The Role of Nutrition in Maintaining Health in the Nation's Elderly Evaluating Coverage of Nutrition Services for the Medicare Population (2000) / Chapter Skim
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9 Nutrition Services in the Acute Care Setting
9 Nutrition Services in the Acute Care Setting
Pages 163-172
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Section In KutrhioD Services A1ODC tbe ConUnuum of Care
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summarizes the roles of venous health care providers in the provision of nutrition services. Traditionally, primary care physicians and nurses have screened patients and provided basic nutrition information.
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, and beneficiaries who required an inpatient hospital stay. The leading diagnoses for hospitalized beneficiaries, in terms of Medicare dollars spent, were malignant neoplasms, heart disease, fractures, pneumonia, and cerebrovascular disease (Health Care Financing Administration, 1998~.
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The Joint Commission on Accreditation of Health Care Organizations (ICAHO) requires that all patients are screened for nutrition problems and, when a problem exists, there is appropriate nutrition intervention.
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Hospital dietitians also work with discharge planners, attempting to provide a smooth transition between the hospital and nutrition services in skilled nursing facilities or home care. However, few dietitians work in home care and the hospital dietitian is often called upon to advise home care agencies or home infusion companies about patients long after they have been discharged from the hospital.
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elderly patients from seven admitting services in a tertiary care teaching hospital. Data in the medical record were used to evaluate the patients' nutritional and functional status, hospital mortality, readmission, and disposition outcome.
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The presence of a positive malnutrition index was associated with older age, impaired functional status, and greater mortality. Patients with malnutrition also required more subsequent health care based on hospital readmissions or referrals to skilled nursing or home care.
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In a large study, the Hospital Outcomes Project for the Elderly, activities of daily living such as bathing and dressing, deteriorated significantly between baseline admission to an acute care hospital and discharge. Forty-one percent of the older individuals were reported to have a continued decline in functional status 3 months after hospitalization; they were unable to recover from hospital-acquired disabilities and had developed additional ones since discharge (Riedinger and Robbins, 1998~.
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Hospital dietitians often provide guidance to home health agencies and home infusion companies who may not have adequate staffing of qualified nutrition professionals. RECOMMENDATIONS · Current standards for screening and assessing nutritional status in hospitalized Medicare beneficiaries need to be reassessed and revised.
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1998. Health Care Financing Review, 1998 Statistical Supplement.
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