Many older emergency department patients are malnourished

August 13, 2014

More than half of emergency department patients age 65 and older who were seen at UNC Hospitals during an 8-week period were either malnourished or at risk for malnutrition.

In addition, more than half of the malnourished patients had not previously been diagnosed, according to a new study by researchers at the University of North Carolina at Chapel Hill. The study was published online August 13 by the journal Annals of Emergency Medicine.

"Malnutrition is known to be a common problem among older adults. What is surprising in our study is that most of the malnourished patients had never been told that they were malnourished," said Timothy F. Platts-Mills, MD, MSc, assistant professor of emergency medicine in the UNC School of Medicine and senior author of the study.

"Our findings suggest that identifying malnutrition among older emergency department patients and connecting these patients with a food program or other services may be an inexpensive way to help these patients," Platts-Mills said. "Older adults make more than 20 million visits to U.S. emergency departments each year. Our results add to a growing body of evidence that more needs to be done to develop the capacity of emergency departments to address the underlying conditions that impact health for older adults, particularly for those with limited resources."

The study included 138 adults age 65 and older who sought treatment in the emergency department at UNC Hospitals during an 8-week period. All were patients with no cognitive impairments, who were not critically ill and did not live in a nursing home or skilled nursing facility.

The nutritional status of each was assessed using the Mini Nutritional Assessment Short-Form (MNA-SF), a 6-item tool that combines body mass index and the patient's answers to questions about weight loss, decline in food intake, recent stress or disease, mobility and neuropsychological disorders. The results produce a score from 0 to 14. Malnutrition is defined as a score of 7 or lower while at risk for malnutrition is defined as a score from 8 to 11.

Sixteen percent were found to be malnourished and most of these (77 percent) said they had not previously been diagnosed as malnourished. Sixty percent were found to be either malnourished or at risk for malnutrition.

There were no significant differences in the prevalence of malnutrition between men and women, across levels of education or between those living in urban versus rural areas. However, the prevalence of malnutrition was higher among patients who reported having depressive symptoms, difficulty eating (due to dental pain, ill-fitting dentures, etc.) or difficulty buying groceries (due to lack of transportation, lack of money, etc.).
First author of the study is Greg F. Pereira, BSPH, a recent graduate of the UNC Department of Nutrition. Co-authors are Wesley C. Holland, Mark A. Weaver, PhD, research assistant professor in the UNC Gillings School of Global Public Health; and Cynthia M. Bulik, PhD, distinguished professor of psychiatry in UNC School of Medicine and nutrition in the UNC Gillings School of Global Public Health.

University of North Carolina Health Care

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