6 The Hampton Roads Messenger


Volume 10 Number 4


Elder Hunger: New Efforts to Combat Common Malnutrition Among Seniors


older people in the United States can’t afford nutritious food. About one quarter of low-income adults 65 and older say they’ve reduced the size of their meals or have skipped meals because money.


they didn’t have enough


Senior Meals Jeffrey Bubar might have been among them — his fixed income places him barely above the federal poverty line. Yet he’s well fed.


One day in November, Bubar, 76,


dug happily into a Sloppy Joe lunch with a baked potato and vegetables. He chatted with four other elderly men, also regulars at a congregate meals program in Northampton, Mass. — one of hundreds of such programs across the country. (Another provision of the Older Americans Act.)


ORLANDO, Fla.--After her


stroke, a 95-year-old woman in New York State found she could no longer taste her food. She was also unable to feel hunger, so she didn’t know when she was supposed to eat. As a result, the woman began losing weight, grew weak and wasn’t getting the nutrients she needed.


Enter Meals on Wheels, national home-delivered a meals


program established by the 1965 Older Americans Act. The woman (who asked that her name not be used) began receiving meals at her home five days a week. This, she says, helped her remember to eat regularly. Her weight improved, health.


and so did her Malnutrition like hers is


surprisingly common. Six percent of elders living at home in the United States and in other developed countries are malnourished, according to a 2010 study in the Journal of the American Geriatric Society.


Skyrocketing Levels The level of elder malnutrition


doubles among those in nursing homes, where it is 14 percent, according to the same study.


And malnutrition skyrockets


among elderly populations in rehabilitation facilities and hospitals: Various measures show an astonishing one third to one half of seniors are malnourished upon being admitted to the hospital.


under-recognized


“Malnutrition is a serious and problem


among


older adults,” said Nancy Wellman, a nutritionist and instructor at Tuft University’s Friedman School of Nutrition Science and Policy. She spoke on a panel at the Gerontological Society


of American’s (GSA) 68th


Annual Scientific Meeting in Orlando, Fla., last month.


It’s not a new problem. But growth in the older population, and concerns about healthcare costs, have helped renew efforts by nutritionists and other


advocates to establish


screenings for malnutrition in medical settings, and to improve interventions that can prevent or reverse the issue.


Basically, malnutrition means not


getting enough nutrients for optimal health. In older adults, the causes are complex, experts say. Illness, disability, social isolation, poverty — often a combination of these — can all


contribute to malnutrition. An older person may become malnourished because she has trouble chewing or swallowing.


The medications she


takes may suppress appetite. She may be unable to get to a grocery store. She may live alone, be depressed or simply be uninterested in eating.


It’s important to know, said Connie Bales, a dietician and faculty member at Duke University Medical Center, that obese and overweight seniors can be malnourished, too. Eating


too many calories general doesn’t


necessarily mean you’re getting the right nutrients for maintaining muscle and bone.


“One can be quite malnourished, yet not be skinny,” said Bales, who also spoke one the GSA conference panel.


High Costs and Food Insecurity Whatever the cause, malnutrition leads to further trouble. It increases older adults’ risk of illness, frailty and infection. Malnourished people visit the doctor and are admitted to the hospital more often, have longer hospital


stays and recover from


surgery more slowly. The


association between


malnutrition and hospitalization goes both ways, say Wellman and other experts: The sick are more likely to become malnourished, and the malnourished are more likely to get sick.


Thus, said elder advocate Robert


Blancato, on the panel, improving nutrition among older people is important not just to their well-being and quality of life, but to containing health care costs. The malnourished generate bills of $2,000 to $10,000 higher per hospital stay than others do, according to findings in the Journal of the American Dietetic Association.


journal Clinical Nutrition found a threefold


Another study published in the increase in medical


costs


among the malnourished. (Hospital stays can also cause or worsen elder malnourishment: Older patients often don’t eat well in the hospital, and doctors may prohibit them from eating or drinking in preparation for medical procedures.)


Not surprisingly, financial hardship is a central cause of elder malnutrition.


According to a 2014 AARP Foundation report, nearly 9 million


Bubar — who has no family, lives alone and has no car — walks to the program every weekday. The meals provide him with both companionship and nourishment — sources of health and well-being that would otherwise likely elude him. “I like being with people,” he said.


