. 21, 2022. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8880030/pdf/nutrients-14-00910.pdf
2. Lueg G, et al. Low self-perception of malnutrition in hospitalized older patients. Clinical Interventions in Aging. Nov. 19, 2020. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/33239871/
3. Tay, et al. Depression symptoms and malnutrition are associated with other geriatric syndromes and increased risk for 30-day readmission in hospitalized older adults: a prospective cohort study. BMC Geriatrics. Aug. 2, 2022. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/35918652/
