Relationships between nutrition screening checklists and the health and well-being of older Australian women

Speaking the same language: Development of a Nutrition Minimum Data Set for healthcare professionals in primary healthcare

Providing the best possible nutritional care requires accurate and precise communication between healthcare professionals. Developing a Nutrition Minimum Data Set will inform professionals in primary healthcare of which core elements should be documented and facilitate a standardized approach to the documentation of nutritional care. A two-step methodological approach was utilized in this study: (1) a systematic scoping review was conducted to map evidence underpinning the development of a Minimum Data Set and (2) the datasources were categorized using the inductive content analysis approach. A total of 32 items were identified in the datasources. Five categories were inductively derived from the data: (1) physiologic measurements, (2) ability to eat, (3) intake, (4) stress factors and (5) factors which indirectly affect intake and needs. Organizing the documentation following the structure presented in this Minimum Data Set will contribute to a standardized terminology, which may lead to increased quality of documentation, increased continuity of care and improved health outcomes.

Validation, reliability and operational equivalency of the nutritional screening method “Determine The Nutritional Health Of The Elderly”

Abstract Objective: To analyze the reliability, validity and operational equivalence of the nutritional screening method "Assessing The Nutritional Condition Of The Elderly". Method: This study was conducted with a subsample of 174 elderly persons from the Health, Welfare and Aging (SABE) study. The “Assessing The Nutritional Condition Of The Elderly” method consists of ten questions which classify individuals according to nutritional risk. Anthropometric and nutritional indicators were adopted as gold standard measures for comparison with the values of the method. Reliability was verified using the McNemar and Bland Altman tests, the validity of the discriminant type was assessed by the Mann-Whitney test and operational equivalence was identified through data relating to the time required to apply the method and the degree of understanding of the same using the Likert scale (1 to 5). Results: Of the 174 elderly persons interviewed, 63.8% were women and 52.3% were in the 60-74 years age group. It was found that 43.1% and 33.3% of the subjects had moderate to high nutritional risk, respectively, with a higher prevalence of high nutritional risk among women (33.3%) and those aged 60-74 years (43.4%). The method analyzed showed satisfactory results for reliability and discriminant validity. The average time required to apply this method was approximately seven minutes and the overall mean grade of understanding was 4.8. Conclusion: The method studied can be used by health professionals in epidemiological and clinical studies to identify the presence of nutritional risk in elderly persons living at home.

Validity assessment of the nutrition screening initiative checklist in older adults

OBJECTIVE

To ascertain whether the NSI (Nutrition Screening Initiative Checklist) is a valid screening instrument for diagnosing nutritional risk in an older population from a medium-size city in the south of Brazil.

METHODS

The study population comprised individuals aged 60 years or older selected from a population-based cross-sectional survey. Data collection was carried out at two different timepoints: first, the NSI (instrument under test) was applied and later a dietary recall (gold standard) based on the previous day. Validity analyses were performed based on sensitivity and specificity as well as the Receiver Operating Characteristic Curve.

RESULTS

A total of 183 older adults were studied. Agreement between the dietary recall and the NSI for positive and negative results was 54.6%.The sensitivity and specificity values were low for all cut-off points of the instrument. The area under the curve was 0.52 (95%CI: 0.44-0.62) for the cut-off point ≥6.

CONCLUSION

Based on sensitivity and specificity values, the NSI proved ineffective for application in the population studied.

The BRIGHT Trial: what are the factors associated with nutrition risk?

OBJECTIVES

To determine the nutrition risk status and factors associated with nutrition risk among older adults enrolled in the Brief Risk Identification Geriatric Health Tool (BRIGHT Trial).

DESIGN

A cluster randomised controlled trial.

SETTING

Three main centres in New Zealand.

PARTICIPANTS

A total of 3,893 older adults were recruited from 60 general practices in three of the District Health Board (DHB) regions aged 75 years and older (or 65 years and older if Māori).

MEASUREMENTS

Nutrition risk was assessed using the Australian Nutrition Screening Initiative (ANSI). Validated questionnaires were used to establish quality of life (WHOQOL-BREF), physical function (the Nottingham Extended Activities of Daily Living) and depressive symptoms (15 item Geriatric Depression Scale). Demographic, standard of living and health data were established.

RESULTS

Sixty two percent of participants were identified to be at moderate or high nutrition risk. The mean ANSI score was 4.9 (range 0-21, maximum 29). Factors which independently predicted moderate or high nutrition risk were female gender, being Māori and other ethnicities versus European, not being married, taking multiple medications, having more depressive symptoms, cardiovascular disease and diabetes. Protective factors independently related to low nutrition risk were living with others, higher physical and social health related QOL and higher functional status. WHOQOL environmental and psychological factors were not associated with nutrition risk when other predictive factors were taken into account.

