Large Numbers of Aging Veterans Are Malnourished
Education, screening and better care are needed
On Veterans Day, we honor all those who have served our country through our nation’s military. Today’s reality is that just as America is aging as a nation, so too is our veteran population. Two-thirds of all vets are 55 and older, and the U.S. Department of Veterans Affairs (VA) projects that veterans 65 or older will make up at least 40 percent of all vets through at least 2040.
As a nation, we should ask whether our federal policies are doing all they can to ensure that veterans, as they age, live healthier lives.
For example, veterans may face higher risks of post-traumatic stress disorder, certain cancers, HIV/AIDS, substance abuse, gastrointestinal disorders and chronic fatigue syndrome. We must target threats to older veterans’ health, including malnutrition — which can be a result of any of these conditions.
Too Many Older Vets Face Malnutrition
Up to half of older adults are at risk for malnutrition, according to the National Blueprint: Achieving Quality Malnutrition Care for Older Adults. And up to 60 percent of older patients in the hospital are malnourished. Further, every 60 seconds, 10 hospitalized patients with malnutrition go undiagnosed, which makes malnutrition screening and prevention vital for older adults’ health overall.
It’s not much different for older veterans: a recent study of malnutrition among older vets in home-based primary care found that 15 percent were malnourished. Further, our veterans may be at even higher risk for malnutrition because they have a higher prevalence of certain chronic disease and social risk factors for malnutrition, including alcoholism and food insecurity.
It is critical to identify and intervene for malnutrition because, left untreated, it results in higher health care costs, poorer health outcomes and greater risk for disability. A study of hospitalized veterans with and without malnutrition found that the malnourished group had increased likelihood of longer lengths of stays, readmissions within 30 days, discharges to a nursing home and mortality within 90 days.
How We Can Improve
The VA already identifies nutrition as an important component of well-being for older adults. Opportunities for further improvement include:
1. Education on malnutrition and the need to prevent unintended weight loss. Unintended weight loss — an important sign of potential malnutrition — has been shown to increase the risk for multiple falls in a veteran population.
2. Consistent malnutrition care. Four multidisciplinary malnutrition care quality measures and a toolkit supporting their use have been recently introduced and are recommended for adoption in federal quality reporting programs. The Centers for Medicare and Medicaid Services (CMS) included the four malnutrition care quality measures in its 2018 hospital inpatient proposed rule, but did not finalize any new quality measures in the 2018 final rule.
This presents an opportunity for VA hospitals. The four malnutrition care quality measures align with the Veterans Health Administration Handbook’s established policy for the “nutritional assessment of Veteran inpatients and outpatients receiving medical care at VA medical facilities” and the policy’s ecommendations for nutrition screening. In addition, it has already been demonstrated in a VA hospital that implementation of a malnutrition diagnosis can be accomplished through a team-based approach.
3. Referral to community-based programs and services such the Supplemental Nutrition Assistance Program (SNAP) and Meals on Wheels. Food insecurity can be a real problem for veterans. Recognizing this, I commend the VA’s recent introduction of a first-of-its-kind program that will “screen all vets who visit its health care facilities for hunger, asking them whether they've struggled to afford food in the past three months.”
Programs such as Meals on Wheels can also provide support; each year it feeds more than 2.4 million Americans 60 and older, including more than half a million veterans.
Vital Support Needed
I have written before that malnutrition is the new older adult crisis. For our older veterans, this is a challenge they should not have to face. As we examine our policies for older adults, we must provide special consideration to older veterans. They need our support and we must address their emerging health issues.
In short, proper malnutrition care — including systematic malnutrition screening and intervention — can help reduce veterans’ risk for disability and help vets maintain their freedom to live independently.