When we think about the health of frail older adults, severe, high-profile illnesses such as dementia, heart disease, cancer, and debilitating arthritis come to mind. But for many seniors, small things can turn a manageable chronic condition into an acute medical crisis.

One is malnutrition.  Spend a little time in a hospital emergency department and you’ll be shocked at how many frail elderly patients arrive malnourished. A new study reports that one of every six older adults living at home reaches a hospital ER weakened by malnutrition and as many as 6 in 10 are at least at risk for the condition.

The study, by researchers at the University of North Carolina and the Karolinska Institute in Stockholm, looked only at people over 65 who came from home and were neither cogitatively impaired nor suffering an immediate life-threatening illness. In other words, the researchers were focusing on older people who were relatively healthy and functioning at a fairly high level.  The paper was published in the Aug 12 edition of the Annals of Emergency Medicine.

Who is more likely to suffer from poor nutrition? More than half of people with depression arrived at the ER malnourished, as did nearly 40 percent of those who had difficulty eating (often because of dental problems), and a third-of those who had trouble buying groceries (perhaps because they couldn’t afford them or had no way to get to the store).

Interestingly, the study found little difference in rates of malnutrition between men and women, people with or without college education, and those living in cities or in rural areas. Whites were more likely to be malnourished than African-Americans.

The consequences of malnutrition among elders are quite severe. Few Americans starve to death, but people weakened by lack of nutritious food are at risk for severe health problems. They are more likely to suffer falls or bed sores, and once hospitalized, to suffer complications. They stay in the hospital longer than those who are well nourished and their death rates are higher.

Malnutrition among the elderly is largely preventable but it requires action by families, communities, and the health care system.

For instance, community volunteers can provide rides to the grocery store or even shop for their neighbors.

For those who cannot afford healthy food, government-funded programs such as SNAP (formerly food stamps) and Meals on Wheels can help. Given the potential costs of malnutrition, spending more on these programs rather than cutting their budgets may be money well-spent.

Similarly, Medicare does not pay for preventive dental services. Opening the door to full coverage could be hugely expensive but given the prevalence of malnutrition among those with dental problems (such as ill-fitting dentures or gum or tooth pain), a modest expansion of the program might be worthwhile.

The medical system must play a key role. A group called the Alliance to Advance Patient Nutrition has recommended clinical changes that could go a long way towards reducing malnutrition. It suggests hospitals spend a few minutes screening patients for nutritional health and improve nursing protocols to identify and respond to these issues.

But those changes only help while a patient is in the hospital. It is far more important to identify patients who are at-risk long before they are hospitalized and take steps to be sure they are well-nourished while still at home.

Since poor nutrition is often associated with chronic disease, both specialists and primary care doctors need better training in both identifying potential problems and helping families address them. That means teaching family members and paid caregivers to recognize signs of poor nutrition and showing them how to respond. A quick guide on what family members should look for when they visit a frail relative would be invaluable.

For instance, is mom’s refrigerator empty? Has she stopped eating since she started on a new medication? Are her teeth bothering her?

At the very least, nutritional health should be part of physician care plans and hospital discharge instructions, and should be addressed in any follow-up physician visits.

The study has its limitations. It was done at only one academic medical center ER over a short period of time. The sample size was small–only 138 people. Still, the results are eye-opening.

Older adults with chronic disease often teeter between stable health and medical catastrophe. Too often, malnutrition knocks them off that edge. And it doesn’t need to.