Homeless and Older Veterans May Be at Risk for Malnutrition and Food Insecurity.

To the Editor: The recent article by Phipps et al 1 emphasizes the importance of patients’ access to adequate and appropriate food. Unmet food needs may worsen existing health conditions and lead to more frequent hospital admissions as well as increased health care costs. The authors highlight that the availability of adequate nutritional food is a major population health issue. Veterans Affairs (VA) health care providers should take note of this issue. Veterans with recent homelessness may be particularly vulnerable to malnutrition and food insecurity leading to decreased control of hypertension, HIV, depression, and diabetes. In older patients, inadequate diet and malnutrition are associated with a decline in functional status, poorer muscle tone, loss of bone mass, immune deficiency, anemia, reduced cognitive function, diminished wound healing, delay in recovering from surgery, and greater hospital and readmission rates and mortality. Recent statistics demonstrate that veterans are overrepresented among the homeless population and that the median age of male as well as female veterans as surveyed in 2014 was significantly higher than their non-veteran counterparts. These 2 groups, elders and the homeless, are commonly cared for at VA clinics and hospitals and should be screened periodically to ensure that both their nonmedical and medical needs are being met. Ensuring adequate nutrition is provided or accessible to older and homeless veterans must be a priority at the VA. As stated by Phipps et al, health care providers should implement interventions that decrease the risk of poor nutrition or hunger among their patients. Primary care and clinic providers at the VA must be responsible and proactive regarding this significant issue. Interviews with all patients to ascertain risk of food insecurity and begin active interventions if required to prevent future problems is paramount. For ambulatory and younger populations, using food pantries or community resources may be a viable solution. For elderly veterans who may be isolated from family members or too frail to travel independently, a helpful plan might include arranging for home delivery of meals and reliance on home health assistants for purchase of food and meal preparation. Another option to maintain adequate caloric intake is mail home delivery of liquid caloric supplements that contain vitamins and minerals. Contact with relatives of older patients would clarify the best manner to assure adequate nutritional support. Homeless veterans should be evaluated to avoid unmet food needs. Social service workers can aid this group by making connections to food banks and religious groups. Neighborhood support also may be of benefit. These aggressive steps might obviate greater medical complications and unnecessary hospitalizations. Phipps et al should be applauded for focusing on the major population health issue of adequate and appropriate food. Lack of adequate nutrition may result in worsening medical problems and increased health care costs. VA health care providers must be cognizant of this important issue. Aggressive proactive management with outpatient dietary screening is necessary to ensure all veterans, especially the homeless and elderly, receive the medical and nonmedical care they deserve.