His fixed income places him


barely above the federal poverty line. Without the meals, food would make a much bigger “dent” in his budget, he says; and the program’s nourishment “helps keep my health up.” It’s a nutritional and social anchor in his otherwise isolated life.


But many eligible seniors


don’t receive such benefits. The AARP report, for example, found that of those elders eligible for the Supplemental Nutrition


Assistance


Program (SNAP), only 13 percent receive the benefit.


It’s an important gap to address, said Lura Barber, director of Hunger Initiatives for the National Council on Aging, and there are many reasons for it. One, she said, is the “huge stigma” attached to food benefits.”


Older people worry, for example,


that by receiving help they’ll take benefits away from children who need it. But, Barber added, “Seniors are also less likely than other age groups to know about the program, about how to apply, and [to know] that they might be eligible.”


Following hospital stays, these programs could also help patients recover from illness or surgery. Yet very few hospital patients


receive


information about nutrition benefits. A recent GSA survey found that


only six percent of hospitalized elderly received information about SNAP. Only three percent of hospitalized older people received


about group meals programs such as the one Bubar benefits from. And merely three percent learned about the availability of delivered meals to home-bound seniors.


Good Nutrition, Better Outcomes Such lack of information


is


another problem worth addressing, Barber says. “There’s a huge gap in how we’re providing vulnerable older adults with help as they move from a healthcare setting” back to their homes. Even those simply “going to a doctor for a regular visit are not learning about [nutrition] programs.”


Rose


nurse and researcher with Drexel University’s College said better


Ann DiMaria-Ghalili, a of


hospital outcomes and reduce hospital readmissions.


nutrition She


continued, “We know that weight loss increases the can


Nursing, improve


information


December 2015


risk of 30-day readmission and that failure to thrive and weight loss are frequent reasons for readmission in surgical patients.”


Nancy Wellman stressed, “If you


can’t eat well, you’re going to end up in a nursing home, or you’re going to end up back in the hospital.”


Last week, Bubar was looking forward to joining his friends at the congregate meals program for Thanksgiving. He’d already checked out the menu: “It’ll be turkey and whipped


potatoes and butternut


squash,” he said. He expected that the program’s


cook would make the pies right there in the kitchen, so Bubar was eagerly anticipating house-made pumpkin pie with whipped cream.


Rethinking Senior Hunger Given mounting


that better nutrition in outcomes—not called both


evidence older


patients and seniors living at home is a cost-effective way to improve health


to mention


quality of life—experts at the recent Gerontological conference


Society of America for several


manageable fixes. “We should be thinking about


nutrition as one of the key aspects of healthy aging, of maintaining our independence, maintaining our quality of life, staying out of nursing homes, and staying out of hospitals,” said Tuft University’s Nance Wellman.


urge individuals, programs, medical


and relatively Interventions:


She and other advocates community professionals


and policymakers to learn about and prioritize


improving health. Nutrition Screenings


Including And nutritional


status and nutrition interventions in patients’ plan of care would promote better outcomes, said Rose Ann Di- Maria-Ghalili of Drexel University.


Wellman noted, “We need to establish systematic intervention


screenings and models” for patients


entering and leaving the hospital. Duke Medical Center’s Connie Bales argued that doctors and nurses could usefully view patients’ nutritional status as a vital sign, as they do blood pressure or temperature: “We know what [a patient’s] pulse rate is, what their respiration rate is,” Bales said. “What about their nutritional status?”


of the National referring


Access To Benefits: Lura Barber Council on Aging


would like to see nurses routinely asking elderly


they’re receiving nutrition benefits, and


them


patients to


meals


whether and


SNAP food-stamps programs where appropriate. Nurses or other staff, she said, could also help older patients fill out applications for benefits before patients leave the hospital.


Eat Well: Wellman also offered


basic advice to older adults: “Bring home more fruits, more vegetables, some low-fat dairy…or full-fat milk if you’re underweight. Bring home prepared or prepackaged food, because it’s more likely that you’ll eat it.” If foods aren’t appealing,


try adding


more spices to enhance taste. If you’re overweight but ill, she said, it’s often better to prioritize eating well over losing weight.


Wellman added that, if possible, seniors should seek out company: “People eat better when they’re with other people.” --Nell Lake


nutrition as an important inexpensive way of


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