Researchers: Consider malnutrition in older adults who present to the ED
A new study suggests that a high number of older patients who present to the ED are malnourished or at risk of being malnourished, and that many of these patients are unaware of their nutritional status. The findings stem from an eight-week study in which researchers from the University of North Carolina (UNC) at Chapel Hill performed nutritional assessments on patients aged 65 and older who presented to the ED at UNC hospitals. The research took place over the summer of 2013.1
The researchers report that none of the 138 older adults who were included in the study had cognitive impairments or lived in nursing homes, and none were critically ill. Their nutritional status was assessed using the mini nutritional assessment short-form (MNA-SF), a tool that considers a patient’s body mass index, as well as answers to a range of questions about food intake, psychological issues, mobility, and recent illnesses. Scores on the MNA-SF can range from zero to 14, with malnutrition defined as any score of seven or below. A score of eight to 11 on the assessment puts patients in a category defined as "at risk for malnutrition."
When the scores of the participants were tabulated, researchers found that 60% of participants were either malnourished or at risk for malnutrition. Further, among the 16% of study participants who were found to be malnourished, 77% had not been previously diagnosed as being malnourished. Researchers found this surprising, given that it is well known that malnutrition is a common problem in older adults.
The investigators report that there were no notable differences in the findings related to gender, education level, or where the individuals lived (rural vs. urban setting). However, the prevalence of malnutrition was higher among participants who reported feelings of depression, difficulty eating due to dental pain or some other oral physical limitation, and those who indicated they had trouble obtaining groceries, either due to financial constraints or transportation limitations.
The authors note that the findings present more evidence that EDs need to strengthen their ability to recognize conditions that commonly impact older adults. They also note that identifying malnutrition in this population and linking malnourished individuals with nutritional support services could be a relatively inexpensive way to provide help to a vulnerable population.
- Pereira G, Bulik C, Weaver M, et al. Malnutrition among cognitively intact, noncritically ill older adults in the emergency department. Annals of Emergency Medicine 2014. Aug 7. [Epub ahead of print].