CHAMPIONS FOR HEALTH AND WELLNESS: IMPORTANCE OF NUTRITION TO HEALTHY AGING

Transcription

1 CHAMPIONS FOR HEALTH AND WELLNESS: IMPORTANCE OF NUTRITION TO HEALTHY AGING Deborah Cotton Atlanta Regional Commission Area Agency on Aging Board of Directors National Association of Nutrition and Aging Services Programs

2 2 Older Americans Profile The population 65+ has increased from 35.9 million in 2003 to 44.7 million in 2013 and is projected to more than double to 98 million in About 28% of noninstitutionalized older persons live alone. A relatively small number and percentage of the 65+ population in 2013 lived in institutional settings such as nursing homes. Source: U.S. HHS Administration for Community Living

3 3 I. WHAT IS MALNUTRITION? II. WHAT ARE THE CAUSES OF MALNUTRITION? III. HUNGER AND FOOD INSECURITY Malnutrition

4 4 Malnutrition What is malnutrition? Malnutrition means poor nutrition whether - Underweight Overweight Clinical What are the causes of malnutrition? Disease oriented problems acute or chronic illness Functional/Mental Health Limited ability to shop, prepare food Depression Aging Physiology Lifestyle Finances and family structure

5 5 Food Insecurity 2014: 3.0 million Americans experienced food insecurity. Food insecure seniors have a significantly lower intake of vital nutrients in their diets when compared to their food secure counterparts. The number of food insecure seniors is projected to increase by 50% when the youngest of the Baby Boom Generation reaches age 60 in Food insecure seniors were 2.33 times more likely to report fair/poor health status and had higher nutritional risk. Source: Feeding America Hunger Fact Sheet

6 6 I. HEALTHCARE PROFESSIONALS II. ADULTS AND FAMILY CAREGIVERS Public Opinion

7 7 Healthcare Professionals: Physicians Opinion A National Medical Association (NMA) survey polled member physicians on their approach on diagnosing malnutrition. 77% of doctors surveyed have diagnosed malnutrition 81% looked for the loss of muscle mass to assess malnutrition Physicians identified the consequences of malnutrition to be: Delayed surgical recovery, Increased hospital readmission, Increased infection Physicians prescribed or recommended patients to: Visit with a dietitian/dietary modification Oral Nutrition Supplement (ONS)

8 8 Adults and Family Caregivers The Gerontological Society of America and National Academy on an Aging Society administered a survey to gain perspective on a adults and family caregiver s views on malnutrition. Key Finding: Americans understand that identifying and treating malnutrition is important for older adult health and would like more information about the problem.

9 9 Adults and Family Caregivers Adults and family caregivers recognize the numerous causes of malnutrition: 87% Not always being able to physically shop, cook, and/or feed oneself 85% Having an illness or condition that makes you change the kind or amount of food you eat 75% Difficulty chewing and/or swallowing 61% Unintended gain or loss of 10 pounds Family caregivers rated the percentage of older adults they thought are malnourished: Percentage of older adults thought to be malnourished 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 20% or less 21% to 40% 41% to 60% 61% to 80% Respondents Source: GSANAAS

10 10 I. HEALTH OUTCOMES OF MALNUTRITION II. HEALTHCARE COSTS III. NUTRITIONAL INTERVENTIONS Outcomes and Economics of Malnutrition

11 Health Outcomes of Malnourished Older Adults 11 Increased risk of admission into hospital Increased complications and dependency Increased length of stay in hospital Increased cost of care Increased risk of being re-admitted post discharge from the hospital Source: Advancing Clinical Nutrition

12 Malnutrition Remains a Common and Costly Healthcare Problem 12 It is critical to quickly identify at-risk patients who can benefit from nutrition intervention

13 Economic Burden Due to Disease Associated Malnutrition (DAM) 13 Disease-associated malnutrition has been identified as a prevalent condition--particularly for the elderly-- that has often been overlooked in the US healthcare system. States with the highest economic burden: $1,200,000,000 $1,000,000,000 State Burden $800,000,000 $600,000,000 $400,000,000 $200,000,000 $0 California New York Texas Florida States

14 Loss of lean body mass impacts 1/3 of age 60+ and 1/2 of age 80+; illness & injury further accelerate muscle loss Loss of lean body mass, strength, and/or functionality (also know as sarcopenia) can reduce the body s ability to heal, fight infection and disease, and increases risk of falls, fractures, and death 14 AVG LOSS OF LEAN BODY MASS WITH AGE 1-4 AND CONSEQUENCES CAN BE DEBILITATING 8% loss Per decade from 40 to 70 15% loss Per decade after age 70 References: 1. Baier S et al. JPEN J Parenter Enteral Nutr. 2009;33(1): Flakoll P et al. Nutrition. 2004;20(5): Grimby G et al. Acta Physiol Scand. 1982;115(1): Janssen I et al. J Appl Physiol. 2000;89(1):81-88.

