Improving lives and reducing medical costs by addressing malnutrition

Improving lives and reducing medical costs by addressing malnutrition

October 24, 2019

Many people are surprised to learn that malnutrition is a problem in America. In fact, a 2017 U.S. Department of Agriculture study estimates that 40 million Americans, including 12 million children, are food insecure, or lack steady access to affordable, nutritious food.[1]

Although malnutrition affects people of all ages, cultural backgrounds, and socioeconomic levels, older adults are the fastest growing food-insecure population in the country, according to a recent Feeding America study.[2] They face specific challenges getting the nutrition they need, including balancing nutrition with other medical needs, or difficulty shopping and preparing nutritious foods.

In addition, many Americans suffer with another form of malnutrition: disease associated malnutrition (DAM). This type of malnutrition is caused by the inability to intake or properly absorb nutrients due to diseases including cancer, chronic obstructive pulmonary disorder (COPD), heart disease, and stroke.[3] It’s often overlooked – and that’s costly. The total economic burden of DAM related to only eight diseases in the U.S. is an estimated $157 billion annually.[4]

Older adults with chronic health conditions are particularly susceptible to malnutrition due to symptoms of their disease and other health issues including cognitive and physical decline, poor oral health, and depressive symptoms.[5] Hospitalizations compound the problem. When someone with DAM goes to the hospital, they’re often admitted in a malnourished state, which complicates their care and discharge. One study estimates that up to 50 percent of patients admitted to the hospital have DAM. [6] Because most patients are admitted for medical reasons other than DAM and hospital stays aren’t usually long enough to resolve related concerns including poor appetite, weight loss, and nutrient deficiency, patients are often discharged malnourished as well.

That’s a big concern malnourished patients have a harder time recovering from their hospital stays. A 2016 analysis shows that, compared to well-nourished patients, malnourished patients have a four-fold increase in mortality rates and their readmission rates are increased by more than 50 percent. [7]

Identifying and treating malnutrition helps improve overall health especially in vulnerable populations and can help reduce hospital readmission rates. The Malnutrition Quality Improvement Initiative (MQii) is a national nutrition-focused quality improvement initiative designed to close the gaps in identifying and caring for malnutrition. The MQii offers a toolkit that providers can use to improve the effectiveness of their malnutrition care and help advance malnutrition best practices. [8]

Using the quality improvement model, clinicians at Legacy Salmon Creek Medical Center in Vancouver, Washington piloted a program to help lower the readmission rates of patients with a malnutrition diagnosis by sending them home-delivered meals after discharge. The results were impressive. Participants in the pilot study had a 30-day readmission rate of 10 percent compared to an overall average hospital readmission rate of 16.3 percent. [9]

Another study by Zhu et al. at the University of Illinois, reviewed scientific evidence on the impact of home-delivered meal services on diet and nutrition among older adults. Eight of the included studies demonstrated that home-delivered meal programs improve diet quality and increase nutrient intake among participants. The review noted additional benefits of home- delivered meals including increased socialization opportunities and higher quality of life. [10]

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