Health Issues Facing Older Americans: Importance of Nutrition to Healthy Aging

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1 Health Issues Facing Older Americans: Importance of Nutrition to Healthy Aging Robert B. Blancato Executive Director of the National Association of Nutrition and Aging Services Programs, NANASP N4A Conference July 14,

2 Health stats Share of 65+ living in nursing homes dropped from 4.5% in 2000 to 3.1% in 2010 Medicaid funding for home and community based care has increased from 13% in 1990 to 43% in Nutrition issues present challenges to older adults. Rising rates of hunger, food insecurity and malnutrition are cause for increased concern 2

3 Nutrition as a Vital Sign Over 20 years ago, nutrition was proposed as a vital sign for older adults but nutrition is still not a routine part of healthcare Dwyer J. (1993). A vital sign: Progress and prospects in nutrition screening of older Americans. Aging. Milano. 5(2 Suppl 1):

4 A Hidden Epidemic of Malnutrition Today, there is a focus on Poor Nutrition which most people define as Overweight & Obesity Food Insecurity Hunger Malnutrition but a hidden epidemic of undernutrition and malnutrition must also be addressed 4

5 What is Malnutrition? Malnutrition simply means poor nutrition. It can be related to: - An excessive or imbalanced diet - Clinical conditions that impair the body s absorption or use of foods - A diet that lacks essential nutrients It can look like this Or it can look like this Aging is a risk factor for malnutrition 5

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7 Policymaker Awareness of Malnutrition Policymakers have also started realizing the impact of malnutrition in America and have begun to promote awareness 2014 Malnutrition Resolutions: IN HR 24, IL HR 418, LA SR41, OH HR Malnutrition Awareness Week Resolutions FL HR 550, GA SR 254, LA HR 87, TX HR 1419 Resolution on Malnutrition 7

8 The Economic Impact of Malnutrition 300% The increase in healthcare costs that can be attributed to poor nutrition status 21.6% The reduction in hospital costs for patients who used Oral Nutrition Supplements $157 Billion The amount of money that disease-associated malnutrition costs the U.S. each year Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate mode analysis. Clin Nutr. 2003;22(3): Amaral TF, et al. The economic impact of disease related malnutrition at hospital admission. Clin Nutr. 2007;26(6): Snider, et al. Economic Burden of Community-Based Disease-Associated malnurition in the United States. JPEN Philipson, et al. Impact of Oral Nutritional Supplementation on Hospital Outcomes. Am J Manag Care. 2013; 19(2):121-8.

9 In this Increasingly Quality- and Value-Centered Market, Malnutrition Has a Significant Impact MALNUTRITION IS ASSOCIATED WITH A HIGH BURDEN OF DISEASE, INCREASED COMORBIDITIES, AND SIGNIFICANT ECONOMIC COSTS 1 in 3 patients are malnourished upon admission 1,2 31 percent of patients experience declines in nutrition status during their hospital stay 3 Malnutrition-associated outcomes include depression of the immune system, impaired wound healing, and muscle wasting 4 Malnutrition increases length of stay by 4 to 6 days 4 Malnutrition increases costs by up to 300 percent 5 1 Coats KG et al. Hospital-associated malnutrition (a reevaluation 12 years later). J Am Diet Assoc. 1993; 93: Giner M et al. In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists.nutrition 1996; 12: Braunschweig C et al. Impact of declines in nutritional status on outcomes in adult patients hospitalized for more than 7 days. J Am Diet Assoc. 2000; 100: Barker et al., Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System. J Environ Res Public Health. Feb 2011; 8(2): Isabel TD and Correia M. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clinical Nutrition. 2003;22(3):

10 What is a Solution? Changing Healthcare Practice and Accountability for Malnutrition The Alliance to Advance Patient Nutrition (The Alliance) created this model for a multidisciplinary approach to addressing malnutrition in hospitals. The care model emphasizes six multidisciplinary actions. Source: The Alliance to Advance Patient Nutrition. 10

11 Malnutrition Quality Improvement Initiative Offers a Solution to Enhance Quality of Malnutrition Care 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 11

