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More than half of older adults who visit emergency departments are either malnourished or at risk for malnutrition, but not because of lack

of access to healthcare, critical illness, or dementia. Despite clear signs of malnutrition or risk of malnutrition, more than three-quarters had never previously been diagnosed with malnutrition, according to the results of a study published online yesterday in Annals of Emergency Medicine ("Malnutrition Among Cognitively Intact, Non-Critically Ill Older Adults in the Emergency Department").

"We were surprised by the levels of malnutrition or risk of it among cognitively intact seniors visiting the ER, and even more surprised that most malnourished patients had never been told they were malnourished," said lead study author Timothy Platts-Mills, MD, of the University of North Carolina Department of Emergency Medicine in Chapel Hill, NC. "Depression and dental problems appear to be important contributors, as is difficulty buying groceries. Given that seniors visit ERs more than 20 million times a year in the US, emergency physicians have an opportunity to screen and intervene in ways that may be very helpful without being very costly."

Of patients age 65 and older, 16 percent were malnourished and 60 percent were either malnourished or at risk for malnutrition. Of the malnourished patients, 77 percent denied having been previously diagnosed with malnutrition. Malnutrition was highest among patients with symptoms of depression (52 percent), those residing in assisted living (50 percent), those with difficulty eating (38 percent), and those reporting difficulty buying groceries (33 percent). Difficulty eating was mostly attributed to denture problems, dental pain, or difficulty swallowing.

In this study, nearly all (95 percent) of patients had a primary care physician, nearly all (94 percent) lived in a private residence, and nearly all (96 percent) had some type of health insurance. More than one-third (35 percent) had a college education.

Malnutrition is defined as lacking "adequate calories, protein, or other nutrients needed for tissue maintenance and repair."

"For patients who report difficulty buying groceries, Supplemental Nutrition Program, Meals on Wheels, Congregate Meals Programs, or community-based food charities can be helpful, although other factors may also need to be addressed," said Dr. Platts-Mills. "The growing role of the emergency department as community health resource makes it an essential place for identifying and addressing unmet needs of older adults. Implementation of oral nutritional supplementation is inexpensive and may reduce overall costs by accelerating recovery from illness and reducing readmissions."

Source: American College of Emergency Physicians, acep.org

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