A recent “What’s Hot” from the Gerontology Society of America focused on elder malnutrition, a topic that Mom’s Meals has been very involved with for a couple of years. Malnutrition in this population has been identified for many years. However, it has taken until now for the realization that elder malnutrition may impact health care costs and that by simply feeding people an adequate and appropriate diet may have positive effects. Interestingly, one of the articles mentions that current models of Transition Care (moving the patient from hospital to home) may have over emphasized the medico-pharma aspects of patient care. A more holistic approach that includes nutritional care is recommended. Mom’s Meals has recognized and been preaching that nutrition support is critical to the well being of the elderly population. It is encouraging that policymakers are finally seeing that feeding people is good for them and good for the health care system.
We understand that seniors want to continue to live independently yet may not know all the steps they can take to help avoid malnutrition. Even small dietary changes can make a big difference in an older adult’s health and well-being. For example:
Engage doctors. If your loved one is losing weight, work with his or her doctors to identify — and address — any contributing factors. This might include changing medications that affect appetite, suspending any diet restrictions until your loved one is eating more effectively, and working with a dentist to treat oral pain or chewing problems. Request screenings for nutrition problems during routine office visits, and ask about nutritional supplements. You might also ask for a referral to a registered dietitian.
Encourage your loved one to eat foods packed with nutrients. Spread peanut or other nut butters on toast and crackers, fresh fruits, and raw vegetables. Sprinkle finely chopped nuts or wheat germ on yogurt, fruit and cereal. Add extra egg whites to scrambled eggs and omelets and encourage use of whole milk. Add cheese to sandwiches, vegetables, soups, rice and noodles.
Restore life to bland food. Make a restricted diet more appealing by using lemon juice, herbs and spices. If loss of taste and smell is a problem, experiment with seasonings and recipes.
Plan between-meal snacks. A piece of fruit or cheese, a spoonful of peanut butter, or a fruit smoothie can provide nutrients and calories.
Make meals social events. Drop by during mealtime or invite your loved one to your home for occasional meals. Encourage your loved one to join programs where he or she can eat with others.
Encourage regular physical activity. Daily exercise — even if it’s light — can stimulate appetite and strengthen bones and muscles.
Provide food-savings tips. If your loved one shops for groceries, encourage him or her to bring a shopping list, check store fliers for sales and choose less expensive brands. Suggest splitting the cost of bulk goods or meals with a friend
Remember, identifying and treating nutrition issues early can promote good health, independence and increased longevity. Take steps now to ensure your loved one’s nutrition.
Over the last few weeks, we have been focusing on how to prevent and detect malnutrition in seniors. The signs of malnutrition in older adults can be tough to spot, especially in people who don’t seem at risk — but uncovering problems at the earliest stage can help prevent complications later. To detect malnutrition:
Observe your loved one’s eating habits. Spend time with your loved one during meals at home, not just on special occasions. If your loved one lives alone, find out who buys his or her food. If your loved one is in a hospital or long term care facility, visit during mealtimes.
Watch for weight loss. Help your loved one monitor his or her weight at home. You might also watch for other signs of weight loss, such as changes in how clothing fits.
Be alert to other red flags. In addition to weight loss, malnutrition can cause poor wound healing, easy bruising and dental difficulties.
Know your loved one’s medications. Many drugs affect appetite, digestion and nutrient absorption.
In the final excerpt of how to prevent and detect malnutrition in seniors we will discuss what steps you can take to help avoid malnutrition.
In our second installment on the serious health consequences of malnutrition in seniors focuses on how malnutrition begins. Information is courtesy of the Mayo Clinic staff writers
The causes of malnutrition might seem straightforward — too little food or a diet lacking in nutrients. In reality, though, malnutrition is often caused by a combination of physical, social and psychological issues. For example:
Health concerns. Older adults often have health problems, such as dementia or dental issues that can lead to decreased appetite or trouble eating. Other factors that might play a role include a chronic illness, use of certain medications, difficulty swallowing or absorbing nutrients, a recent hospitalization, or a diminished sense of taste or smell.
Restricted diets. Dietary restrictions — such as limits on salt, fat, protein or sugar — can help manage certain medical conditions, but might also contribute to inadequate eating.
Limited income. Some older adults might have trouble affording groceries, especially if they’re taking expensive medications.
Reduced social contact. Older adults who eat alone might not enjoy meals as before, causing them to lose interest in cooking and eating.
Depression. Grief, loneliness, failing health, lack of mobility and other factors might contribute to depression — causing loss of appetite.
Alcoholism. Too much alcohol can interfere with the digestion and absorption of nutrients. Nutrients might also be lacking if alcohol is substituted for meals.
Be alert of the early triggers and warning signs of malnutrition to prevent the onset of malnutrition before it begins. The next blog in our series will focus on how to spot malnutrition in seniors.
Over the next several weeks we will be sharing information from the Mayo Clinic staff writers on the importance of nutrition for seniors. Specifically, we will focus on malnutrition and the serious health consequences.
Good nutrition is critical to overall health and well-being — yet many older adults are at risk of inadequate nutrition. Know the causes and signs of nutrition problems in older adults, as well as steps you can take to ensure a nutrient-rich diet for an older loved one.
Problems caused by malnutrition
Malnutrition in older adults can lead to various health concerns, including:
A weak immune system, which increases the risk of infections
Poor wound healing
Muscle weakness, which can lead to falls and fractures
In addition, malnutrition can lead to further disinterest in eating or lack of appetite — which only makes the problem worse.
Malnutrition is a serious senior health issue. Know the warning signs and how to help an older loved one avoid poor nutrition. Next week we will focus on how malnutrition begins.
