The prevalence of malnutrition among older adults is on the rise, contributing to overall higher healthcare costs.  In fact, estimates are that the cost of disease-associated malnutrition in older adults is $42 billion per year, and up to one out of every two older adults are at risk of becoming malnourished.1   Malnutrition is a major contributor to multiple morbidities, decreased physical and cognitive function, and impaired quality of life.  It is also a contributor to increased hospital readmissions.  Identifying and treating malnutrition early on will not only improve patient outcomes, but with a diagnosis, facilities will now receive reimbursement under the new patient driven payment model (PDPM).

Malnutrition can simply be defined as a nutrition imbalance, including under-nutrition and over-nutrition.  Malnutrition may include concerns such as macro/ micronutrient deficiencies, obesity, and nutrition imbalances stemming from acute or chronic disease and medical treatments.  Nutrition screening and assessment upon admission can help to identify those who are malnourished or at risk for malnutrition.  With proper identification and diagnosis facilities will receive reimbursement if malnutrition is captured on an admission MDS identified by length of stay day five.  And with early identification and intervention, improved nutrition outcomes during their stay will be seen.

Identifying malnutrition or risk of malnutrition can be accomplished using a valid malnutrition screening tool.  The tool is designed to identify those would benefit from nutritional intervention from a registered dietitian 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:

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.  The assessment may include

  • Food and Nutrition related history/Client History
  • Nutrition Focused Physical findings
  • Anthropometric measurements including height/weight
  • Biochemical data, Medical tests & Procedures
  • Food and Fluid Intake
  • Medications that may affect nutritional status/intake/nutrient absorption
  • Chewing/Swallowing Problems
  • Functional Abilities

The assessment may use existing information from sources such as assessments from other disciplines, laboratory tests, patient/resident observations, and individual and family interviews.  Upon completion of the assessment, the facility may choose to have the RDN or designee notify the physician in writing, when an individual’s nutrition assessment indicates malnutrition for further diagnosis.    The RD in coordination with the health care team will determine the best interventions to help improve nutrition status.

Quickly evaluating and diagnosing malnutrition will be taking on more significance with PDPM and could lead to appropriate reimbursement for nutritional assessments and interventions. Collaborate with the interdisciplinary team to help achieve success both clinically and financially.

 

Sources:

Call for Action for Malnutrition Policy:  https://jandonline.org/article/S2212-2672(19)30508-8/fulltext

Academy of Nutrition and Dietetics: Quality Measures for Malnutrition: https://jandonline.org/article/S2212-2672(19)30848-2/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