Innovations in 

Nutrition Grant* 

Initiatives 

*Administration for Community Living Grant # 90INNU0002

MDoA-MASNP conference call 

May 16, 2019

10am

Call in information:

260-639-8679

PIN: 989 167 542#
Presentation 

Content

What is Malnutrition? Why is it an Important Issue 

for Older Adults?

Meal Packages

Community Malnutrition Care Pathways

Stepping Up Your Nutrition

HDM Priority Tool Validation Study
What is malnutrition?

Malnutrition is the inadequate intake of nutrients, 

particularly protein, over time and may contribute to chronic 

illness and acute disease or illness and infection.

Two or More of the Following*

Weight 

loss

Insufficient 

food intake

↓Body fat

↓Muscle 

Reduced 

handgrip

Fluid 

• Often associated with general physical wasting

• Linked to chronic disease

• Individuals with malnutrition may be underweight, normal weight, 

overweight or even obese

*Source: White JV, et al. J Parenter Enter Nutr. 2012;36(3):275-283. 
Why Older 

Adult 

Malnutrition?

1 in 2 older adults at risk

300% increase in healthcare costs for those 

with poor nutritional status

4 to 6 days longer in the hospital

$51.3 billion in costs for disease-associated 

malnutrition in older adults annually

60% of older adults in hospitals may be 

malnourished
Hidden Co-Morbidity

10%

• Impaired Immunity 

(infections)

20%

• Decreased Healing

30%

• Pressure Ulcers

40%

• At Risk of Death 

(pneumonia)

LEAN BODY MASS

Goates S, Du K, Braunschweig CA, Arensberg MB (2016) Economic Burden of Disease-Associated Malnutrition at the State Level. PLoS ONE 11(9): e0161833. 

https://doi.org/10.1371/journal.pone.0161833. Interactive page accessed at: http://avalaunchmedia.com/inter/Abbott/malnutrition.html
Causes of Malnutrition in Older Adults

 Limited income 

 Trouble swallowing/chewing 

 Poor dental health 

 Changing taste buds 

 Living alone 

 Medication side effects 

 Poor appetite

 Restricted diets 

 Lack of mobility

 Depression 

 Dementia

 Gastrointestinal problems

 Chronic conditions 
Meal Packages

Post-Discharge Meals Program

12 days, shelf stable, medically tailored

Hospitals select at-risk patients, measure 

outcomes 

Partners: Maryland Food Bank, Bethesda 

NEWtrition (BNWS), MAC, University of 

Maryland Hospital St Joseph’s and Medical 

Center, Peninsula Regional Medical Center, 

Atlantic General Hospital.

Peer Network for Post Discharge Meals

Slack network

Quarterly calls/webinars (ending Sept 2019 

– new home?)

50 national members. Interested? Contact 

laura.sena@Maryland.gov
Post-Discharge, Medically-Tailored Meal Packages
Community Malnutrition Care Pathways

Aging Network Solutions Addressing Socio-Behavioral Determinants of Health 

Partners: AAA Pilot sites (Baltimore City, Carroll Co, MAC, Washington Co), BNWS consultants. 

Product: Community Malnutrition Toolkit (Summer-Fall 2019)
HDM Priority Tool

Sahyoun, N.S., Vaudin, A.M., and Simon J.R. (2019). Developing a tool to prioritize home-delivered meals to the neediest older adults. Manuscript submitted for publication.

• Cognitive interviews completed by University of Maryland to ensure 

questions in the tool are understood by respondents

• Validation study underway with 200 home delivered meal applicants 

to determine if higher priority level is associated with poorer diet 

quality, lower socioeconomic status, and use of coping strategies

• Mobile phone app being created to allow for easy re-assessment and 

data recording

• Graphic designer working on paper version to make tool more 

approachable and user-friendly
STEPPING UP YOUR NUTRITION

 2.5 Hour Workshop Paired with Evidence-Based Programs

Workshop Goal: Understand the importance of balanced nutrition for the 

prevention of falls and how to identify the key warning signs of poor nutrition.

Key Messages:

• Nutrition status and muscle health are linked to falls risk

• Exercise and protein are key factors to help maintain and build strong 

muscles

• How to take action and collaborate with your health care provider to reduce 

falls risk

• How to find local resources for food/nutrition services
Measuring Malnutrition Risk Level
Stepping Up Your 

Nutrition Evaluation

• Documentation of Malnutrition and Food Insecurity Risk

• Referral to provider/services for at risk individuals

• Referral to Food Banks and other community 

resources for food insecurity

• Screening for social determinants/social isolation

• Referral to appropriate evidence-based programs

• Pre/Post Knowledge and Behavior change Assessment 

(week 1 and end of week 7)

• Grip Strength measurement (week 1 and end of week 7); 

potential follow-up at 3 months 

• Malnutrition Risk, Grip Strength and Action Plan shared 

with provider
Jan 1 2018 – April 28 2019: 415 Participants

 40 Workshops, 11 Counties

QUESTION PERCENT 

Live alone 94%

Age 70 - 89 91%

Race, Ethnicity AA 63% Caucasian 36%

Eat one or more meals with someone Sometimes 48% Never 13%

Difficulty getting groceries Sometimes 19% Often 4%

Food just didn’t last, no $ for more Sometimes 14% Often 2%

Skip meals Sometimes 46% Often 4%

Have someone to eat healthy meals with Sometimes 48% Rarely 5%

Unintentional weight loss 24%
SUYN Early 

Success and 

Next Steps

• The International Council on 

Active Aging® (ICAA) August 

2017 ICAA Innovators 

Achievement Award 

• National Association of Area 

Agencies on Aging (n4a) 

2018 Aging Innovations 

Award 

• Transition from in-person to 

online interactive training 

available soon