Based on a Centers for Disease Control and Prevention (CDC) database of death certificates, a fascinating Washington Post article by Andrew Van Dam titled Why Are Malnutrition Deaths Soaring in America? reports a sixfold increase in the U.S., especially among those 85 and older. While it accounts for fewer than 1 in 100 deaths, this number is rising so quickly that it now matches deaths from arterial disease, mental disorders, and assault.
Clinical nutrition professionals are likely familiar with the rise in malnutrition diagnoses beginning around 2010, as research documenting its impact expanded and guidance on nutrition assessment and diagnosis in clinical settings was published. However, Mr. Van Dam’s analysis of the rise of malnutrition as a cause of death is new information for the field. Analyzing this CDC data, he found that Americans 85 or older die of malnutrition at about 60 times the rate of the rest of the population.
To explore the reasons behind this, Mr. Van Dam spoke with experts in clinical nutrition (including ASPEN), hospice and palliative medicine, medical examiners, and funeral directors to gain a deeper understanding of malnutrition as a cause of death and how death certificates are completed.
- Guidance for diagnosing malnutrition in the clinical setting was published in 2012 and has since been widely implemented, leading to an increase in the number of coded malnutrition diagnoses among hospitalized patients over time.
- Our understanding of malnutrition as being related to inflammation (in both acute and chronic disease) and food insecurity has expanded.
- Many professionals, including forensic pathologists, hospitalists, residents, and hospice program clinicians, complete death certificates, and there is no standardized way to fill out a certificate.
- Standard U.S. death certificates allow up to four lines for the cause of death to list the sequence of conditions leading to death.
- With the widespread use of electronic health records, listed underlying conditions such as malnutrition may also be making it to death certificates.
Importantly, this article provides new information on the potential role of malnutrition in the death of older adults and further highlights the critical need for all healthcare clinicians and administrators to assess for, diagnose, prevent, and treat malnutrition. As Peggi Guenter, PhD, RN, FAAN, FASPEN, former ASPEN senior director of clinical practice, quality, and advocacy, notes, “Malnutrition has always been there — we’re just identifying and documenting it better than we ever have in the past.”
Visit nutritioncare.org/malnutrition for resources on malnutrition, and the Clinical Resources section of this site for ASPEN guidelines and additional resources.