In the upcoming BAYADA Home Health Care Speaker Series, Rose Ann DiMaria-Ghalili, PhD, associate professor of nursing in the Doctoral Nursing Department and Department of Nutrition Sciences, will tackle a topic that is becoming increasingly important as the first baby boomers enter their golden years – the Aging of America. 

 

This drastic change in the population, which DiMaria-Ghalili referred to as the “silver tsunami,” will undoubtedly bring about social and economic challenges, but another area that will continue to feel impact is health care delivery in the United States. Nutrition, though often overlooked by providers upon discharge from the hospital or even at a preventative visit, plays a critical role in successful aging. To understand the need for community programs and comprehensive geriatric assessments, DiMaria-Ghalili believes there must first be a holistic understanding of the unique factors that when compounded, put older adults at an increased risk for malnutrition.

 

“Older adults are particularly at risk for malnutrition, and have always been at risk for a variety of physiological changes that happen as we age but also psychosocial and environmental factors,” said DiMaria-Ghalili. “For instance, anxiety and depression can cause weight loss, and any type of weight loss whether intentional or unintentional is indiscriminate, meaning they’re not just losing fat, they also lose muscle. When older adults lose muscle, they become more at risk for frailty and functional decline. So that’s why malnutrition is a very big problem.” 

 

Grieving the loss of a spouse, accessibility and fixed income can also make getting the proper amount of protein exceptionally difficult for geriatric patients. The loss of muscle mass in older adults can increase risk for infections and pressure ulcers and raise health care costs and extend hospital stays as a result. It truly can become problematic. “These are a variety of risks running the gamut from medical to social. Put together, you have the perfect storm.”

 

Though providers can manage nutrition during a hospital stay or a stint in a rehabilitation facility, more needs to be done to ensure that older adults returning home after a surgery or treatment for a chronic condition can give themselves the nourishment needed to heal. The hurdle here is a lack of resources. “The way health care is situated today, most of the dietitians we see are housed in the hospital setting. There are very few in the community and part of the reason for that is reimbursement, and there aren’t enough dietitians to go around in the home care setting,” said DiMaria-Ghalili, stressing the need to implement nutritional interventions for high-risk patients to help fill the gap between discharge and the start of home care. 

 

“We need to make some policy changes to account for what is needed when people leave the hospital. Screenings are required when folks get into the hospital and a screen upon discharge should be mandatory to figure out what needs to be done when they get home,” she added.