It is estimated that at least one-third of patients in
developed countries such as the United States are malnourished upon admission
to the hospital. According to The Malnutrition Quality Collaborative’s National Blueprint: Achieving Quality Malnutrition
Care for Older AdultsUp to 1 out of 2 older adults (>65
years old) are at risk for malnutrition.
If left untreated, two-thirds of those malnourished patients
may experience adverse outcomes including suppression of the immune system,
impaired wound healing, muscle wasting, longer lengths of hospital stay and
a team approach that includes all health care providers, patients and their
families. In the hospital, patients are required to have a nutrition screening
conducted within 24 hours of admission by nursing staff. A consult is sent to
the dietitian if nutrition concerns are identified. The Registered Dietitian
sees the patient and assesses their needs. Standard malnutrition characteristics
are used as set forth by The Academy of Nutrition & Dietetics (AND) and
A.S.P.E.N. guidelines to identify malnutrition.
“Nutrition concerns may include unplanned weight loss, decreased appetite or
food intake, difficulty chewing or swallowing, chronic non-healing wounds, or
need for tube feeding, IV nutrition or
nutritional supplements in order to meet
patient’s needs”, says Bethesda North Hospital Registered Dietitian Karolin
Saweres, RDN, LD.
Academy of Nutrition and Dietetics (AND) and the American Society for Enteral
and Parenteral Nutrition (ASPEN) require two out of six criteria (decreased
energy intake, weight loss, body fat loss, muscle mass wasting, fluid/edema,
hand grip strength) to support a diagnosis of malnutrition.
Protein (albumin, pre-albumin, and transferrin) labs are no longer supported to
diagnose malnutrition as these are more indicative of inflammation.
If malnutrition is identified, Saweres works with them to develop
an individualized nutrition care plan. She works on increasing actual food
consumption. A nutritional supplement is often needed to accomplish this. The
nutrition care plan is a continuous process. Positive or negative outcomes are monitored
and revised as needed.
Steps to Treating
Saweres recommends the following:
dense, high protein foods
nutritional supplements (including liquid nutritional supplements, protein bars
or homemade shakes)
family to visit during meal times to help encourage or feed the patient
nutrition programs such as home-delivered meals
up with an outpatient dietitian to evaluate treatment plan
“Malnutrition can be prevented and is treatable. Malnutrition
is common, especially in an acute care setting, but is frequently unrecognized.
Early detection is key,” Saweres adds.
Karolin Saweres, RDN,
LD is a Clinical Dietitian with special interest in malnutrition. She practices
with TriHealth and sees inpatients at Bethesda North Hospital. She also sees
patients at her private practice, My Nutrition & Me. She has 10+ years of