Malnutrition Health Impacts and Healthcare Costs

AGENDA Malnutrition Health Impacts and Healthcare Costs Working with Hospital Systems Stepping Up Your Nutrition Curriculum Resources for Developing Your Plan

Malnutrition Health Impacts and Healthcare Costs

Health and Malnutrition Falls: Loss of muscle mass and dizziness from malnutrition can increase the risk of falling among older adults Chronic Disease: Older adults with chronic illness are at greater risk for poor nutrition; an unhealthy, inadequate diet can contribute to heart disease, type 2 diabetes, osteoporosis, high blood pressure, high cholesterol, and some cancers

Malnutrition Defined What is malnutrition? Malnutrition is the inadequate intake of nutrients, particularly protein, over time and may contribute to chronic illness and acute disease or illness and infection. Two or More of the Following: Weight loss Insufficient food intake Body fat Muscle Reduced handgrip Fluid Source: White JV, et al. J Parenter Enter Nutr. 2012;36(3):275-283. What is food insecurity? Food insecurity is the state of being without reliable access to a sufficient quantity of affordable, nutritious food.

Impacts of Malnutrition Frailty Disability Loss of independence Increased risk for falls Increased risk for infections Delayed wound healing Increased medical complications for other diseases Hospital readmissions Increased length of stay Decreased effectiveness of medical treatments

Malnutrition: Common & Costly Source: National Blueprint: Achieving Quality Malnutrition Care for Older Adults, 2017.

Malnutrition: Common & Costly $157 Billion Cost of Disease-associated malnutrition (DAM) annually $51.3 Billion The total annual burden from DAM borne by the older adult population Source: Snider JT, et al. JPEN J Parenter Enteral Nutr. 2014;38(2 Suppl):77S-85S.

Research: Malnutrition, Falls and Community-Dwelling Older Adults Characteristics of Fallers vs Non-Fallers Care Dependency Malnutrition Undesired Weight loss (6kg/6 mo or 3kg/1 mo) Meijers, JMM, et all. Predicting Falls in Elderly Receiving Home Care: The Role of Malnutrition and Impaired Mobility. J Nutr Health Aging. 16(7): 654-658, 2012. Malnutrition & Frailty 2/3 of older adults with malnutrition were physically frail 1 of 10 frail older adults were malnourished Verlaan, S. et al. High Prevalence of Physical Frailty Among Community-Dwelling Malnourished Older Adults A Systematic Review and Meta-Analysis. JAMDA 1-9, 2017. Malnutrition Risk Falls Risk Score Need help with Shopping Lower intake protein foods Lives Alone Self rated health: poor Life Satisfaction Westergren, A, et cal. Malnutrition and Risk of Falling Among Elderly Without Home-Help Service A Cross Sectional Study. J Nutr Health Aging, 18(10): 905-911, 2014. Risk of Malnutrition (Screening Tool) 5 minute screen Risk for Falls over next 3 years Tsai, AC, Lai, MY. Mini Nutritional Assessment and short-form Mini Nutritional Assessment can Predict the Future Risk of Falling in Older Adults Results of a National Cohort Study. Clin Nutr 33:844-849, 2014.

Effects of Lean Body Mass Loss 10% 20% 30% 40% Impaired Immunity (infections) Decreased Healing Pressure Ulcers At Risk of Death (pneumonia)

Working with Hospital Systems

MAC, INC. Selected by ACL for Malnutrition Pilot Define Referral process from clinical setting to community provider Determine capability to share plan with clinical team Review the data capture process and reporting requirements Test the referral and data capture process with a set of five (5) participants Refine the process based on test results Expand the project to a larger population of participants

Onsite MAP (MD Access Point) ADRC Assessment MAC AAA in-hospital RNs work with discharge nurses to identify malnutrition risk and other potential services Assessment based on identified malnutrition risk at hospital intake Triggers application for Medicaid Community Choice Waiver Discharge planners and AAA RNs review appropriate services AAA Registered Dietitian receives copy of discharge plan

Onsite MAP (MD Access Point) ADRC Assessment Community Choice resources can covers home-delivered meals Approximately 3-weeks for approval Interim strategies: Utilize other services/resources to pick up and deliver food bank/food pantry food to be delivered by individuals doing additional in-home visits AAA provides in-home assessment of additional needs/resources Work with patient s primary care provider to document malnutrition risk and intervention

Onsite MAP (MD Access Point) ADRC Assessment Identify additional opportunities to support home-delivered meals and malnutrition interventions such as Medicare Complex Care Management $$ to support AAA malnutrition intervention Document care plan, services provided and change in nutrition status

Stepping Up Your Nutrition: Recruitment Session Zero for Stepping On Falls Prevention Evidence-Based Healthy Aging Program

Partnership to Develop Malnutrition Community Assessment, Education and Behavioral Intervention MAC, Inc. Living Well Center of Excellence Executive Director Registered Dietitian State Evidence-Based Program Coordinator Maryland Department of Aging Registered Dietitian Abbott Nutrition Registered Dietitians Marketing Expertise

Stepping Up Your Nutrition Curriculum Goal: Participants will understand the importance of balanced nutrition for the prevention of falls and be able to identify the key warning signs of poor nutrition. Key Messages: How nutrition status, and muscle strength are linked to falls risk How exercise and protein are key to maintaining strong muscles

