Using malnutrition and food insecurity screening to identify broader health‐related social needs amongst older adults receiving emergency department care in the Southeastern United States: A cross‐sectional study

Abstract

Unmet health-related social needs are common amongst older US adults and impact both quality of life and health outcomes. One of the ways that unmet health-related social needs impact health is through malnutrition, an imbalance in a person's intake of energy and/or nutrients. Lack of reliable access to a sufficient quantity of nutritious food is a specific health-related social need that can be assessed rapidly and, when unmet, is a direct risk factor for malnutrition and may be indicative of a broader range of unmet health-related social needs. We conducted a cross-sectional study to characterise malnutrition and food insecurity amongst older adults receiving emergency department (ED) care using brief, validated measures and to assess the burden of a broader range of health-related social needs amongst these patients. Patients were asked about their need for and willingness to receive a range of social services.The study was conducted in an academic ED serving a racially and socioeconomically diverse population in the Southeastern United States. A convenience sample of noncritically ill adults aged 60 years and older was approached between November 2018 and April 2019. Study patients (n = 127) were predominantly non-Hispanic white (67%), community dwelling (91%) and urban residents (66%) with 28% screening positive for malnutrition risk, 16% for food insecurity and 5% for both. Of those at risk for malnutrition, 25 (69%) reported ≥2 unmet health-related social needs and 14 (38%) were receptive to social services. Amongst food insecure patients, 18 (90%) reported additional unmet health-related social needs and 13 (65%) were receptive to receiving social services. In conclusion, a brief set of questions can identify subgroups of older ED patients who are food insecure or at risk for malnutrition. Individuals who screen positive for food insecurity have a high burden of unmet health-related social needs.

Evaluating a social risk screening and referral program in an urban safety‐net hospital emergency department

“…9,13 Research studies implementing temporary social needs screening in EDs suggest that similar barriers likely exist, with additional barriers of illness acuity and unique ED workflow constraints. 15,[17][18][19][20][21][22][23][24][25] High levels of clinician burnout may also be a barrier, as burnout levels among ED physicians and nurses have been exacerbated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. [26][27][28]…”

“… 7 , 14 , 15 There has been growing interest in the past 2 decades in expanding social needs screening and referral programs to the ED. 7 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 34 …”

“… 20 Among EDs who have begun screening for social needs, research has confirmed the high prevalence of unmet social needs among the ED patient population. 15 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 However, there is little consensus about best practices for screening and referral program implementation in an ED setting. Less is known about the effectiveness of such programs in connecting patients with resources as few studies follow patients after discharge from the ED.…”

“…Because of the nature of the ED as a safety net, researchers identified the ED as an ideal location to identify social needs among patients who might otherwise lack access to social needs referral programs in ambulatory care settings 7,14,15 . There has been growing interest in the past 2 decades in expanding social needs screening and referral programs to the ED 7,14–25,34 …”

“…One recent scoping review found that among 135 related studies, only 2% of EDs addressed food insecurity, and only 3% addressed housing 20 . Among EDs who have begun screening for social needs, research has confirmed the high prevalence of unmet social needs among the ED patient population 15,17–25 . However, there is little consensus about best practices for screening and referral program implementation in an ED setting.…”