12 What is a Solution? Older Americans Act A critical program that has helped older adults age 60+ remain at home and in community for 50 years Nutrition (congregate, Meals on Wheels) is largest program in the Act, provides meals and nutrition education which should include more screening. Money flows to states and locally-based Area Agencies on Aging 4 years late in being reauthorized New bi-partisan bill S 192 passed Senate HELP, on way to Senate floor Also supports family caregivers who are key to helping prevent malnutrition Program saves Medicaid and Medicare, but need the data to prove it Long Term Care as A Solution Long term care biggest unfunded liability of the boomer generation Lacks a national policy, piecemeal to date CLASS act was an attempt that failed Rebalancing of federal dollars toward home and community-based care a good start Must address access, cost, financing, choices, outcomes Nutrition key to home and community based services 12

13 What is a Solution? Other Policy Solutions Affordable Care Act Emphasize malnutrition screening and intervention in care transitions grants and other relevant grants and or projects Make future grants or projects contingent on inclusion of malnutrition screening and intervention in care delivery models, such as integrating nutrition into the Coleman Care Transitions Intervention Expand Essential Health Benefits to include malnutrition screening and therapy Hospital Readmissions Include malnutrition screening and interventions in state healthcare quality initiatives and care models, especially those related to hospital readmissions and healthcare-acquired conditions Include malnutrition screening and intervention in electronic health record templates visible to all healthcare professionals 13

14 What is a Solution? Other Policy Solutions Federal and State Health Goals Add malnutrition into the Healthy People 2020 goal for nutrition and weight status and as a key indicator of older adult health Address increased protein requirements of older adults and need for increased protein Dietary Reference Intake for this group Expand Medicare-covered medical nutrition therapy to include diabetes and other conditions Address malnutrition in state obesity plans 14

15 What is a Solution? Other Federal Opportunities Senate Finance Committee Chronic Care Management: working to include nutrition 21 st Century Cures: House Energy and Commerce Committee Does not include nutrition, must work to have this included in final version. Managed Care Rules from CMS Does not include nutrition as a part Elder Justice as A Solution Elder abuse, neglect and exploitation growing threat to health of older adults 1 in 10 persons over age 60 are victims Those victims of elder abuse lose at least $3 billion a year. Self neglect on the rise malnutrition can be a factor Federal response has been minimal to date EJA passed as part of ACA. Funding remains elusive 15

16 White House Conference on Aging Held yesterday July 13, 2015, 6 th in history. Proud to attend, 4 th one of my career 2 of the 4 priority topics are Healthy Aging and Long-Term Services and Supports Both are relevant to nutrition. NANASP and others have worked to make nutrition a key indicator and combating malnutrition as a goal For more information, visit the website: 16

17 White House Conference on Aging NANASP working with Abbott submitted responses to the policy papers issued by the WHCOA on healthy aging and LTSS. Hosted a listening session at the NANASP annual conference in June Submitted a petition on need to recognize malnutrition by the WHCOA 17

18 White House Conference on Aging The WHCOA hosted a National Listening Session on nutrition Conducted by NANASP, AND and Abbott Nutrition The archived presentation is available at: ANHI.org 18

19 At the conference 19

20 White House Conference Now that the the WHCOA has been held focus is on its final work product. Follow up advocacy on malnutrition will be needed. A new national malnutrition coalition will be forming to do follow up advocacy on the solutions and issues presented today 20

21 Why the time is NOW! 2015 is 80 th Anniversary of Social Security 50 th Anniversary of Medicare and Medicaid 50 th Anniversary of the Older Americans Act The 6th White House Conference on Aging 5 th Anniversary the Affordable Care Act This makes 2015 the opportune time to assure that these policies are aligned with current healthcare priorities, which include a focus on: Preventative care Quality of Care Cost Containment And malnutrition screening and intervention support all of these goals Source: Centers for Disease Control and Prevention. 21