Stepping Up Your Nutrition Curriculum Key Messages, continued: The importance of protein and fluids for older adult nutrition Identification of personal nutrition risk status Setting personal goals to improve nutritional status and muscle health

Stepping Up Your Nutrition Agenda How Nutrition Affects Falls Why Muscle Matters Nutrients to Know: Protein and Fluid Your Personal Nutrition Risk Score Pre-/Post Screen II and Food Insecurity Self-Assessment (week 1 and end of week 7) Grip Strength measurement (week 1 and end of week 7); potential follow-up at 3 months Action Planning

Activity: Know Your Protein

ACTION PLAN Think about making a weekly action plan about something you want to do to Improve your nutritional health. Here are some ideas for an action plan to Step Up Your Nutrition: Weigh myself weekly Drink more liquids during the day Drink more water Eat more protein at mealtime Eat protein snacks Eat more vegetables Eat more fruits Eat a meal with a friend Have lunch at the senior center Drink a liquid nutritional supplement Drink/eat more dairy foods Find someone to food shop for me Eat a variety of foods at every meal Eat at least 3 meals a day Talk with my friends or family about my nutrition concerns Talk with my doctor or a dietitian about my nutrition concerns Answer these questions: 1. What you are going to do? 2. How much you are going to do? 3. When you are going to do it? 4. How many days a week you are going to do it?

Resources for Developing Your Plan

National Council on Aging Survey If your organization is not getting hospital-based referrals, do you think your organization would like to receive them? Yes 47% No 3% N/A 49% 0% 10% 20% 30% 40% 50% 60% Answered: 352 Skipped: 19 To help close this gap, we created the Community Malnutrition Resource Hub.

COMMUNITY MALNUTRITION RESOURCE HUB Build A Knowledge Base Integrated Approach Across Professional Roles Existing Organizations and Programs Assessments and Screening Tools https://www.ncoa.org/center-for-healthy-aging/resourcehub/

AAA Executive Director RECOGNIZE RELEVANCE Community Malnutrition Resource Hub Knowledge Base Estimate existing healthcare costs of malnutrition for individuals in your community. FOSTER ORGANIZATIONAL COMMITMENT Establish cross-departmental meetings to develop healthcare-community linkages. Review existing resources and research best practices. Brainstorm ideas with your team given your existing resources. Create a malnutrition coalition or workgroup within an existing council. BECOME INVOLVED Initiate meetings with hospital administration. Joint proposals for funding. Inform stakeholders including Board. Identify organizations bearing the cost of malnutrition and falls. Review alternative payment options for providing new or existing services. Start small and develop solid delivery systems and partnerships. Team up with other organizations which address causes of malnutrition.

CASE MANAGER SCREEN Malnutrition Screen Falls Screen Frailty Screen Depression Screen Benefits Checkup ADDRESS ROOT CAUSES Enroll in financial supports Assist with securing insurance Refer to Behavioral Health, caregiver support, Physician, Community Health Worker SUPPORT CARE PLAN Enroll in social supports Refer to meal programs Identify insurance and program eligibility options Refer to EB programs Transportation COMMUNICATE PROGRESS Report progress and service delivery to healthcare provider Client goals Regular follow-up for high risk clients Assist with hospital messages

Senior Nutrition Program Home Delivered Meals & Safety Checks Group Dining Nutrition Education Nutrition Counseling Person Centered Assistance Medicare/Medicaid Eligibility & Information SNAP, financial supports Options Counseling Health Promotion Disease Prevention Falls Prevention, Healthy Eating Chronic Disease Self Management Physical Activity Programs Health Screenings & Immunizations

Additional Malnutrition Resources Community/Non-Clinical Resources DefeatMalnutrition.Today Academy of Nutrition and Dietetics http://www.eatright.org/resource/food/nutrition/healthyeating/what-is-malnutrition Administration for Community Living Malnutrition Issue Brief http://nutritionandaging.org/wpcontent/uploads/2017/03/malnutrition-issue-brief-final-3-2017.pdf National Resource Center on Nutrition and Aging malnutrition information http://nutritionandaging.org/?s=malnutrition Malnutrition Awareness Week, September 18-22, 2017 www.nutritioncare.org/maw/ Clinical Resources Malnutrition Quality Indicators Initiative http://mqii.defeatmalnutrition.today/mqii-toolkit.html American Society for Parenteral and Enteral Nutrition https://www.nutritioncare.org/guidelines_and_clinical_resources/ Toolkits/Malnutrition_Toolkit/ Alliance to Advance Patient Nutrition (Academy of Nutrition and Dietetics, Academy of Medical-Surgical Nurses, Society for Hospital Medicine, Abbott Nutrition). http://malnutrition.com/

Questions? Contacts: Leigh Ann Eagle, Executive Director, Living Well Center of Excellence, MAC, Inc. lae2@macinc.org Sue Lachenmayr, Program Director,, Living Well Center of Excellence, MAC, Inc. sl1@macinc.org Judy Simon, Nutrition and Health Promotion Programs Manager, Maryland Department of Aging. Judy.simon@Maryland.gov