Malnutrition Prevalence and Burden on Healthcare Resource Use Among Spanish Community-Living Older Adults: Results of a Longitudinal Analysis

Purpose Little is known about the economic burden that malnutrition or its risk imposes on community-dwelling older adults. Using cross-sectional and longitudinal analyses, we assessed the impact of malnutrition risk on healthcare utilization and costs in a cohort of older adults living in Spanish community. Patients and Methods Data from 1660 older (range 66-98 years), community-living adults participating in the Toledo Study on Healthy Ageing, waves 2 (year 2011-2013) and 3 (year 2015), were analyzed. Nutritional status categories were defined according to the Global Leadership Initiative on Malnutrition (GLIM) criteria, using a two-step approach. First, screening for malnutrition risk. Once positive, individuals were classified as malnourished according to some phenotypic (body mass index, grip strength, and unintentional weight loss) and etiologic (disease burden/inflammation and reduced food intake or assimilation) criteria. Outcomes assessed included healthcare resources (hospital admissions, number of hospitalizations, length of hospital stay per hospitalization, and number of medications). Results Fifteen percent of the population was found to be at risk of malnutrition, while 12.6% was malnourished. Overall, patients from both groups were older, had lower functional status, and had more comorbidities compared to well-nourished counterparts (p<0.05). Results of our cross-sectional analysis showed that being at-risk/malnourished was associated with greater medication utilization, higher rates of hospital admission and longer stays, and higher hospitalization costs. However, when adjusting for covariates, malnutrition/risk was associated only with higher hospitalization costs (range: 11-13%). Longitudinal analysis results indicated that malnutrition/risk was significantly associated with more frequent hospitalizations, longer lengths of stay, higher hospitalization costs, and polypharmacy at follow-up. Conclusion Malnutrition or its risk, found in over one of four older adults in the Toledo community, was associated with higher healthcare resource use and increased costs. Such findings suggest that malnutrition risk-screening for older adults, and provision of nutrition counseling and care when needed, hold potential to improve their health and to lower costs of care in the Spanish healthcare system.