Does being underweight lead to unplanned hospital readmissions?

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 readmissions. The risk of readmission was also increased in patients with depression. The below chart summarizes the probability of different factors predicting readmission.

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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!