Too Little Food, Too Many Hospitalizations
Food might not qualify as medicine, but an inadequate amount of it could be a factor in repeated hospitalizations, according to a study by an Einstein Healthcare Network researcher.
The report, cited in several publications, found that many patients who are frequently hospitalized have “food insecurity”—often worried about having enough food and, at times, forced to go without eating or to reduce portions because they can’t afford to buy more.
“Without access to sufficient and healthful food, patients simply cannot care for their own health, cannot comply with diet regimens, cannot promote healing,” said Etienne Phipps, PhD (right), lead author on the study recently published in Population Health Management, a peer-reviewed journal about health care management and quality.
Editor-in-chief David Nash, MD, said the research would provide “important insights for healthcare providers who are working to help vulnerable populations avoid hospitalizations.”
A team led by Dr. Phipps, director of Einstein’s Center for Urban Health Policy, surveyed 40 adults who’d been hospitalized at Einstein Medical Center Philadelphia three or more times in the previous 12 months. Most of them were hospitalized five times in the previous year. The study was conducted in conjunction with the International Society for Pharmacoeconomics and Outcomes Research of Lawrenceville, N.J.
The majority of patients who answered the 27-question survey were African American women; the average age was 60.5 years. Most of them had more than six chronic conditions, including diabetes, hypertension, reflux disease and coronary artery disease.
According to the study, 16 patients—40 percent of the participants—said, in the past 30 days, they “worried that their food would run out”; 14 said the food had not lasted the month; seven “did not eat for a full day,” and four said they were “hungry but did not eat.”
One 66-year-old patient explained “At the end of the month, I don’t have money really,” she said. “By the time you buy personal, household … you’ve got to have coffee, you’ve got to pay your copay for doctors … I go to doctors a lot, transportation, gas.” The patient said when she’s out of money, she relies on her daughter for food. “I go the first of the month and buy what I can and when it goes, it goes,” she said.
The study also found that three out of four patients were unable to shop for food on their own for lack of transportation. Nearly six out of 10 were unable to prepare their own food; one woman said, for instance, her wheelchair is eye level with the stove and she can’t see into a pot on a burner.
Food insecurity is not the same as hunger, as defined by the US Department of Agriculture. The federal agency defines food insecurity as “household-level economic and social condition of limited or uncertain access to adequate food,” and hunger as “an individual-level physiological condition that may result from food insecurity.”
As the nation’s health care community focuses on ways to improve population health and keep people from being hospitalized repeatedly—which is a financial drain on health care system—patients’ nonmedical issues, such as access to food, are a crucial part of the equation.
“Recognition of the problem is an important step,” Phipps said. Einstein’s Kineret Shakow, EdD, director, Women and Childrens Education, works with SHARE to provide nutrition education at the food banks. “This isn’t just a research agenda but more importantly, a social one,” she said.