Using the Emergency Department Visit to Link Malnourished Older Adults with Food Insecurity to Community-based Services

Malnutrition is common among older adults. In fact, up to 50% of older adults in this country are at risk for malnutrition. This complex, multifaceted condition contributes to poor health and premature death and has numerous health-related and social risk factors. Food insecurity (i.e., lack of access or inability to afford adequate food) is considered a critical social risk factor for malnutrition and is associated with poor physical, mental and dental health, poverty, insecure housing, lack of transportation, and mobility and functional limitations.

A growing number of our nation’s older adults are using emergency departments (EDs) as a critical safety net for both health and social care. As such, EDs provide a critical touch point that can be leveraged to identify older patients who are malnourished or at-risk for malnutrition and connect them to the services and supports in the community that addresses the social risk factors associated with malnutrition, including food insecurity.

To advance malnutrition care for older adults, the Gary and Mary West Health Institute has partnered with the University of North Carolina Hospitals Emergency Department (UNC ED) to develop and test a process to systematically identify older patients who are at risk for malnutrition and food insecurity and link them to community-based solutions to address the social risk factors of both food insecurity and malnutrition. In Phase 1 of this multi-phase research study, which began in October 2018, the feasibility of screening for malnutrition and food insecurity in an ED setting is being assessed. Screening tools are being identified and tested, and a new process and workflow will be established and then integrated into UNC’s electronic health record (EHR). In the second phase, the new process and workflow will be implemented, and older UNC ED patients who screen positive for both malnutrition risk and food insecurity will be linked to a community-based organization that will determine the best approach to address the food insecurity and other social risk contributing factors.

The tools and workflows developed through this collaboration, as well as learnings related to forming and maintaining community and healthcare partnerships, will serve as a model for future efforts to utilize EDs as a setting for bridging the gap between healthcare and social services for older adults.