National Blueprint Updates Malnutrition Care Strategies for the New Decade

By Kristi Mitchell

The COVID-19 pandemic has changed many aspects of our daily lives. It also has brought into sharper focus ongoing issues that have increased in severity for older adults, including the issue of malnutrition. For example, a recent publication by Bencivenga et al. outlined the many ways in which malnutrition and immunosenescence likely lead to higher morbidity and mortality in older patients with COVID-19, and how improving their nutritional status earlier in life could help to reduce harmful immune responses.

Results of a cross-sectional study in Wuhan, China, showed that among older patients with COVID-19, 27.5 percent were at risk of malnutrition and 52.7 percent were malnourished, leading the authors to highlight the importance of strengthening nutritional support during treatment. The Academy of Nutrition and Dietetics also recently published guidance for caring for malnourished adult patients in various settings during the COVID-19 pandemic, including screening and assessing for malnutrition among adults with suspected or confirmed COVID-19 infection, and providing medical nutrition therapy for adults with suspected or confirmed infection in their homes. 

Such guidance is significant given the current lack of nutrition guidelines focused on adults with or at risk for COVID-19 infection. Thus, the timing couldn’t be better for a new National Blueprint: Achieving Quality Malnutrition Care for Older Adults, 2020 Update.

Nearly one of every two older Americans is malnourished or at risk of malnutrition. Disease-associated malnutrition in older adults is estimated to cost nearly $53 billion annually. With the release of the National Blueprint, a broad group of advocates presents an updated roadmap for continuing national efforts to address this critical clinical and public health issue. 

The National Blueprint calls for a range of strategies to implement across the healthcare continuum and focuses on four primary goals:

  • Improving quality care practices
  • Improving access
  • Generating research
  • Advancing public health 

The original National Blueprint was released in 2017. Some progress toward these goals has been made, such as:

  • Publication of a 2019 U.S. Government Accountability Office report on federal nutrition assistance programs;
  • 2020 reauthorization of the Older Americans Act, which recognized malnutrition prevention as part of the Act’s purpose; 
  • Approved inclusion of malnutrition quality measures in two qualified clinical data registries for 2020 participation in the Merit-Based Incentive Payment System (MIPS); 
  • Expansion of the Malnutrition Quality Improvement Initiative’s Learning Collaborative to 289 leading healthcare institutions across the country. It seeks to improve quality of care for malnourished patients (many of whom have published abstracts about their experiences and positive outcomes); and 
  • Creation of state resolutions and commissions on malnutrition in at least eight states across the country.

However, much more remains to be done to expand the impact of these initiatives.

The American Society on Aging (ASA), a member of the Defeat Malnutrition Today coalition, joined Avalere Health and a multi-stakeholder Malnutrition Quality Collaborative of experts to update the National Blueprint. Even before the pandemic, these leading organizations pointed to concerning statistics that demonstrated the significant healthcare costs of older adult malnutrition. The lack of systematic use of malnutrition best practices, standards and screening tools in routine medical care or across care settings contributes to the current epidemic of malnutrition.

While the Centers for Medicare & Medicaid Services agrees that malnutrition is a serious issue and MIPS offers inclusion of malnutrition quality measures beginning this year, malnutrition care is not a mandatory component of inpatient healthcare quality incentive programs. The updated National Blueprint aims to help address this and other gaps, particularly as growing disparities and social isolation exacerbate the risk of malnutrition and its related negative health outcomes.

The multiple and complex causes of malnutrition among older adults require collaboration among many organizations, government bodies and communities to find solutions. The updated National Blueprint offers strategies across all points of care—including healthcare institutions, community settings and even telehealth services. ASA members can use these implementation-ready recommendations in their individual care settings. 

ASA members and other stakeholders across the continuum of care can work together to promote innovative and effective approaches to delivering high quality malnutrition care, and thus make a real difference in the health and wellness of older Americans.


The National Blueprint: Achieving Quality Malnutrition Care for Older Adults, 2020 Update was developed by the Defeat Malnutrition Today coalition, Avalere Health and other multidisciplinary stakeholders, with support provided by Abbott.

Kristi Mitchell, MPH, is practice director at Avalere Health and leads its Center for Healthcare Transformation in Washington, DC.