15 15 Clinical Research Recent randomized clinical study, one of the largest nutritional trials ever. Study showed use of a high protein oral nutrition supplement with HMB (helps build muscle) effective for malnutrition. Reduced mortality rate by 50% 90 days post discharge: Source:JPEN J Parenter Enteral Nutr. 2016;40(1): Nicolaas E. Deutz, MD, PhD; Eric M. Matheson, MD; Laura E. Matarese, PhD, RD; Menghua Luo, MD, PhD; Jeffrey Nelson, PhD; Maria Geraldine E. Baggs, PhD; Refaat Hegazi, MD, PhD; Kelly A. Tappenden, PhD, RD5; Thomas Ziegler, MD

16 16 Key Points on Healthcare Costs Reduction of health care costs is key to reducing overall burden on Medicare. Evidence shows that early malnutrition screening and nutrition intervention in hospitalized older adult patients is associated with improved clinical outcomes and decreased health care costs. Nutritional interventions provide inexpensive, evidencebased approach to meeting Affordable Care Act quality targets.

17 17 I. PUBLIC POLICY ACTION - FEDERAL AND STATE II. EDUCATION AND AWARENESS PROGRAMS III. TESTING, SCREENING, AND QUALITY MEASURES Malnutrition Efforts

18 18 Older Americans Act Congress passed the Older Americans Act (OAA) in 1965 in response to concern by policymakers about a lack of community social services for older persons. In 2014, 3 million people received OAA Title III services (Meals and Nutrition Services) FY2014 s OAA federal appropriation was $1.88 billion The Act is up for reauthorization to continue funding for programs that support older Americans. Senator Alexander (TN) was the lead sponsor of the Older Americans Act Reauthorization of 2015 with 26 cosponsors from WA, NC, VT, UT, GA, AK, ME, DE, IA, HI, NH, FL, MT, VA, MN, KS, OR, IL, NY, CO, and MO. Passed Senate on July 16, 2015

19 19 State Malnutrition Policy Actions Malnutrition policies are needed to promote awareness and create a sense of urgency Efforts in a number of states have begun: Indiana, Illinois, Louisiana, and Ohio introduced Malnutrition Resolutions to call attention to the malnourished constituents. Florida, Georgia, Louisiana, and Texas introduced Malnutrition Awareness Week resolutions to increase awareness. Massachusetts and Ohio have introduced Malnutrition Prevention Commissions to document and identify state level solutions to eradicate malnutrition.

20 Education and Awareness Programs: National Council on Aging (NCOA) NCOA has a toolkit in English and Spanish that helps identify and treat malnutrition in older adults and includes resources on community meals programs ncoa.org\nutritiontools 20

21 Malnutrition Quality Improvement Initiative Offers a Solution to Enhance Quality of Malnutrition Care 21 Malnutrition Care Workflow Screening Nutrition screening using a validated tool for all patients age 65 years and older with a medical or surgical hospital admission Assessment Nutrition assessment using a validated tool for all patients identified as malnourished or atrisk for malnutrition Diagnosis Documentation of nutrition diagnosis for all patients identified as malnourished or atrisk for malnutrition Treatment Establishment and implementation of a nutrition treatment plan, including intervention and monitoring, for all patients identified as malnourished or atrisk for malnutrition

22 22 Moving Forward Education and Awareness Programs Educate constituents including caregivers with a malnutrition awareness day or support launch of a malnutrition prevention campaign Include in medical schools curriculum and health professionals education to implement malnutrition protocols Quality Initiatives Include malnutrition screening and intervention in healthcare quality initiatives and care models, especially programs focused on readmission reduction, care transitions and accountable care Document the state burden associated with malnutrition Establish state-level goals and implement solutions that target malnutrition Incorporate nutritional supplementation in treatment plans

23 23 Moving Forward Federal Health Goals Establish malnutrition as a key indicator of health for older adults and add malnutrition to the Healthy People 2020 goal for nutrition and weight status

24 Questions?? 24