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Does being underweight lead to unplanned hospital readmissions?

Posted by Maureen Garner, MS, RD, LD on Feb 2, 2015 9:19:00 AM

This is the second of a 5-part series, Impact of Nutrition Care on Patient Outcomes.  In this series, we will review original research that shows the impact nutrition care has on patient outcomes.


Predictors for Rehospitalizations

Last week's blog post focused on a study that identified risk factors for avoidable hospital readmissions. This week, we will review a study1 that evaluated factors that could be used as predictors for unplanned readmissions. As the authors point out, very few studies have reported predictors of readmissions. The ones that have been published, focus on demographic and disease characteristics. While these studies help identify populations at high risk, they do not provide a basis for developing strategies for individual intervention.

Mudge and her colleagues studied 142 inpatients that were 50 years and older that had 2 or more unplanned hospitalizations within a 6 month period. Patients admitted from long-term care facilities or with a terminal illness were excluded. Patients with language or cognitive difficulties were also excluded.  

Being Underweight has a High Probability

The presence of a chronic disease had the strongest correlation to predicting unplanned readmissions.  Heart failure, renal disease, and diabetes were associated with a higher risk of readmission when present as a primary diagnosis or co-morbidity. When the data was analyzed using odds ratio, being underweight had the highest probability of unplanned hospital readmissionsThe risk of readmission was also increased in patients with depression.  The below chart summarizes the probability of different factors predicting readmission. 


Factors that did not predict probability of unplanned readmissions include age, sex, medication adherence, length of hospitalization, and functional status impairment.

Post-discharge Meals as a Transition Care Strategy

The researchers concluded that post-hospitalization programs that address management of chronic disease, nutritional status, and depression have the potential to reduce hospital readmissions.  Including nutrition interventions in the transition care plan after a hospital discharge impacts both chronic disease and being underweight.

The need for nutrition intervention is further supported in the Academy of Nutrition and Dietetics' position paper2 on food and nutrition for older adults:

  • Five of the eight causes of death in adults 65 and older have a known nutrition effect.
  • In 2007, 68% of people needing home health care had chronic disease conditions, such as diabetes, heart disease, COPD, and hypertension. All are nutrition-related diagnoses and could be improved with appropriate diets.
  • Quantity of food and caloric intake decreases with age and can result in malnutrition, worsening of health conditions, and frailty.
  • Caregivers may lack the information and skills needed to adapt a diet to meet recommendations for chronic diseases.

Health plans are responding to these findings and many are adding post-discharge meals and chronic disease management meals to their supplemental benefits. The GA Foods' home-delivered meals program allows members to have nutritious, easy-to-prepare meals and remain independent in their homes.  The great news for the health plans adding home-delivered meals, is the return on investment is 3 to 1!  

Contact John Siegel at GA Foods

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1Mudge, AM, et al. J Hosp Med. 2011;6(2)61-67.

2Bernstein, M, et al. J Acad Nutr Diet. 2012;112(8):1255-1277.

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Topics: Malnutrition in Elderly, Home Delivered Meals, MCO ROI

Malnutrition in Older Americans

Posted by Maureen Garner, MS, RD, LD on Sep 16, 2014 1:09:00 PM


Most people know that malnutrition is prevalent in developing countries, but most don’t realize malnutrition is also common among the elderly in the United States. This is a growing problem, as the Census Bureau predicts there will be 92 million people over age 65 by 2060. Malnutrition in our elderly population is a serious issue, due to the associated adverse outcomes.

 The causes are multifactorial, but studies have shown nutrition care leads to better outcomes and saves money. 

At-risk individuals that receive nutrition care during and after a hospitalization are 3 times less likely to die.1

Nutrition care can reduce hospital stays by two days.2

Maureen-GarnerIndividuals with weight loss are at a higher risk for avoidable hospital readmissions. The greater the weight loss, the greater the probability of readmission.3

Malnourished patients have 2-3 times more complications than those not at risk for malnutrition.4

Malnutrition was found in 1/3 of inpatients and resulted in poor hospitalization outcomes and survival.5  

59% percent of patients identified with malnutrition risk, were unable to be discharged home with self-care.6

Hospitalized patients discharged with malnutrition are older and sicker. Their inpatient care was 2 ½ times more expensive than those without malnutrition.7

Being underweight is the strongest predictor for hospital readmissions.8


Post-discharge meals reduced hospital readmissions by 39% in a CMS pilot in Florida.9
MCO paid $12,000 per month less for HIV/AIDS members receiving home-delivered meals than comparison group without home-delivered meals.10
Nutrition care is an essential element to support the independence of older Americans, reduce their hospital admissions, and postpone nursing home placement. Home-delivered meals have shown to be effective in preventing and treating malnourished individuals. Something to consider when the cost of a single day in the hospital is 200 times the cost of three home-delivered meals.

1 Feldblum I, et al, J Am Geriatr Soc, 2011;59(1):10-17. 
2 Barker LA, et al, Int J Environ Res Public Health, 2011;8(2):514-527.
3 Friedman JM, et al, Am J Clin Nutr, 1997;65(6):1714-1720. 
4 Sorenson J, et al, Clin Nutr, 2008;27(3)340-349.
5 Lim SL, et al, Clin Nutr, 2012;31(3):345-350.
6 Chima C, et al, JADA, 1997;97(9):975-978.
7 Corkins, MR, et al, JPEN, 2014;38(2):186-195.
8 Mudge AM, et al, J Hosp Med, 2011;6(2):61-67.
9 FMQAI, Florida’s Medicare Quality Improvement Organization, under contract with CMS.

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Topics: Nutrition, Malnutrition in Elderly, Home Delivered Meals

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