Photo: Volunteer Juan Montalvo fills senior nutrition boxes for a federal food program at an Ohio foodbank. The Salvation Army distributes the boxes. (Adam Cairns/Columbus Dispatch)
COLUMBUS, Ohio--The United States has done a good job of making the obesity epidemic a public-health priority. But it has largely ignored an equally important threat: senior malnutrition, according to many advocates.
“Malnutrition is a serious, prevalent, growing problem for many older adults in our nation,” said Ainsley Malone, a nutrition-support dietitian at Mount Carmel West hospital in Columbus, Ohio. “But many other countries have really been working much harder to address it.”
$157 Billion a Year Problem
Malnutrition costs the U.S. an estimated $157 billion annually — $51.3 billion for those 65 or older, Malone said. Poor nutrition has been associated with a 300 percent increase in health-care costs.
One-in-three hospital patients is malnourished when admitted, Malone said. Nearly one-third experience declines in nutrition during their hospital stays, putting them at risk of other complications.
With people living longer and the number of older adults set to explode, the problem is expected to get worse, advocates say.
Patients who don’t get proper nutrition have a higher rate of depression, are at increased risk of infections and are less likely to be discharged.
Malnutrition often is caused by an insufficient or imbalanced diet and/or clinical conditions that impair the body’s absorption or use of foods, said Debra BenAvram, chief executive officer of the American Society for Parenteral and Enteral Nutrition.
Despite what people might think, those who weigh too much, not enough or the right amount all can fall short of their body’s necessary nutrients, she said.
Last spring, BenAvram’s 69-year-old father was admitted to the hospital because of a high fever and general malaise. He had lost 12 percent of his body weight, but because he wasn’t underweight, he didn’t appear malnourished, BenAvram said.
He should have received a nutritional assessment and been placed on a care plan within 48 hours. Instead, he was placed on a diet of clear liquids, amounting to only about one-third of his required dietary needs, she said.
Although his condition continued to deteriorate, it wasn’t until day 10 of an 11-day hospital stay that he was started on a nutritional intervention. That was after he underwent an emergency gall-bladder removal because of diverticulitis.
“Because I know the signs of malnutrition, I was able to insist on a nutrition consult for Dad,” BenAvram said. “But not everyone has the information they need.”
More Than a Good Meal Needed
Patients who enter a hospital malnourished also are at greater risk of longer stays, complications and higher readmission rates, BenAvram said. They also have a more difficult time fighting infections and are at greater risk of dying.
“We need to change people’s understanding of nutrition and health as more than just a good meal,” Robert Blancato, executive director of the National Association of Nutrition and Aging Services Programs, said in November at a gathering of gerontological experts in Orlando, Fla.
During the past several months, several health-related groups have made recommendations that include promoting increased and better screening for everyone 65 or older who has been admitted to a hospital, Blancato said.
Also needed are assessment tools and intervention programs for other health-care settings such as primary-care practices and nursing homes, plus standards to ensure that people’s nutritional needs are met even if they move to another setting, Blancato said.
Increasing funding for state and federal programs that help older adults remain in the community and out of the hospital also would help, Blancato said. Examples are food pantries and Meals on Wheels programs.
Ohio State Sen. Gayle Manning, a Republican, has introduced a bill to establish a Malnutrition Prevention Commission in an effort to find out the extent of the problem in Ohio.
If the bill passes, the 17-member group would include a physician, two registered nurses, three dietitians and a hospital representative. It also would have designees from the state departments of aging, agriculture, health and bob and family services, plus an Ohio Association of Area Agencies on Aging representative and a university researcher with expertise in gerontology or nutrition.
The commission would look for evidence-based solutions, such as increased access to registered dietitians, community nutrition programs and oral nutrition supplements, and it would develop strategies for improving data collection and analysis.
“We see senior hunger as a big part of the problem,” said Beth Kowalczyk, chief policy officer of the Ohio Association of Area Agencies on Aging. “A lot of people make do with what they have,” even if it amounts to only a 400-calories-a-day diet.
Some older adults don’t have enough to eat because they are on limited incomes but don’t qualify for home-delivered meals. Others lack transportation to a grocery store or the ability to cook a hot meal.
Senior Hunger Jumped 160%
The number of seniors who used food banks, soup kitchens and pantries in Ohio has jumped dramatically in the past eight years, and most live solely on small monthly Social Security checks, said Lisa Hamler-Fugitt, executive director of the Ohio Association of Foodbanks.
In the last quarter of 2007, 158,599 older Ohioans depended on the supplemental food services; in the last quarter of 2015, 411,570 did — a nearly 160 percent increase.
“Seniors are always the last ones to show up, and when they do, they’re usually in desperate need,” Hamler-Fugitt said.
More support for preventive programs would help, she said.
“We know what needs to be done to address hunger, food insecurity and malnutrition for seniors,” Hamler-Fugitt said. “The question is: Do we have the political will?”
Encarnacion Pyle wrote this article for The Columbus Dispatch with support from the Journalists in Aging Fellowships, a program of New America Media and the Gerontological Society of America, sponsored by the Commonwealth Fund.