Addressing Malnutrition in Older Adults During Care Transition

Generally, there are a number of factors that contribute to malnutrition in older adults compared to the younger population. However, the impacts of malnutrition on older adults as they transition from inpatient care facilities to outpatient facilities or home- and community-based settings are not widely known. Meals on Wheels America commissioned this study to better understand these factors, as well as barriers and opportunities to address malnutrition in older adults during such care transitions. This report emerged from an effort to develop a partnership between acute care hospitals and community-based Meals on Wheels providers to improve nutritional status among older adults, resulting in reduced non elective nutrition-related health care usage following discharge from the hospital.

This study provides insight into areas for improving transition care, recommendations for system improvements and promising practices to better meet the nutritional needs of older adults along the continuum of care. As the population of vulnerable older adults increases, care providers, local Meals on Wheels providers and other community-based nutrition service providers, policymakers, payers, patients and caregivers can work collectively to improve malnutrition care of older adults.

Key Findings

The study found that malnutrition in older adults is under diagnosed in all care settings, with communication gaps about nutritional care as older adults transition across care settings. This results in higher risks for negative health outcomes related to malnutrition. Nutrition practitioners reported receiving little or no nutrition information as older adults are transitioned between care settings.

Barriers to assessing malnutrition in long-term, hospital and community care

• Time constraints 
• Limited access to historical nutrition information
• Lack of training in assessment tools
• Incomplete nutrition screenings
• Last-minute discharges
• Unvalidated screening tools
• Low client receptivity
• Limited awareness and referrals from staff
• High costs for outpatient nutrition counseling

Examples of best practices in providing transitional care to malnourished older adults

• Developing a list of community food and nutrition resources to be distributed by registered dietitian nutritionists (RDNs), discharge planners, primary care providers or emergency departments
• Registering older adults for congregate or home-delivered meals prior to discharge and documenting this in the medical record
• Communicating with the RDN from the admitting facility
• Using the Nutrition Focused Physical Exam (NFPE)
• Improving coding for malnutrition in medical records
• Communicating nutrition diagnosis for malnutrition to physicians along with recommendations for follow-up post-discharge
• Including nutrition information in the discharge summary
• Providing nutrition counseling for older adults screened to be malnourished or at risk for malnutrition

Recommendations for making Meals on Wheels providers part of discharge planning

• Marketing, such as brochures with information about the provider and services
• Providing SNAP information
• Educating discharge planners
• Simplifying access to food and nutrition programs
• Developing meal programs to be more acceptable to older adults
• Using health coaches to help promote nutrition programs and services to older adults

As the population of vulnerable older adults increases, care providers, local Meals on Wheels providers and other community-based nutrition service providers, policy makers, payers, patients and caregivers should work collectively to improve malnutrition care of older adults.

In reproducing any excerpts of this report, please provide a credit that recognizes Meals on Wheels America, such as: Meals on Wheels America. (2019). Addressing Malnutrition in Older Adults During Care Transition: Current State of Assessment. https://www.mealsonwheelsamerica.org/research/addressing-malnutrition-in-older-adults-during-care-transition/

External Publications

Leveraging Home-Delivered Meal Programs to Address Unmet Needs for At-Risk Older Adults: Preliminary Data Morris,A. M., Engelberg, J. K., Schmitthenner, B., Dosa, D., Gadbois, E., Shield, R. R., Akobundu, U., & Thomas, K. S., Journal of the American Geriatrics Society, 2019.