DIETITIANS’ USE AND PERCEPTIONS OF NUTRITION SCREENING TOOLS FOR THE OLDER ADULT

Malnutrition is a significant issue affecting the health of many adults over the age of 65. Screening for malnutrition in this population can help identify those in need of a complete nutritional assessment. Many screening tools have been developed to aid healthcare team members in identifying those at risk for malnutrition. A population of dietitians with a focus in older adult nutrition was surveyed to determine dietitians’ perceptions and use of screening tools for the older adult. The results of the study showed many dietitians did not use validated screening tools at their place of work and were not confident in their knowledge regarding the topic. Despite dietitians’ having the expertise in nutrition, other interdisciplinary team members are performing the screening in many settings in the United States and some dietitians’ feel this is an obstacle in identifying older adults at risk

Nutrition screening tools and the prediction of clinical outcomes among Chinese hospitalized gastrointestinal disease patients

Background/Objective: Nutritional Risk Screening 2002 (NRS-2002) and Subjective Global Assessment (SGA) are widely used screening tools, but there is no gold standard for identifying nutritional risk. The purpose of this study was to assess the nutritional risk among hospitalized gastrointestinal disease patients, the agreement between NRS-2002 and SGA, and to compare the clinical outcome predicting capacity of them. Subjects/Method: This study was an analysis of secondary data including 332 patients collected by gastrointestinal department of Peking Union Medical College Hospital (PUMCH). All questions of NRS-2002 and SGA, complications, length of hospitalization stay (LOS), cost, and death were collected. To assess the agreement between the tools, κ statistic was adopted. Before assessing the performance of NRS-2002 and SGA in predicting LOS and cost using linear regression, full and saturated model was compared via the global f-test. The complications and death predicting capacity of tools was assessed using receiver operating characteristic curves. Results: NRS-2002 and SGA identified nutritional risk at 59.04% and 45.18%. The agreement between two tools was moderate (κ index \u3e0.50) for all age groups except individuals aged ≤ 20, which was slight agreement (κ index 0.087). The saturated model did not improve the outcomes of LOS and cost. There was no significant difference in the association of one step of NRS-2002 and LOS (B=2.127, p=0.002) and the association of one step of SGA and LOS (B=2.296, p=0.001). One step of SGA was associated with a relatively large increase in cost (B=0.272, p=0.001) compared to one step of NRS-2002 (B=0.086, p=0.000), but the difference was not significant. There was no difference of NRS-2002 (infectious complications: 0.615, death 0.810) and SGA (infectious complications: 0.600, death: 0.846) in predicting infectious complication and death, but NRS-2002 (0.738) had larger areas under ROC curve than SGA (0.552) in predicting non-infectious complications. Conclusion: The prevalence of nutritional risk of hospitalized patients was high. There was moderate agreement between NRS-2002 and SGA for all ages except ≤ 20 age group. NRS-2002 and SGA have similar capacity to predict LOS, cost, infectious complications and death, but NRS-2002 seems to perform better in predicting non-infectious complications

The prevalence of nutrition risk and associated risk factors among older adults recently admitted to age-related residential care within the Waitemata District Health Board region : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Auckland, New Zealand

