New Tool to Address Quiet Epidemic of Malnutrition in Older Adults

3 min
January 10, 2022

SAN DIEGO, CA – JANUARY 10, 2022 — Research teams from West Health Institute, a nonpartisan, nonprofit organization dedicated to lowering healthcare costs and improving aging, and the University of North Carolina at Chapel Hill have developed a timely and easy-to-use new assessment program to diagnose and address a lesser-known epidemic among older Americans — malnutrition.

Despite affecting an estimated 7.3 million older adults, malnutrition is an under-recognized and under-reported problem. It is often challenging to identify malnutrition in older adults because the symptoms are subtle and can occur in individuals at any weight. Older adults are also more susceptible to malnutrition because they are more likely to suffer from chronic conditions that can impact appetite, make eating difficult, change metabolism, or require dietary restrictions.

The guide, A Practical Guide: Creating a Screening & Referral Program to Address Malnutrition, provides medical sites with the insights and tools to prepare, implement, and evaluate a screening and referral program to address patient malnutrition and food insecurity.

“Food insecurity and related malnutrition can have dire effects on a patient’s immune system – complicating treatment for other diseases – but the condition often isn’t properly treated because it’s rarely obvious at first sight,” said Dr. Zia Agha, West Health’s Chief Medical Officer. “In an effort to provide the best possible care to older adults, it’s critical health systems adopt effective and efficient screenings to identify at-risk patients and ultimately improve health outcomes.”

“The guide presents modest actionable steps that can address this long-standing challenge plaguing seniors,” said co-author Dr. Tim Platts-Mills, formerly of UNC-Chapel Hill. “There is no reason a medical facility can’t read this guide and start their program today. Some big problems have simple solutions that can produce large effects if you know what to look for.”

While the USDA has an 18-item assessment for adult food security which asks about food insecurity worry, experience, ability to eat balanced meals, and resource constraints, the time necessary to complete a lengthy assessment can be a considerable burden in emergency care settings where time and resources are already limited.  

In contrast, the West Health Institute-UNC guide identifies practical two-question tools that require less than a minute to complete but tests for the signs of malnutrition nearly as well as the USDA questionnaire. Studies have confirmed that a brief set of questions can efficiently identify food insecure patients or those at risk for malnutrition. By asking patients to respond to yes-or-no food security questions or true-false-sometimes statements about food and money, medical staff can use this guide to identify an underlying nutrition problem with more than 80 percent accuracy.

The need for this tool has exploded in the wake of the COVID-19 pandemic. Prior to the pandemic, more than 35 million Americans struggled with hunger. That number grew to more than 50 million Americans (1 in 6) suspected of being food and nutrition insecure in 2020. 

The actionable steps laid out in this guide can serve as a starting point to finding a lasting remedy by leveraging the resources within our emergency departments. The guide also includes information on staff training, tested screening questions, and tips on evaluating and sustaining programs in fast-paced emergency care settings that get patients in contact with the help they need. The resource expands upon a previous toolkit designed to assist medical staff in acute care settings, including emergency departments and urgent care clinics.


About West Health

Solely funded by philanthropists Gary and Mary West, West Health is a family of nonprofit and nonpartisan organizations including the Gary and Mary West Foundation, Gary and Mary West Health Institute in San Diego, and the Gary and Mary West Health Policy Center in Washington, D.C. West Health is dedicated to lowering healthcare costs to enable seniors to successfully age in place with access to high-quality, affordable health and support services that preserve and protect their dignity, quality of life, and independence. Learn more at and follow @WestHealth.


About UNC School of Medicine 
The UNC School of Medicine (SOM) is the state’s largest medical school, graduating approximately 180 new physicians each year. It is consistently ranked among the top medical schools in the US, including third overall for primary care by US News & World Report, and sixth for research among public universities. More than half of the school’s 1,700 faculty members served as principal investigators on active research awards in 2020. Two UNC SOM faculty members have earned Nobel Prize awards.