Nutrition & Foodservice Edge Magazine - March/April 2022 - 16

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symptoms during COVID-19 infection. Several studies have also
linked Vitamin D deficiency to increased severity of COVID-19
infection.
But the infection itself may also contribute to malnutrition.
Acute illness may preclude good nutritional intake and might
simultaneously increase requirements due to inflammation and
respiratory distress. The infection can also cause diminished
smell and taste, leading to reduced intake.
For example, one study in Endocrinology, diabetes and nutrition
estimated that up to 60 percent of hospitalized COVID patients
suffer from malnutrition. Of note, this same study found that
early nutritional intervention-specifically early assessment, a
higher protein diet, and additional supplements as needed-was
linked to shorter hospital stays for COVID.
Perhaps more surprising, though, are potential long-term
impacts on malnutrition.
A study in Nutrients looked at the prevalence of malnutrition of
COVID hospitalized patients over six months post-discharge.
This group included adults age 18 and up, with a mean age of
approximately 60 years old. After one month, 33 percent of
study participants experienced persistent malnutrition. After six
months, 15 percent of the group still experienced malnutrition
(despite receiving nutritional guidance during or after
hospitalization).
A similar study in Nutrition found that malnutrition persisted in
41 percent of patients at one-month post-discharge. And in other
research, patients with " long COVID " may suffer from skeletal
muscle weakness and exercise intolerance months after diagnosis,
reducing functional movement and potentially contributing to
malnutrition.
COMBATTING MALNUTR I TION
Not surprisingly, malnutrition leads to numerous negative
consequences in addition to those discussed above:
* Longer recovery times from illnesses
* Increased risk of medical complications
* Greater number of hospital readmissions
* Higher medical costs
* Loss of muscle mass and function
* Weakened immune system
* Increased risk of mortality
16 NUTRITION & FOODSERVICE EDGE | March-April 2022
Clearly, one of the most important priorities as a CDM, CFPP
is to provide foods that nourish older adults and prevent these
risks. Here are 12 strategies to help you do so:
1. Offer energy-dense snacks between meals.
Many older adults experience decreased appetite and/or
increased feelings of fullness. Smaller meals can be balanced
with calorie- and protein-dense snacks in between.
For example, Katie Dodd, MS, RDN, CSG, FAND, Owner of
The Geriatric Dietitian, often recommends high-calorie shakes:
" I've found that even when an older adult can't take another bite
of food, they can still sip on a tasty shake. High-calorie shakes
served in-between meals can increase the caloric intake of an
older adult, preventing unintended weight loss. "
Your department could even host a weekly smoothie event where
residents can gather in the afternoon and get made-to-order
shakes.
2. Encourage community.
Social isolation increases the risk of malnutrition, so
encouraging residents to eat together and/or with visiting family
members can help increase intake. Clearly, spikes in infection
rates during the pandemic have made this challenging, but
providing group meals in a safe setting should be a priority
whenever possible.
3. Act like a detective.
Residents that are at risk for malnutrition may exhibit
unconventional signs. Channel your inner detective and ask
questions. For example, if you frequently see a resident near the
dining area outside of mealtimes, could they be hungry between
their meals but are simply not verbalizing it? If a resident is
sitting in the dining area but not eating, do they know how
to use their utensils? Starting conversations can help identify
problems.
4. Use a food-first approach when possible.
Supplements may certainly be helpful, but a food-first approach
is often ideal-and one that a CDM, CFPP can truly help
execute. You can create menus that are appealing, well-seasoned,
and filled with nutrient-dense foods.
Lisa Andrews, MEd, RD, Owner of Sound Bites Nutrition,
offered up advice: " Patients often experience taste burnout from
oral supplements-but may be able to get nutrients in with
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