Background: New Zealand has a rapidly growing ageing population, aligned with the ageing population trend occurring globally. Older adults account for a significant proportion of the government health care expenditure, primarily due to higher needs for disability services and a higher level of care, such as residential care. Malnutrition is multi-factorial and may result in disability and poor health contributing to a significant decline in the independence in older adults. Internationally, previous research has found a high prevalence of malnutrition among older adults in the residential care setting. This study aims to investigate the prevalence of malnutrition and associated risk factors among older adults (aged 64 to 84 years) newly admitted to residential care facilities across the Waitemata District Health Board (WDHB) region. Methods: A cross-sectional study was undertaken among older adults newly admitted to WDHB residential care facilities. A questionnaire was used to assess participant sociodemographic and health characteristics. Anthropometric and body composition measurements were recorded. Grip strength was measured using a handgrip dynamometer and gait speed was measured by a 2.4m walk test. Nutrition risk was assessed using the Mini Nutritional Assessment- Short Form (MNASF), dysphagia risk was determined from the 10-item Eating Assessment Tool (EAT-10) and the Montreal Cognitive Assessment (MoCA) examined cognitive function. Results: The mean age of participants was 78.7 ± 5.0 years. Of 77 participants, just under half (45.5%) were malnourished with a further 49.4% were at high nutrition risk. Over a third (37.7%) of participants were at dysphagia risk. Malnourished participants were more likely to require daily help prior to admission (p=0.011) and have a slower gait speed (p=0.014). A higher nutrition risk (lower MNA-SF score) was strongly correlated with a lower BMI (r=0.274, p=0.024), grip strength (r=0.368, p=0.001), higher dysphagia risk (r=-0.248, p=0.029) and higher medication use (r=-0.213, p=0.043). Conclusion: Nearly half the participants were malnourished, and over a third were at risk of dysphagia. This study highlights that low BMI, grip strength and higher dysphagia risk and medication use are potential risk factors for malnutrition. Findings highlight the importance of malnutrition and dysphagia screening among older adults upon admission to residential care. This will ensure appropriate diagnosis and treatment for those identified at risk

Nutrition screening tools for risk of malnutrition among hospitalized patients

Background: Malnutrition is a clinical problem with a high prevalence in hospitalized adult patients. Many nutritional screening tools have been developed but there is no consensus on which 1 is more useful. The purpose of this review protocol is to provide an overview of which nutritional screening tool is most valid to identify malnutritional risk in hospitalized adult patients and to analyze the sensitivity and specificity of the different tools. Methods: The protocol of this systematic review and meta-analysis was registered on the INPLASY website (https://inplasy.com/inplasy-2020-9-0028/) and INPLASY registration number is INPLASY202090028. We will perform a systematic literature search of main databases: PubMed, EMBASE, CINAHL and Web of Science and the Cochrane database. Also, grey literature will be search. Peer-reviewed studies published in English, Portuguese or Spanish language will be selected. Screening of titles, abstract and full text will be assessed for eligibility by 2 independent blinded reviewers and any discrepancies will be resolved via consensus. After screening the studies, a meta-analysis will be conducted, if it is possible. Results: Results from this systematic review will help health professionals to identify malnutrition in hospitalized patients and to make decisions to prevent or treat it as well as provide new clues to researchers. Conclusion: Our systematic review will provide aknowledge about the most valid malnutrition risk screening tool in hospitalized adult patients

Optimising nutrition in residential aged care: A narrative review

In developed countries the prevalence of protein-energy malnutrition increases with age and multi-morbidities increase nutritional risk in aged care residents in particular. This paper presents a narrative review of the current literature on the identification, prevalence, associated risk factors, consequences, and management of malnutrition in the <i>residential aged care (RAC)</i> setting. We performed searches of English-language publications on <i>Medline, PubMed, Ovid and the Cochrane Library</i> from January 1 1990 to November 25 2015. We found that, on average, half of all residents in aged care are malnourished as a result of factors affecting appetite, dietary intake and nutrient absorption. Malnutrition is associated with a multitude of adverse outcomes, including increased risk of infections, falls, pressure ulcers and hospital admissions, all of which can lead to increased health care costs and poorer quality of life. A number of food and nutrition strategies have demonstrated positive nutritional and clinical outcomes in the <i>RAC</i> setting. These strategies extend beyond simply enhancing the nutritional value of foods and hence necessitate the involvement of a range of committed stakeholders. Implementing a nutritional protocol in <i>RAC</i> facilities that comprises routine nutrition screening, assessment, appropriate nutrition intervention, including attention to food service systems, and monitoring by a multidisciplinary team can help prevent decline in residents’ nutritional status. Food and nutritional issues should be identified early and managed on admission and regularly in the <i>RAC</i> setting