Food scarcity and poor oral health are the major causes that lead older adults suffering from malnutrition—and who are already at high risk of functional decline, decreased quality of life, and increased mortality—to land in the emergency department.
“For patients who don’t have enough food at home, the solution is pretty obvious and likely much less expensive than paying for the medical care that results from malnutrition,” says Tim Platts-Mills, assistant professor of emergency medicine at the University of North Carolina at Chapel Hill.
“There is an existing national system of food assistance programs, such as Meals on Wheels, and we believe we can use the emergency department to link patients in need to those programs.”
“Even though such programs are relatively inexpensive—about $6 per individual per day—many many programs are underutilized and under-funded. We need to link patients to these programs and fund these programs,” says Platts-Mills, who is also co-director of the Division of Geriatric Emergency Medicine at the UNC School of Medicine.
A new study, published in the Journal of the American Geriatrics Society, included 252 patients age 65 and older seeking treatment in emergency departments in North Carolina, Michigan, and New Jersey. Participants were screened for malnutrition and then asked about the presence of risk factors.
The overall prevalence of malnutrition in the study sample was 12 percent, which is consistent with previous estimates from US emergency departments and about double the prevalence in community-dwelling adults (those who are not hospitalized and do not live in an assisted-living facility).
Of the three sites, patients receiving care in the North Carolina emergency department had the highest rate of malnutrition, 15 percent. North Carolina also has one of the highest rates of older adults living below the poverty line (ranked third out of 50 states).
Of the risk factors studied, poor oral health had the largest impact on malnutrition. More than half of the patients in the study had some dental problems, and patients with dental problems were three times as likely to suffer from malnutrition as those without dental problems.
Ten percent of patients experienced food insecurity—as evidenced by their responses to questions about not having enough food, eating fewer meals, and going to bed hungry. Further, food insecurity was strongly associated with malnutrition. Other factors that may contribute to malnutrition problems include social isolation, depression, medication side effects, and limited mobility.
“Improving oral health in older adults will be more challenging but also important. Medicare does not cover dental care,” says Collin Burks, a UNC medical student and the study’s lead author.
“Fixing dental problems not only makes it easier for these individuals to eat but also can improve their self-esteem, quality of life, and overall health. We need affordable methods of providing dental care for older adults.”
A research training grant from the National Institutes of Health supported the work.
Source: UNC-Chapel Hill