No new admission is alike. Residents come to us seeking care for a variety of needs and wishes. However, up to half of them may have one thing in common. They are at risk for being malnourished or developing malnutrition.
As the Mayo Clinic outlines, the following factors contribute to the development of malnutrition:
- Limited income and access to food
- Reduced social contact and depression
- Side effects from medications
- Acute and chronic illness
- Expected age-related changes including a decrease in taste and smell, and the ability to chew or swallow
Many of our residents enter our door bringing a combination of the above factors. Yes, there are residents who may easily appear thin and malnourished; however even ill overweight or obese individuals who have been unable to consume sufficient nutrition to promote healing or tissue maintenance can be malnourished.
Malnutrition interferes with a resident’s quality of life and goals. It is a major contributor to multiple morbidities and decreased physical and cognitive function, leading to frailty, falls, loss of independence, or even readmission to the hospital. Despite the risks associated with malnutrition, residents often do not admit with a diagnosis of malnutrition, let alone a treatment plan. Dietitians can help to implement a validated screening tool to identify those who are malnourished or at risk for malnutrition. With early identification and intervention, improved nutrition outcomes during their stay may be seen.
Identifying malnutrition or risk of malnutrition is best accomplished using a valid malnutrition screening tool. The tool is designed to identify who would benefit from nutritional intervention from a Registered Dietitian (RD) or expert clinician. Malnutrition screening tools are usually a simple questionnaire that addresses risk factors for malnutrition (e.g. poor appetite or functional limitations) and indicators of malnutrition (e.g. recent involuntary weight loss). They are most often administered by staff other than dietitians, such as nursing staff. Based on the score, referrals are then made to the appropriate clinician or dietitian for further evaluation. Malnutrition screening should take place within 24-48 hours of admission. There are several validated malnutrition screening tools available:
- Mini Nutritional Assessment
- Malnutrition Screening Tool
- Malnutrition Universal Screening Tool
If a patient is deemed malnourished or at risk for malnutrition, a full nutrition assessment should be completed by the dietitian. The comprehensive nutrition assessment can further identify risk factors that may contribute to under or overnutrition, protein energy malnutrition, dehydration, unintended weight loss, pressure injuries and other nutrition problems.
Upon completion of the assessment, the RD in coordination with the health care team will determine the best interventions to help improve nutrition status and can notify the physician if there’s a need to pursue a diagnosis of malnutrition. If malnutrition or risk of malnutrition is captured by length of stay day 5 on the MDS, it can also lead to increased reimbursement through the Patient Driven Payment Model (PDPM).
A malnutrition screening is the catalyst for quickly pursuing a diagnosis of malnutrition and implementing necessary nutrition interventions. Our dietitians are versed in the importance of screening and treating malnutrition. They can assist in designing a customized process for a validated and widely applicable screening tool. Collaboration with the interdisciplinary team will ensure that malnutrition screening becomes a simple, routine measure that yields clinical and financial success for your facility.
Academy of Nutrition and Dietetics: https://www.eatrightpro.org/-/media/eatrightpro-files/news-center/in-practice/dialogueproceedingsmalnutritiontransitionsofcare2018.pdf?la=en&hash=F20732B27FBACB8CD9AB25321CD943BD275CE2B0
Academy of Nutrition and Dietetics: Quality Measures for Malnutrition: https://jandonline.org/article/S2212-2672(19)30848-2/fulltext
Call for Action for Malnutrition Policy: https://jandonline.org/article/S2212-2672(19)30508-8/fulltext
Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition): https://jandonline.org/article/S2212-2672(12)00328-0/fulltext
Journal of Parenteral and Enteral Nutrition: https://onlinelibrary.wiley.com/doi/full/10.1177/0148607112440285
Malnutrition: A Hidden Cost in Health Care. (2006). Retrieved from https://static.abbottnutrition.com/cms-prod/abbottnutrition.com/img/Malnutrition.pdf
Mayo Clinic: https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/senior-health/art-20044699
Position of the Academy of Nutrition and Dietetics: Individualized Nutrition Approaches for Older Adults: Long-Term Care, Post-Acute Care, and Other Settings, Volume 118, Number 4, April 2018