¡Descarga The Economic and Health Consequences of Malnutrition in Hospitalized Older Adults y más Monografías, Ensayos en PDF de Nutrición solo en Docsity! MQii MALNUTRITION QUALITY IMPROVEMENT INITIATIVE Briefing: The Value of Quality Malnutrition Care Burden of Malnutrition in Hospitalized Adults Malnutrition is a leading cause of morbidity and mortality, especially among older adults. Evidence suggests that 20% to 50% of all patients are at risk for or are malnourished at the time of hospital admission! and yet a recent study shows that only 7% of patients are typically diagnosed with malnutrition during their hospital stay, leading to millions of cases left undiagnosed and potentially untreated.2Up to 31% of these malnourished patients and 38% of well-nourished patients experience nutritional decline during their hospital stay.3 Significantly, many patients continue to lose weight after discharge, and patients with weight loss are at increased risk for readmission,* with data demonstrating that malnourished hospitalized adults have 54% higher likelihood of hospital 30-day readmissions than those who are well nourished.S Malnutrition is the inadequate intake of nutrients, particularly protein, over time and may contribute to chronic illness and acute disease or illness and infection. People can be underweight or overweight (obese) and malnourished when they lack sufficient nutrients needed to promote healing, rehabilitation, and reduce the risk of medical complications. Malnutrition and weight loss can also contribute to sarcopenia, the age-associated loss of skeletal muscle mass and function, which can impact recovery, mobility, and independence.$ Contributing Factors that Lead to Malnutrition among Older Adults There are many contributing factors that can lead to malnutrition among older adults (see figure 1). Chronic diseases such as cancer, stroke, diabetes, gastrointestinal, pulmonary, and heart disease and their treatments can result in changes in nutrient intake and ability to use nutrients, which can lead to malnutrition.?8 Disease-associated malnutrition is often multifactorial, including inflammatory responses which can increase metabolic demand, decreased appetite, gastrointestinal problems, and difficulty chewing and swallowing, leading to decreased nutrient intake that can diminish immune response and wound healing, and increased infection rates.? Such changes can increase risks for functional disability, frailty, and falling.” Hospitalized patients are vulnerable to nutritional decline for many reasons, including dietary restrictions because of tests, treatments, and medical conditions, as well as poor appetite and gastrointestinal problems. Malnourished surgical patients are two to three times more likely to experience post-operative complications and increased mortality than their more well-nourished counterparts.1% One study noted that one-fifth of hospitalized patients aged 65+ had an average nutrient intake of less than 50% of their calculated maintenance energy requirements. Nutritional status is also considered an important factor in the recently identified “post-hospital syndrome,” which can result from the stress of hospitalization. 11 Figure 1: Contributing Factors that Lead to Malnutrition among Older Adults12 Function- Associated Risk Factors Disease- Associated Risk Factors Social € Mental Health Risk. Factors Hunger 8 Food- Insecurity Risk Factors Malnutrition in Older Adults The Cost of Malnutrition Patients who are malnourished while in the hospital have a greater risk of complications, falls, pressure ulcers, infections, readmissions, and length of stay, which is associated with up to a 300% increase in costs.13 A 2016 analysis of U.S. hospital discharges reported that average hospital costs for all non- neonatal and non-maternal hospitals stays were $12,500, while patients diagnosed with malnutrition had hospital costs averaging up to $25,200 depending on the type of malnutrition indicated.2 A recent study of over 1,000 patients across 18 hospitals found that costs for patients with malnutrition were between 31% and 34% higher than well-nourished patients with similar patient characteristics. 14 When looking at costs of each readmission associated with malnutrition, average cost per readmission is $16,900 per patient for those with protein-calorie malnutrition and $17,900 per patient for those with post- surgery non-absorption. This is 26 and 34% higher respectively than readmission costs for patients without malnutrition.5
