Hospital Impact: Adoption of malnutrition measures is critical to ensuring health of seniors

Millions of older adults don't get enough of the nutrients they need to stay healthy. That weakens their bodies, heightens the impact of chronic disease and ratchets up our nation's healthcare costs. (Getty/gpointstudio)

America's senior population is exploding. By 2050, the number of people older than 65 will nearly double compared to 2010, according to the Kaiser Family Foundation. The number of Americans older than 80—the group that accounts for one-third of Medicare spending—will almost triple.

That will send healthcare costs skyward. Medicare spending will account for 6% of our nation's economy by 2050—nearly double its share today, noted (PDF) the Population Reference Bureau. 

To rein in these costs, federal officials must make smart investments that prevent costly, serious illnesses from taking root in seniors—and thus reduce the need for more expensive care. 

They can start by addressing the epidemic of malnutrition among seniors. The Centers for Medicare & Medicaid Services is currently considering new measures that would ensure hospitalized seniors are promptly screened, assessed and treated for malnutrition. Patients and doctors must let the agency know that it should implement those measures this year.

As a registered dietitian nutritionist, I know that millions of older adults don't get enough of the nutrients they need to stay healthy. That weakens their bodies, heightens the impact of chronic disease and ratchets up our nation's healthcare costs. 

Those who have cared for an aging parent or had a chronic disease themselves may have witnessed firsthand how people can become malnourished.

For instance, older adults with limited mobility may struggle to get to the grocery store. Even if they can make the trek, cooking what they bring home can be a challenge. 

Seniors who are sick or suffer from a chronic condition may take medications that make eating more difficult or cause food to be less appetizing. The chronic disease itself may exacerbate malnutrition.

No matter the cause, malnutrition has devastating consequences. 

Those who are malnourished have a harder time recovering from illnesses or surgery, are readmitted to the hospital more frequently, and face an increased risk of infection or falling.  

One study found that malnourished patients had more than double the mortality rate of well-nourished patients. The malnourished group also stayed in the hospital more than twice as long.  

It's no wonder that malnutrition exerts a big financial toll on our healthcare system—more than $15 billion each year in direct medical costs, per another study. Tack on indirect costs—like those from depression, dementia and other diseases associated with malnutrition—and the total surpasses $150 billion annually, research shows. 

The federal government does have programs in place to address malnutrition. The Older Americans Act, for example, funds home-delivered meals and communal dining opportunities for seniors. But these initiatives don't reach all seniors—and don't go far enough to prevent malnutrition.

Indeed, malnutrition often goes undetected. While studies estimate that up to 50% of adults admitted to hospitals are malnourished or at risk, other research (PDF) shows that only 7% of hospitalized patients are diagnosed with the condition. That's because patients are typically not admitted for malnutrition but for other, more acute conditions. 

Fortunately, there are several ways that federal officials can improve nutrition care. 

To start, CMS could adopt the malnutrition quality e-measures that the Academy of Nutrition and Dietetics, Avalere Health and a broad coalition of experts have developed for healthcare providers. 

These e-measures track how well institutions follow certain steps designed to improve nutritional care. These steps include:

  • Screening all admitted patients for malnutrition
  • Assessing patients who are at risk
  • Developing a long-term care plan with a registered dietitian nutritionist for diagnosed patients
  • Documenting the diagnosis

CMS could help standardize these steps through its Inpatient Quality Reporting Program. This program offers hospitals financial incentives to report on how well they adhere to specific standards of high-quality care.

CMS has a track record of improving nutrition care for seniors. If the agency adopts one or more of the e-measures in its program, it could significantly aid the nutritional health of hospitalized older adults.

CMS has invited public comments on whether to include these e-measures in next year's reporting program. Those who have experienced adult malnutrition—patients, caregivers and providers alike—should share the power of their stories to help implore the agency to do so.

Our nation can't afford to wait to address malnutrition, especially when tools exist that can help seniors feel better and reduce healthcare costs. We need CMS' help to take on senior malnutrition this year.

Lucille Beseler is a registered dietitian nutritionist and president of the Academy of Nutrition and Dietetics.