The global population, including the United States, is experiencing a demographic shift with the proportion of older adults (aged ≥ 65 years) growing faster than any other age group. This demographic group is at higher risk for developing nutrition-related chronic conditions such as heart disease and diabetes as well as infections such as influenza and pneumonia. As a result, an emphasis on nutrition is instrumental for disease risk reduction. Unfortunately, inadequate nutrient status or deficiency, often termed hidden hunger, disproportionately affects older adults because of systematic healthcare, environmental, and biological challenges. This report summarizes the unique nutrition challenges facing the aging population and identifies strategies, interventions, and policies to address hidden hunger among the older adults, discussed at the scientific symposium “Hidden Hunger: Solutions for America’s Aging Population”, on March 23, 2018.
As many as 50% of hospitalised patients are estimated to be malnourished or at risk of malnutrition on hospital admission, but this condition often goes unrecognised, undiagnosed and untreated. Malnutrition is associated with an elevated need for continued medical interventions, higher costs of care and increased patient safety risks. Tampa General Hospital (TGH), a large teaching hospital in the southeastern USA, initiated a project to improve the quality of patient care at its institution. They did this first by focusing on improving the care quality for their malnourished patients (or patients who were at risk of malnourishment) and by using elements of the national Malnutrition Quality Improvement Initiative (MQii) Toolkit as a mechanism to measure and improve quality. The aim of this study was to evaluate the impact of quality improvement interventions on patient length of stay (LOS), infection rates and readmissions, particularly for malnourished patients. The structure of the MQii and the use of the MQii Toolkit helped staff members identify problems and systematically engage in quality improvement processes. Using the MQii Toolkit, TGH implemented a multipronged approach to improving the treatment of malnourished patients that involved creating interdisciplinary teams of staff and identifying gaps in care that could be improved through a series of changes to hospital-wide clinical workflows. They enhanced interdisciplinary coordination through increased dietitian engagement, the use of electronic health record alerts and new surgical protocols. These interventions lasted 8 months in 2016 and data reported here were collected from 985 patients before the interventions (2015) and 1046 patients after the interventions (2017). The study examines how these process changes affected LOS, infection rates and readmissions at TGH. Following implementation of these quality improvement processes, patients who were malnourished or at risk of malnutrition had a 25% reduction in LOS (from 8 to 6 days, p<0.01) and a 35.7% reduction in infection rates (from 14% to 9%, p<0.01). No statistically significant changes in readmission rates were observed. This study adds to a growing body of literature on quality improvement processes hospitals can undertake to better identify and treat malnourished patients. Hospitals and health systems can benefit from adopting similar institution-wide, quality improvement projects, while policy-makers’ support for such programmes can spur more rapid uptake of nutrition-focused initiatives across care delivery settings.
The rising cost of health care continues to be a key driver of the growing national debt. Improving the nation's health requires a dedicated and holistic advancement of access to quality and affordable patient-centered health care, as well as a strong focus on the core elements of prevention, including nutrition. Programs must be put in place, such as the Malnutrition Quality Improvement Initiative (MQii), to identify and address the root causes of malnutrition. Registered dietitian nutritionists have an important role to lead malnutrition quality improvement efforts in their organizations to promote better patient health outcomes, keep health care costs affordable, and protect Medicare. It is a unique time where there is an opportunity to achieve meaningful change in malnutrition care, and working together to implement quality improvement programs can ensure the health and vitality of current and future generations of Americans.
This study explored the relationship between the opioid epidemic and elder abuse. Twenty professionals from four states with working knowledge of elder abuse cases participated in focus groups. Thematic analysis revealed four themes characterizing the relationship between opioid misuse and elder abuse: (a) Opioid-Related Elder Abuse i s an Escalating Problem; (b) Vulnerable Older Adults a re Prisoners in Their Own Home; (c) Health Care Professionals Perpetrate Opioid-Related Elder Abuse; and (d) Older Adults Abuse and Deal Opiates. In addition, all participants noted the lack of reliable, retrievable data to address cases of elder abuse when opioids are involved. Findings lay the groundwork for further research to understand the breadth and depth of the opioid-elder abuse relationship that can ultimately be used to develop prevention and intervention strategies and policies to address this hidden but widespread concern.
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