Much like the meals you make at home, Mom’s Meals NourishCare prepares meals from fresh ingredients that are purchased from our local suppliers. For some recipes, we go through a pallet of fresh green peppers, cleaning and trimming just like you do at home. Meal components are made and then plated under the direction of Quality Assurance chefs, who are formally trained and come from restaurant backgrounds.
Prior to the finalizing a recipe, we go through a rigorous testing process to come up with the finished product. First, we determine our target meal nutritionals. For this process, we always use reputable sources, such as American Heart Association or American Diabetes Association. Once the chefs and dietitians determine the nutritional profile of the meal, a brainstorming session occurs in which some general meal concepts are developed.
During this process, we may go to local restaurants and grocery stores to sample comparable foods that have the flavor but not necessarily the “right” nutritional composition. You would be amazed at the sodium and fat content of some commercially available products – heart attacks in a jar. We recently reformulated our marinara sauce and in doing so tasted 15 different brands of marinara. What was amazing to us was that some of the commercial brands had over 1,000 milligrams of sodium per serving! Who Knew?
Once we have a chance to taste and evaluate commercial samples, our chefs produce a couple of versions, looking for the “gold standard” that reflects both nutritional requirements as well as great taste. This recipe is tasted and evaluated by our employees (their favorite part of their job) and then customers. Once we have the final stamp of approval from them, the recipe is scaled and piloted in the kitchen to ensure that we can produce it in quantity for our customers.
A lot of time and effort is put into each meal — just like Mom made it herself.
When someone is diagnosed with a chronic or potentially life-threatening disease, their nutrition plays a critical role in their recovery. We asked Dr. Sam Beattie Ph.D. for his view on the topic, as he is an expert in the field of food safety and quality and is the Director of Nutrition Services and Education at Mom’s Meals NourishCare.
Dr. Beattie received his undergraduate degree in Food Technology from Iowa State University, his Master’s degree from South Dakota State University, and his PhD from Oregon State University in Food Science and Technology with minors in Biochemistry and Microbiology.
“Healthy eating is critical to all, and for those with a chronic illness, eating the appropriate diet can have significant impacts. For example, recent clinical studies by Dr. Scott Hummel at the University of Michigan have shown that a low sodium diet can actually improve heart function in those diagnosed with a specific type of heart failure. Consuming the appropriate nutrition can mitigate symptoms, slow disease progression and, in some cases, even reverse signs of the disease in some chronic conditions such as renal failure, diabetes, obesity, heart disease and high blood pressure.”
The root cause for many chronic diseases is, in fact, poor nutrition. Consider the incidence of obesity, high blood pressure, and heart disease — these are almost always caused by poor food choices and the amount consumed.
Nutrition is equally critical in recovery from a hospital stay or surgery, as it is central to supporting the body’s ability to heal itself. Before starting Mom’s Meals NourishCare or making a change to your diet, we recommend talking to a physician and dietitian regarding the best nutrition plan for your particular circumstance.
By Staci Hemesath, Board Certified Specialist in Renal Nutrition, Registered Dietitian
Based on new research published in the Journal of Parenteral and Enteral Nutrition (Corkins, et al., 2014), there is an alarming number of undiagnosed malnourished patients in U.S. hospitals. Findings from the 2010 Healthcare Cost and Utilization Project revealed that only 3.2% of hospitalized patients were correctly coded as malnourished.
The Malnutrition Gap
But how many patients arrive at the hospital malnourished? Between 33%-54%, depending on the study. This means roughly 1/3 to 1/2 of hospitalized patients are not being properly coded as malnourished! Plus, among patients that are not malnourished upon admission, approximately one third may become malnourished while in the hospital.
If left untreated, two thirds of these malnourished patients will suffer a greater decline in nutritional status during their hospital stay. This translates to a significant number of patients leaving the hospital in a nutritionally compromised state.
As an outpatient dialysis dietitian, I have witnessed the post-discharge downward spiral of many of my patients. It’s concerning that they go to the hospital to “get better,” but often leave in a weak, malnourished state. And in many cases, they either:
1) Get readmitted after suffering a fall at home or being diagnosed with an infection or
2) Get admitted to a nursing home with a further decline in functional status
It is sad to see and makes me ponder what can be done to improve this reality.
This “malnutrition gap” reveals a tremendous opportunity to optimize quality of patient care, improve clinical outcomes, and reduce cost. My example above highlights a few of the common adverse outcomes of malnutrition, but there are many others.
Prompt Diagnosis is Critical – New ICD-10 Codes May Help
Identifying and treating malnutrition early on is a critical step in addressing hospital malnutrition.
New ICD-10 Codes: A promising step in the right direction is the mandatory implementation of ICD-10 codes, effective October 1, 2015. The new codes require users to more specifically define each health condition. In doing so, nutrition-related issues are more likely to be identified and institutions can be reimbursed appropriately. Successful implementation of this process can result in significant gains in hospital revenue.
Nutrition Care Model: The Alliance to Advance Patient Nutrition, an interdisciplinary collaboration of the Academy of Nutrition & Dietetics and other industry leaders, has developed a nutrition care model (Tappenden, et al., 2013) with six principles designed to improve hospital nutrition practices. One of the key principles, which is often overlooked, is the inclusion of nutrition in the discharge planning process. Ensuring that nutrition is part of the transition to home is crucial in preventing hospital readmissions.
Patients and caregivers must be given detailed instructions for nutrition care at home, and nutrition should be an essential component of follow-up appointments. Also, dietitians should be involved in the care transitions process so that appropriate interventions can be implemented, recommended, and monitored.
Mom's Meals does not claim to treat or cure heart disease, diabetes, kidney disease or celiac and is not a substitute for medications. Consult with your physician or Registered Dietitian before starting any nutritional program.