March is National Nutrition Month, a "nutrition education and information campaign created annually by the Academy of Nutrition and Dietetics which focuses attention on the importance of making informed food choices and developing sound eating and physical activity habits." All Americans should observe this month but one group of people that deserves special attention during this month are older adults, who are at higher risk for health issues related to poor nutrition.
A lot of appropriate attention is focused on hunger and food insecurity as well as obesity. However, malnutrition, also known as undernutrition, is a bigger threat because of the deeper health consequences it creates.
What is malnutrition? Simply stated, it means poor nutrition or "insufficient food intake compared with nutrition requirements." It can be related to an excessive or imbalanced diet, clinical conditions that impair the body's absorption or use of foods and a diet that lacks essential nutrients.
Malnutrition is a growing problem among older Americans. Of the millions of older adults admitted to the hospital every year, at least one in three is malnourished upon admission. The economic impact of malnutrition is enormous. It is estimated that disease-associated malnutrition costs the U.S. $157 billion each year. Other research points to a 300 percent increase in healthcare costs that can be attributed to poor nutrition status.
There are a variety of factors that go into these statistics: "taste disturbances, difficulty accessing or preparing food because of functional limitations or cognitive decline, anxiety, depression, bereavement, and poverty may cause older individuals to eat less" and thus be at higher risk for malnutrition, according to a Gerontological Society of America paper.
Further, patients who enter the hospital malnourished have heightened risks of poorer health outcomes, including longer hospital stays, higher healthcare costs, greater complication and readmission rates, and higher mortality rates. They also can show a decrease in strength and immune response.
A more determined national response is needed to address malnutrition. It involves the health care system from hospitals to individual consumers. It also should involve all levels of government, especially the federal government.
We need to change healthcare practice and accountability for malnutrition. The Alliance to Advance Patient Nutrition created an important model for an interdisciplinary approach to addressing malnutrition in hospitals. The hospital environment needs to be transformed to create an institutional culture where good nutrition is viewed as a priority for improving care quality and care costs.
Clinicians' roles should be redefined to include nutrition. They should be able to screen and diagnose all patients at risk, monitor these patients continuously while in a hospital setting, and incorporate nutrition in patients' discharge plans.
Once patients are discharged, clinicians should clearly communicate patients' nutritional needs to the patient and his or her caregiver. Electronic health records should be standardized to contain this nutrition plan so that the patient's primary care physician can follow up with the patient. In short, care transitions should place a greater emphasis on nutrition. There are also therapeutic nutrition resources available online for caregivers.
Solving senior malnutrition also means strengthening federal programs that already exist in the elderly nutrition space, which can be used to help patients remain in the community and out of the hospital. One example is the Older Americans Act (OAA) which provides federal funding for senior nutrition programs, including home-delivered meals and meals in senior centers. 2.6 million seniors per year receive meals. The programs that are run at the local level with OAA money also leverage these federal dollars to raise millions of dollars in private support, creating true public-private partnerships.
However, the OAA is perpetually decreasing in funding due to inflation and the growth in the senior population, as well as sequestration. Funding for most of the Act has been frozen at lowered levels for several years, meaning that it is losing ground rapidly. Though nutrition funding was raised slightly again in 2014, it simply cannot keep pace with population growth, inflation, and rising food costs. President Obama's FY 2016 budget would add an additional $40 million in funding to senior nutrition programs to help these programs catch up. The budget would also provide $20 million for nutrition innovation demonstration grants, encouraging programs to showcase innovative means of providing senior nutrition. This is one example of a potential way to further incentivize solutions to issues such as malnutrition.
Other federal programs such as the Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, should be more closely targeting older adults. Approximately three out of five seniors who qualify for the program are not enrolled. Senior centers could provide more benefits outreach and enrollment assistance.
Also at the national level, a White House Conference on Aging is being held this summer, as it is every ten years, and one of the four main topics being addressed is healthy aging. A national webinar was held in January to discuss the links between nutrition, especially malnutrition, and healthy aging. We expect these links to be reflected in the final work of the conference.
Finally, as consumers, we also play a role. We must raise pressure to lower the price disparities between higher-cost nutritious food and lower-cost nutritionally deficient food. We must advocate for federal resources to support local programs and innovations.
Senior malnutrition affects all of us, whether personally or through higher healthcare costs. We must take a stand for nutrition and against malnutrition.
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