Background: Malnutrition is a complex and costly condition that is common among older adults in the United States (US), with up to half at risk for malnutrition. Malnutrition is associated with several non-medical (i.e., social) factors, including food insecurity. Being at risk for both malnutrition and food insecurity likely identifies a subset of older adults with complex care needs and a high burden of social vulnerability (e.g., difficulty accessing or preparing meals, lack of transportation, and social isolation). US emergency departments (EDs) are a unique and important setting for identifying older patients who may benefit from the provision of health-related social services. This paper describes the protocol development for the Building Resilience and InDependence for Geriatric Patients in the Emergency Department (BRIDGE) study. BRIDGE was designed to assess the feasibility of an ED-based screening process to systematically identify older patients who are at risk for malnutrition and food insecurity and link them to health-related social services to address unmet social needs and support their health and well-being.Methods: Phase 1 efforts will be formative and focused on identifying screening tools, establishing screening and referral workflows, and conducting initial feasibility testing with a cohort of older patients and ED staff. In phase 2, which includes process and outcome evaluation, the screening and referral process will be piloted in the ED. A partnership will be formed with an Area Agency on Aging (AAA) identified in phase 1, to assess resource needs and identify community-based social services for older ED patients who screen positive for both malnutrition risk and food insecurity. Data on screening, referrals, linkage to community-based social services, and patient-reported quality of life and healthcare utilization will be used to assess feasibility.Discussion: The tools and workflows developed and tested in this study, as well as learnings related to forming and maintaining cross-sector partnerships, may serve as a model for future efforts to utilize EDs as a setting for bridging the gap between healthcare and social services for vulnerable patients.

Unmet health-related social needs are common amongst older US adults and impact both quality of life and health outcomes. One of the ways that unmet health-related social needs impact health is through malnutrition, an imbalance in a person's intake of energy and/or nutrients. Lack of reliable access to a sufficient quantity of nutritious food is a specific health-related social need that can be assessed rapidly and, when unmet, is a direct risk factor for malnutrition and may be indicative of a broader range of unmet health-related social needs. We conducted a cross-sectional study to characterise malnutrition and food insecurity amongst older adults receiving emergency department (ED) care using brief, validated measures and to assess the burden of a broader range of health-related social needs amongst these patients. Patients were asked about their need for and willingness to receive a range of social services.The study was conducted in an academic ED serving a racially and socioeconomically diverse population in the Southeastern United States. A convenience sample of noncritically ill adults aged 60 years and older was approached between November 2018 and April 2019. Study patients (n = 127) were predominantly non-Hispanic white (67%), community dwelling (91%) and urban residents (66%) with 28% screening positive for malnutrition risk, 16% for food insecurity and 5% for both. Of those at risk for malnutrition, 25 (69%) reported ≥2 unmet health-related social needs and 14 (38%) were receptive to social services. Amongst food insecure patients, 18 (90%) reported additional unmet health-related social needs and 13 (65%) were receptive to receiving social services. In conclusion, a brief set of questions can identify subgroups of older ED patients who are food insecure or at risk for malnutrition. Individuals who screen positive for food insecurity have a high burden of unmet health-related social needs.

BACKGROUND Home‐delivered meal programs serve a predominantly homebound older adult population, characterized by multiple chronic conditions, functional limitations, and a variety of complex care needs, both medical and social. DESIGN A pilot study was designed to test the feasibility of leveraging routine meal‐delivery service in two home‐delivered meal programs to proactively identify changes in older adult meal recipients’ (clients’) health, safety, and well‐being and address unmet needs. INTERVENTION Meal delivery personnel (drivers) were trained to use a mobile application to submit electronic alerts when they had a concern or observed a change in a client's condition. Alerts were received by care coordinators, who followed up with clients to offer support and help connect them to health and community services. RESULTS Over a 12‐month period, drivers submitted a total of 429 alerts for 189 clients across two pilot sites. The most frequent alerts were submitted for changes in health (56%), followed by self‐care or personal safety (12%) and mobility (11%). On follow‐up, a total of 132 referrals were issued, with most referrals for self‐care (33%), health (17%), and care management services (17%). Focus groups conducted with drivers indicated that most found the mobile application easy to use and valued change of condition monitoring as an important contribution. CONCLUSION Findings suggest that this is a feasible approach to address unmet needs for vulnerable older adults and may serve as an early‐warning system to prevent further decline and improve quality of life. Efforts are underway to test the protocol across additional home‐delivered meal programs. J Am Geriatr Soc 67:1946–1952, 2019

Study Objective: We sought to identity questions that can be used in the ED to identify older adults with unmet social service needs. We selected questions from validated malnutrition and food insecurity screening tools as these problems are prevalent among older ED patients, can be assessed with brief questionnaires, and were hypothesized to accurately predict the need for a range of social services.Methods: We conducted a prospective observational study in an academic ED serving a racially and socioeconomically diverse population of older adults. Noncritically ill (ESI Score >2) adults aged 60 years and older were eligible. Screening questions were selected from four validated malnutrition and food insecurity screening tools and compared to self-reported need for and willingness to receive social services. Social services included home-delivered and congregate meals, SNAP, transportation, home health, home care, utility assistance, and insurance and benefits assistance.Results: Of 127 patients, 28% screened positive for malnutrition risk per the Malnutrition Screening Tool (MST), 16% for food insecurity per Hunger Vital Sign (HVS), and 5% (6) for both. A majority of patients who were positive for both MST and HVS expressed a need for (100%) and a desire to receive (83%) social services. Among patients who were negative for both malnutrition and food insecurity screens, a minority expressed a need for (42%) and a desire to receive (31%) social services. As a predictor of self-reported need for one or more social services, MST had a sensitivity of 0.37 and a specificity of 0.84; HVS had a sensitivity of 0.25 and a specificity of 0.98. Combined, MST and HVS had a sensitivity of 0.24 and a specificity of 0.98. As a predictor of receptivity to services, MST and HVS combined had a low sensitivity (0.15) and a high specificity (0.99).Conclusion: Questions assessing malnutrition and food scarcity provide a subgroup of older ED patients with a need for and willingness to receive social services with high specificity but poor sensitivity. Further refinement of these screening tools may be needed to optimize accuracy of a brief ED-based screening to identify patients who may benefit from linkage to social services.