Using the Holiday Season to Address Persistent Malnutrition

4 min
December 08, 2021
By Liane Wardlow and Virginia Suarez

The holiday season is a traditional time of giving to those in need, particularly those who are food insecure. Favorite foods, family and good cheer go hand-in-hand, but the deluge of meals, packaged goods and grocery deliveries can’t correct a year-long struggle with malnutrition that increased sharply during the pandemic.

In the face of such abundance, now is a great time for medical providers to engage in a healthy discussion about nutrition and connect patients with vital services that can help. Questions like, “What are you doing for the holidays?” present a great opportunity to talk about home, family and eating habits. And to ask crucial questions about whether someone has enough to eat the rest of the year.

In an effort to combat what is often called a “silent epidemic,” West Health and University of North Carolina at Chapel Hill developed “A Practical Guide: Creating a Screening & Referral Program to Address Malnutrition.” An extensive analysis showed that simple steps can be taken to relieve a condition that has dire consequences, especially among vulnerable older adults who are the most likely to have medical or socioeconomic issues that contribute to poor nutrition.

Bolstered support during the holidays is always something for which we are thankful, but the need to address hunger and food insecurity is yearlong and affects more Americans than ever.

Prior to the COVID-19 pandemic, more than 35 million Americans struggled with hunger and malnutrition. In 2020, that number rose to 50 million, or 1 in 6 Americans. Although people of all ages face these issues, older adults are particularly vulnerable due to a range of factors including social isolation, low incomes and chronic health conditions. The pandemic only exacerbated these issues for elders, due to their heightened risk of infection and illness and a rise in social isolation.

Given the detrimental outcomes associated with malnutrition and food insecurity, particularly for older adults, it is important to assess and intervene whenever possible. Every interaction with medical professionals offers an opportunity and the most tried-and-true method of detection takes less than a minute to implement.

Every interaction with medical professionals offers an opportunity to assess food insecurity.

A Practical Guide: Creating a Screening & Referral Program to Address Malnutrition” explains how to implement a brief malnutrition screening for older adults in an emergency department (ED) or other acute care setting. The program and guide were developed using implementation science methodology. Publications have shown the effectiveness of screening in identifying patients who are food insecure or at risk for malnutrition, and this guides goes further by providing insights regarding barriers and opportunities for implementation.

The first step is to identify food insecure elders, the next is to connect them with community-based organizations to meet their nutrition needs. For older adults, this means intervening at the sites where they receive clinical care, including EDs and acute care settings, where they often arrive with symptoms from food insecurity (such as weakness or lethargy), but where food insecurity as a cause may be missed.

One story detailed in the guide is that of Darrel J., 60, of Durham, NC. A severe, debilitating vision disorder cost him his job, his ability to drive, and hampered his ability to leave the house alone. He struggled to afford his basic needs, including access to food. His plight sounds straightforward, but his doctors didn’t diagnosis him as suffering from malnutrition until an unexpected visit to the ED connected him to Meals on Wheels.

Mr. J. had acute back pain and sought treatment. Back pain and vision disorders are not conditions typically associated with food insecurity but that’s because anyone, at any weight, can be food insecure. Emergency personnel used the tools detailed in the guide to assess Mr. J. and discovered he couldn’t afford proper nutrition. Even though more than 10 percent of older adults in North Carolina struggle with food access (the fifth highest rate in the nation), malnutrition remains underdiagnosed.

Although emergency settings are often separate from elders’ medical home and Primary Care Physician team, there is terrific opportunity for positive impact. A simple two-question assessment, necessitating minimal staff and financial resources, can help elders who are falling through the cracks.

Considering the complexity of resources and the difficulty many elders face in accessing them, it is even more important for emergency personnel and those in acute care settings to have a direct warm hand-off to community-based organizations (CBOs) when possible. Although it sounds daunting, reaching out to one or two local organizations to establish a partnership can be extremely helpful in ensuring a more fluid and successful referral process that can result in savings due to averted hospital visits, health improvements and decreased symptom severity.

The guide provides step-by-step help through the assessment, preparation, implementation and evaluation phases of establishing a screening and referral program. The first steps can be adopted immediately to increase year-round awareness and response to hunger and food insecurity—a true gift this season.

This guide, and its accompanying toolkit, are available for free and can be implemented with minimal resources. The lingering effects of a pandemic that continues to surge requires creative support systems and straightforward resources for providers and staff. Implementing the tools and workflows necessary for a malnutrition screening and referral program do not require a heavy lift from the organization.

Those who are looking to fully develop a malnutrition screening and referral program will benefit from reading the guide more thoroughly, as it explains each stage of development from initial assessment, preparation, implementation and evaluation. Also, it is critical that we shore up the nation’s home- and community-based services infrastructure, including food and medical assistance, support for family caregivers, transportation and skilled nursing for older adults and people with disabilities.

Ensuring that these programs in every state are funded adequately is long overdue and heightened by the aftermath of COVID-19. Congress is expected to pass an additional $150 billion in support of these services through President Joe Biden’s Build Back Better Act. This funding, while large in scale, is just the beginning of efforts to repair a fragile economy, stagnant caregiver wages and a dire homecare shortage. Funding will allow nutrition-based programs to take on new clients and address the growing need for nutrition and food education services for elders.

Addressing food insecurity for the holidays isn’t necessarily the happiest topic, but it’s one that’s sure to help millions have a happy, healthier new year.


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Liane Wardlow
Senior Director, Clinical Research & Telehealth