22 References Amaral TF, et al. The economic impact of disease related malnutrition at hospital admission. Clin Nutr. 2007;26(6): Braunschweig C, Gomez S, Sheean PM. Impact of declines in nutritional status on outcomes in adult patients hospitalized for more than 7 days. J Am Diet Assoc. 2000;100(11): Castaneda C, Charnley JM, Evans WJ, et al. Elderly women accommodate to a low-protein diet with losses of body cell mass, muscle function, and immune response. Am J Clin Nutr. 1995;62: Centers for Disease Control and Prevention Social Ecological Model. Challa S, Sharkey JR, Chen M, et al. Association of resident, facility and geographic characteristics with chronic undernutrition in a nationally represented sample of older residents in US nursing homes. J Nutr Hlth & Aging. 2007;11(2): Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate mode analysis. Clin Nutr. 2003;22(3): Forster S, Gariballa S. Age as a determinant of nutritional status: a cross sectional study. Nutr J. 2005;4(28) Fry DE,et al. Arch Surg. 2010;145: Hamilton C, Boyce VJ. Addressing malnutrition in hospitalized adults. JPEN. 2013;37(6): Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360: [Erratum, N Engl J Med. 2011;364:1582] Kaiser MJ, Bauer JM, Ramsch C, et al. Frequency of malnutrition in older adults: A multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010;58(9): Kamel HK. Sarcopenia and aging. Nutr Rev. 2003;61(5): Koren-Hakim T, Weiss A, Hershkovitz A, et al. The relationship between nutritional status of hip fracture operated elderly patients and their functioning, co-morbidity and outcome. Clin Nutr. 2013;31(6): Kortebein P, Ferrando A, Lombeida J, et al: Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA 2007;297: Krumholz HM. Post-hospital syndrome an acquired, transient condition of generalized risk. N Engl J Med. 2013;368: Landi F, Liperoti R, Russo A. Sarcopenia as a risk factor for falls in elderly individuals: results from the ilsirente study. Clin Nutr. 2012;31(5): Lee MR, Berthelot ER. Community covariates of malnutrition based mortality among older adults. Ann Epidemiol May;20(5): doi: /j.annepidem Paddon-Jones, D. (2009, October). Lean Body Mass Loss With Age. Abbott Nutrition Research Conference: Selected Summaries The Role of Nutrition in Accretion, Retention, and Recovery of Lean Body Mass. Paddon-Jones D, Sheffield-Moore M, Urban RJ, et al: Essential amino acid and carbohydrate supplementation ameliorates muscle protein loss in humans during 28 days bedrest. J Clin Endocrinol Metab 2004;89: Pereira GF, Bulik CM, Weaver MA, et al. Malnutrition among cognitively intact, noncritically ill older adults in the emergency department. Ann Emerg Med In press corrected proof. doi: /j.annemergmed Philipson, et al. Impact of Oral Nutritional Supplementation on Hospital Outcomes. Am J Manag Care. 2013; 19(2): Roubenoff, R. (2004). Sarcopenic Obesity: The Confluence of Two Epidemics. Obesity Research, 12(6), Snider, et al. Economic Burden of Community-Based Disease-Associated malnutrition in the United States. JPEN Sullivan DH, Bopp MM, Roberson PK. Protein-energy undernutrition and life-threatening complications among the hospitalized elderly. J Gen Intern Med. 2002;17: Von Haehling S. Morley JE, Anker SD. An overview of sarcopenia: facts and numbers on prevalence and clinical impact. J Cachexia Sarcopenia Muscle. 2010;1(2):

23 Resource Page National Association of Nutrition and Aging Services Programs, NANASP: The Alliance to Advance Patient Nutrition: White House Conference on Aging: What s Hot? Aging Policy: Preventing, Treating Malnutrition to Improve Health and Reduce Costs Newsletter download: Congressional Black Caucus Institute Annual Report: The Legislator, Publication of the National Black Caucus of State Legislators: NBCSL Resolution on Malnutrition: NOBEL Resolution on Malnutrition: Archived White House Conference on Aging National Listening Session, Nutrition = Solutions to Healthy Aging and Long-Term Services and Supports: ANHI.org Alzheimer s Association Facts and Figures 2014 Report: Training Doctors for Prevention-Oriented Care: For more information: rblancato@matzblancato.com 23