Malnutrition Among Cognitively Intact, Noncritically Ill Older Adults in the Emergency Department

Abstract

Objectives We estimate the prevalence of malnutrition among older patients presenting to an emergency department (ED) in the southeastern United States and identify subgroups at increased risk. Methods We conducted a cross-sectional study with random time block sampling of cognitively intact patients aged 65 years and older. Nutrition was assessed using the Mini Nutritional Assessment Short-Form (0–14 scale) with malnutrition defined as a score of 7 or less and at-risk for malnutrition defined as a score of 8–11. The presence of depressive symptoms was defined as a Center for Epidemiological Studies Depression-10 score of 4 or more (0–10 scale). Results Among 138 older adults, 16% (95% Confidence Interval [CI], 10%–22%) were malnourished and 60% (95% CI, 52%–69%) were either malnourished or at-risk for malnutrition. Seventeen of the 22 malnourished patients (77%) denied previously being diagnosed with malnutrition. The prevalence of malnutrition was not appreciably different between males and females, across levels of patient education, or between those living in urban and rural areas. However, the prevalence of malnutrition was higher among patients with depressive symptoms 52%, those residing in assisted living 50%, those with difficulty eating 38%, and those reporting difficulty buying groceries 33%. Conclusion Among a random sample of cognitively intact older ED patients, more than half were malnourished or at-risk for malnutrition, and the majority of malnourished patients had not previously been diagnosed. Higher rates of malnutrition among those with depression, difficulty eating, and difficulty buying groceries suggest the need to explore multifaceted interventions.

Risk Factors for Malnutrition among Older Adults in the Emergency Department: A Multicenter Study

“…Among older adults presenting to three EDs in distinct areas of the US, the prevalence of malnutrition was estimated to be 12%. This value is within the range of a prior estimate by our group (16%; 95% CI 11%, 23%; n = 138) and is similar to that from a study conducted in Australia (15%; 95% CI 9%, 21%) . These estimates are more than double the estimated prevalence of malnutrition in community‐dwelling older adults (5.8%), supporting the idea that EDs provide access to a nutritionally vulnerable subset of older patients .…”

“…These estimates are more than double the estimated prevalence of malnutrition in community‐dwelling older adults (5.8%), supporting the idea that EDs provide access to a nutritionally vulnerable subset of older patients . Despite the fact that malnutrition screening takes less than 5 minutes to complete, screening is rarely performed. While a majority of malnourished patients in our study were admitted, 21% of malnourished participants were discharged home from the ED without any formal assessment or treatment for malnutrition.…”

“…As such, the ED is a potentially important setting for identifying and addressing malnutrition. Prior research has found that the burden of malnutrition is high among older adults presenting to the ED, with prevalence point estimates ranging from 12% to 16% . Only one clinical trial has examined the value of identifying and treating malnutrition in older ED patients .…”

Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

“…Attention to the non-medical problems such as social isolation, malnutrition, poor health literacy, and neglect, which have strong influences on health behaviors and outcomes may be necessary to meet older adults’ needs and reduce EMS demand in this population. 46,47 Patients with these problems might benefit from education regarding alternatives to calling 911 for these symptoms or efforts to develop non-EMS transport options. Additionally, alternative healthcare delivery models such as mobile integrated health care and community paramedicine programs have been proposed and are currently being studied, particularly for patients with chronic conditions such as congestive heart failure.…”

Nutrition as a Vital Sign: Progress Since the 1990 Multidisciplinary Nutrition Screening Initiative and Opportunities for Nursing

“…A recent study on a random sample of "cognitively intact, non-critically, ill older adults" in an emergency department found that over half were malnourished or at risk for malnutrition, and the majority of the malnourished patients had not been previously diagnosed with the condition. The researchers concluded that the growing role of emergency departments as sites of care and entry point makes them essential places for identifying and addressing unmet needs such as malnutrition for older adults [75]. In this regard, a simple "vital sign" for malnutrition screening would facilitate the nurse's work.…”