Recipe for change.

Curbing malnutrition can lessen many other problems

A RECENT STUDY OF HOSPITALIZED OLDER patients that draws a link between malnutrition and mortality holds strong implications for long term care facilities and their role in managing resident nutrition, experts say.

Published in the June 2 issue of the Journal of the American Medical Association, the study found that one-fifth of hospitalized patients took in less than half the food they needed, which correlated with a higher rate of in hospital mortality and 90-day mortality.

Dennis H. Sullivan, MD, a physician and geriatric researcher with the Central Arkansas Veterans Healthcare System and principal author of the study, says the study doesn't establish a causal relationship between malnutrition and mortality, but lays the foundation for the development of a standard of care.

Nutrition is of particular concern in older patients, Sullivan says, because appetites decline more significantly during illness and are slower to reestablish during recovery. Older people also are less likely to make up lost nutritional intake. "Our goal now is to begin to test interventions to see if we can break that downward spiral, and to see what kinds of interventions are most effective," he says.

Malnutrition is a challenge in nursing homes because it can be difficult to diagnose in its early stages and because declining reimbursements are eroding staffing, said Mark H. DeLegge, MD, a professor with the University of North Carolina School of Medicine who specializes in nutrition. Data from the National Eldercare Institute on Nutrition in Washington, D.C., says 35 to 50 percent of older residents in long term care facilities are malnourished, in part because they are admitted malnourished or they suffer chronic illness or disability problems that make nutrition difficult to manage.

HCFA has put nutrition and hydration high on its agenda, working with the American Dietetic Association and other agencies to share best practices for residents at risk. The ADA advocates that a registered dietitian be an integral member of an interdisciplinary health care team treating nursing home residents.

DeLegge says patients would have fewer problems with infection and pressure wounds and would better respond to physical therapy and medications if not for malnutrition. "If aggressive nutrition was part and parcel treatment for every patient, we could treat other problems more aggressively and maybe even return patients back to the home setting more often," he says.

Researchers acknowledged the problem is complicated, but Sullivan notes some facilities are more proactive in managing nutrition. The key, he said, is to build awareness and determine appropriate interventions, which can include measures to encourage appetite in early stages or the use of appetite stimulants that are not now commonly used in older patients.