Utilize Malnutrition Awareness Week To Assess Community & Patient Engagement Strategies
September 20, 2019
Hunger in our communities is often a tough problem to see, let alone combat. Unbeknownst to us, our neighbors may not have the resources to buy food. Others live in a food desert, where there are few if any grocery stores or venues where nutritional food can be purchased. Exacerbating the problem, there’s also an unwillingness to self-report on food insecurity, as people may not want their situation known. Those are just a few reasons why Malnutrition Awareness Week, coming up Sept. 23-27, is such a good time for providers to assess how they can help improve patient outcomes around diet and eating.
It’s a bigger problem than we might think. Here’s a snapshot from WhyHunger:
- 40 million Americans are food insecure, which is defined by the USDA as the limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to obtain food in socially acceptable ways. This means skipping or eating less at meals, buying cheap non-nutritious food, and/or feeding their children but not themselves.
- There are 15 million households suffering from food insecurity – 11.8 percent of all households.
- 40.6 million Americans currently rely on SNAP (Supplemental Assistance Program, formerly food stamps) to meet their food needs.
- 92 percent of SNAP households have incomes below the poverty line. Additionally, 82 percent of all SNAP benefits go to the most vulnerable households — those with children, elderly, or disabled people.
Often, and understandably, the focus of hunger relief and malnutrition-abatement efforts is on children. For adults, however, the issue can be equally severe. Food insecurity can lead to illness and the development of chronic diseases, as well as contribute to or exacerbate mental health issues, such as depression.
Food insecurity creates negative outcomes for seniors
Further, the effects of malnutrition on seniors is also extreme. They can experience rapid health declines, as well as cognitive function impairment and accelerated chronic disease development. Providers can do their part to identify malnutrition in seniors. A sudden weight loss, for instance, is a red flag. Asking if the patient is eating and what they are eating can be informative questions around this issue, and are not overly intrusive. It could be that a new medication is affecting the patient’s appetite, for instance, and so the issue can be addressed by looking at possible substitutes. There could also be other environmental concerns, such as a new residence, loss of a spouse or partner, or other sudden change to the home setting that is affecting diet and eating habits.
One way to assess a senior is by using the FRAIL acronym, say Dr. Eleanor McConnell, director of the Duke Centers for Excellence in Geriatric Nursing Education, and Dr. Mitchell Heflin, associate professor of medicine at the Duke School of Medicine and senior fellow in the Center for the Study of Aging and Human Development, who recently spoke to HealthStream about the issue. FRAIL means:
- Fatigue — Do you tire easily?
- Resistance— Can you climb one flight of stairs?
- Ambulation— Can you walk one block?
- Illness — Do you have more than five chronic illnesses?
- Loss of weight — Have you lost more than 5% body weight?
Making these evaluations in the physician’s office, or early in a hospitalization, can help address current situations as well as reduce future risk. It also allows for better release planning and lowering that risk during transition also helps reduce adverse outcomes and readmissions.
“Frailty, in combination with other risk factors, increases an older patient’s vulnerability to a difficult transition of care and re-hospitalization,” McConnell says. “Older patients are more vulnerable during transitions of care because they may have poor health literacy, decreased social support, functional impairment, and or medical problems, such as coexisting chronic medical problems.”
“Over 80% of older adults in the acute care setting are malnourished. Poor nutrition can be caused by social isolation, depression or cognitive impairment.,” Heflin adds. “For adults living at home, poor nutrition may result from a reduced appetite or a lack of transportation that limits access to healthy foods. Financial constraints can also be a factor.”
Providers can do much to combat the issue of food insecurity and malnutrition in older adults. In addition to the FRAIL assessment, they may also be able to connect the patient and their family to community resources for food or meal delivery. Whatever the case, now is a good time to take a look at whether or not diet and nutrition are a part of ongoing care assessment for patients, as well as learning what outside resources are available so that helpful referrals can be made.