​Malnutrition among elderly individuals is a condition that often goes unnoticed but is steadily becoming more prevalent. When left unaddressed, malnutrition can result in a gradual deterioration of overall health and a decline in both physical and cognitive capabilities. Over time, this insidious threat can lead to extended hospital stays, increased readmission rates, a wide range of chronic health issues, and even fatalities. Recent data from the U.S. Centers for Disease Control and Prevention show that deaths attributable to malnutrition among older adults have more than doubled between 2018 and 2022.

Accurate prevention and early detection of malnutrition are crucial not only for the well-being of residents but also for the efficient allocation of community resources. The encouraging news is that timely identification of this nutritional issue by a registered dietitian (RD) can significantly enhance residents' quality of life and contribute to cost savings for your community.

In simple terms, malnutrition refers to an inadequate supply of essential nutrients in the body. As individuals grow older, they typically become less physically active, and their metabolism slows down, resulting in reduced dietary needs. Concurrently, the ability of older adults to absorb and utilize nutrients diminishes. Moreover, numerous chronic illnesses and the treatments often encountered in skilled nursing facilities (SNFs) can contribute to unintentional weight loss and impact the metabolism of essential nutrients. Contrary to what might be expected, the nutritional needs of most seniors tend to increase as they age.

Early detection of malnutrition is key to its reversal, and this can be achieved through the expertise of RDs and health care experts. Rigorous nutrition screening protocols are in place during the admission of residents to SNFs, and regular weight monitoring provides a valuable opportunity to promptly identify and take action when needed. 

Preventing and promptly addressing the adverse consequences of malnutrition are of paramount importance. While there may not be a quick solution, the sooner person-centered nutrition support is provided, the more favorable the outcomes tend to be. It is essential for communities to fully engage RDs who excel in the following areas:

1. Assessing the nutritional health of residents and identifying those at risk.
2. Crafting individualized nutrition care plans aimed at managing chronic illnesses and enhancing overall well-being.
3. Promoting effective communication among interdisciplinary teams, particularly during resident transfers between care settings.
4. Providing guidance to community staff through proven strategies and techniques to enhance mealtime experiences and encourage improved food consumption.

In addressing malnutrition, effective collaboration among the interdisciplinary team is essential. Accurate documentation of the condition in a resident's health record holds utmost significance as it forms the basis for reimbursement within the Patient-Driven Payment Model (PDPM) system. It is imperative that the resident care plan incorporates supporting documentation and established interventions, as these would be essential in the event of an audit. Timely and correct coding and documentation of malnutrition in the admission Minimum Data Set (MDS) by the fifth day of the resident's stay ensures communities receive the reimbursement they are entitled to. Failure to do so significantly undervalues the services provided by SNFs, representing missed revenue opportunities when malnutrition remains undiagnosed.

Of course, most senior living communities are dedicated to fulfilling the pledge of enabling older adults to enjoy their lives to the fullest. And families place their confidence in the devoted staff members who consistently go the extra mile in caring for their elderly and vulnerable family members. However, malnutrition represents a concealed health emergency that often eludes detection. By instituting a thorough malnutrition program encompassing routine evaluation, active resident involvement, personalized care, and nutritious meals and snacks, executive leaders can yield advantages not only for individual residents but also for the entire community.

Emily Fear, MS, RDN, LDN, CDP, is the senior manager, area clinical support, at Sodexo Seniors.  She is a registered dietitian and a certified dementia practitioner with a master of science degree in nutrition and dietetics. She’s a member of the Academy of Nutrition and Dietetics, the Healthy Aging Dietetic Practice Group, the Dietetics in Health Care Communities Dietetic Practice Group, and the Greater Seattle Dietetic Association where she served on the board for six years.