Risk Factors for Malnutrition among Older Adults in the Emergency Department: A Multicenter Study

Background: Among older adults, malnutrition is common, often missed by healthcare providers, and influences recovery from illness or injury.

Objective: To identify modifiable risk factors associated with malnutrition in older patients.

Design: Prospective cross-sectional multicenter study.

Setting: 3 EDs in the South, Northeast, and Midwest.

Participants: Non-critically ill, English-speaking adults aged ≥65 years.

Measurements: Random time block sampling was used to enroll patients. The ED interview assessed malnutrition using the Mini Nutritional Assessment Short-Form. Food insecurity and poor oral health were assessed using validated measures. Other risk factors examined included depressive symptoms, limited mobility, lack of transportation, loneliness, and medication side effects, qualified by whether the patient reported the risk factor affected their diet. The population attributable risk proportion (PARP) for malnutrition was estimated for each risk factor.

Results: In our sample (n = 252), the prevalence of malnutrition was 12%. Patient characteristics associated with malnutrition included not having a college degree, being admitted to the hospital, and residence in an assisted living facility. Of the risk factors examined, the PARPs for malnutrition were highest for poor oral health (54%; 95% CI 16%, 78%), food insecurity (14%; 95% CI 3%, 31%), and lack of transportation affecting diet (12%; 95% CI 3%, 28%).

Conclusion: Results of this observational study identify multiple modifiable factors associated with the problem of malnutrition in older adults.