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

Abstract

Background Among older adults, malnutrition is common, often missed by healthcare providers, and influences recovery from illness or injury. Objective To identify modifiable risk factors associated with malnutrition in older patients. Design Prospective cross-sectional multicenter study Setting 3 EDs in the South, Northeast, and Midwest Participants Non-critically ill, English-speaking adults aged ≥65 years Measurements Random time block sampling was used to enroll patients. The ED interview assessed malnutrition using the Mini Nutritional Assessment Short-Form. Food insecurity and poor oral health were assessed using validated measures. Other risk factors examined included depressive symptoms, limited mobility, lack of transportation, loneliness, and medication side effects, qualified by whether the patient reported the risk factor affected their diet. The population attributable risk proportion (PARP) for malnutrition was estimated for each risk factor. Results In our sample (n=252), the prevalence of malnutrition was 12%. Patient characteristics associated with malnutrition included not having a college degree, being admitted to the hospital, and residence in an assisted living facility. Of the risk factors examined, the PARPs for malnutrition were highest for poor oral health (54%; 95% CI 16%, 78%), food insecurity (14%; 95% CI 3%, 31%), and lack of transportation affecting diet (12%; 95% CI 3%, 28%). Conclusion Results of this observational study identify multiple modifiable factors associated with the problem of malnutrition in older adults.

Interventions to prevent and treat malnutrition in older adults to be carried out by nurses: A systematic review

“…Malnutrition is a frequent and major problem among older adults (The Dutch Malnutrition Steering Group, ; Volkert et al, ). The prevalence of malnutrition and risk for malnutrition in older adults across settings varies considerably: up to 30% of older adults in the community (Cereda et al, ), 56%–63% of older community‐dwelling adults who receive home care (Cereda et al, ; Yang et al, ), 48%–76% of older adults in hospitals (Burks et al, ; Cereda et al, ; VanderWee et al, ), up to 78% of older adults in nursing homes and institutional long‐term care (Cereda et al, ). In older adults with cognitive impairment and geriatric syndrome, the prevalence is up to 83% and 44%, respectively (Meyer, Gräske, Worch, & Wolf‐Ostermann, ; Saka, Kaya, Ozturk, Erten, & Karan, ).…”

Leveraging emergency department visits to connect older adults at risk for malnutrition and food insecurity to community resources: design and protocol development for the BRIDGE study

“…Malnutrition is common among older adults [1] and contributes to poor health and premature death [2][3][4][5]. The annual economic burden of disease-associated malnutrition in the United States (US) is over $155 billion, with more than $51 billion of that cost attributable to older adults [6,7]. Malnutrition is a complex, multifaceted condition and is associated with numerous risk factors that are often synergistic or bidirectional in nature.…”

“…Clinical risk factors include, but are not limited to, polypharmacy, chronic medical conditions, depression, poor oral health, impaired swallowing, and frailty. Nonmedical (i.e., social) risk factors include, but are not limited to, lack of transportation, loneliness and social isolation, low-quality diets, and food insecurity [6,8,9].…”

“…EDs in the US receive over 20 million visits by older adults annually and are a common and essential site of care for individuals with limited financial resources [18]. Recent estimates indicate that approximately 15% of older patients seeking ED care are malnourished, and almost half are either malnourished or at risk of malnutrition [1,6]. Further, food insecurity was identified as an important contributing factor to malnutrition for more than 25% of ED patients with malnutrition [1,6].…”

“…Recent estimates indicate that approximately 15% of older patients seeking ED care are malnourished, and almost half are either malnourished or at risk of malnutrition [1,6]. Further, food insecurity was identified as an important contributing factor to malnutrition for more than 25% of ED patients with malnutrition [1,6]. Thus, based on these estimates, a national ED-based screening intervention has the potential to impact over 500,000 affected older adults.…”