CONCLUSION

Nearly two thirds of participants were identified to be at higher nutrition risk. Women, living alone, taking multiple medications, with depressive symptoms, cardiovascular disease and ndiabetes were factors associated with higher nutrition risk. Those at low nutrition risk had a better functional status and physical and social health related QOL.

Nutritional screening strategy in nonagenarians: the value of the MNA-SF (mini nutritional assessment short form) in NutriAction

OBJECTIVES

To identify older subjects at risk of malnutrition using the most appropriate tool available for the specific setting and to evaluate the Mini Nutritional Assessment short form (MNA-SF) in a sample of nonagenarians.

DESIGN

Questionnaire based national screening week for the risk and prevalence of malnutrition in older people (NutriAction).

SETTING

Older people in the community (CD) and in nursing homes (NH).

PARTICIPANTS

General practices (n=70) and Nursing Homes (n=70).

MEASUREMENTS

Questionnaire based on items from validated screening instruments: the MNA-SF, the Short Nutritional Assessment Questionnaire (SNAQ) and additional clinically relevant parameters (mobility, independence, social isolation and co-morbidities).

RESULTS

In total 5,334 people were screened of which 16% were aged over 90 years. In this age group, 66% of the screened individuals were at risk of malnutrition (MNA ≤ 11), and women were affected significantly more than men (p<0.001). Actual malnutrition was present in 22% (BMI <20), 20% (SNAQ) and 25% (clinical evaluation). The MNA appeared to be very sensitive but had a low specificity as well in the nonagenarians (98% and 44%) as in the younger old (97% and 52%). The SNAQ was not a sensitive tool for detecting malnutrition in this study population (25%). Although clinical impression had a low sensitivity (60-61%) it has a good specificity (86% in 90+ and 91% below 90yr).

CONCLUSION

The overall risk of and the prevalence of malnutrition is common in older people. The prevalence is higher in women, in nursing homes and in older age groups. The MNA-SF followed by a clinical subjective evaluation seems to be the preferred strategy for detecting malnutrition in nonagenarians.

The impact of education, cultural background, and lifestyle on symptoms of the menopausal transition: the Women's Health at Midlife Study

AIMS

This study aimed to examine differences in symptom clusters among women in midlife from different cultural origins and to identify sociodemographic, lifestyle, and health characteristics that could account for the differences between the cultural groups in symptom reporting.

METHODS

Israeli women aged 45-64 were randomly selected according to age and population strata of three groups: long-term Jewish residents (LTR), Jewish immigrants from the former Soviet Union, and Arab women (mostly Israeli-born). Interviews were conducted with 540 LTR, 151 immigrants, and 123 Arab women. The survey instrument included the occurrence and rating of how bothersome to everyday function were 16 symptoms. Three outcome variables included hot flashes and two scales for mental and somatic symptoms extracted from exploratory factor analysis.

RESULTS

Multivariate logistic regressions showed that immigrants and Arab women (compared to LTR) had a significantly lower risk of reporting hot flashes and mental and somatic symptoms. Menopausal status was related only to hot flashes. Low education and depression were associated with the three symptom scales, whereas nonhealthy lifestyle was related only to somatic symptoms.

CONCLUSIONS

Our main finding is that cultural group is an independent predictor of each of the three menopausal symptom scales. A possible explanation for the lower reporting of symptoms among Arab and immigrant groups is that they differ from the LTR in level of acculturation and attitudes toward menopause. These findings support the proposition of a cultural factor in menopausal symptomatology that needs to be addressed by clinicians caring for women at midlife.

Exercise and nutrition in older Canadian women: opportunities for community intervention

BACKGROUND

The objectives of this study were to examine age differences in the extent to which older Canadian women exercise and eat nutritiously, and to identify the interventions they desire to help them adopt and maintain physical and nutritional fitness.

METHODS

A cross-sectional postal survey of 5,000 community-dwelling women aged 55-95 was conducted across Canada in October 2003. The survey queried exercise frequency, nutritional risk, functional status, and factors deemed facilitative to adopting and maintaining a physically fit and nutritiously healthy lifestyle.

RESULTS

Data from 2,484 women were available for analysis; 31% were 75 years and older. Among women aged 55-74 versus those over age 75, 62% compared to 56% reported exercising 3 times/week for 20 minutes or longer (p = 0.003), 33% in both age groups were eating nutritiously, and 24% compared to 21% were both exercising and eating nutritiously. Thirty-five percent of women aged 55-74 who were not exercising or eating nutritiously desired increased availability of low-cost, suitable health promotion programs and additional written materials to improve these health habits, compared to 25% of women in the 75 year and older group (p < 0.001). Improved transportation to programs was the only intervention preferred by women aged 75 years and older (OR 1.66 (1.30-2.11)). Sedentary women and those at higher nutritional risk were two to three times more likely to identify encouragement from health professionals (OR 1.93 (1.48-2.52)), as well as from family and friends (OR 3.03 (1.89-4.85)) as important facilitators.

INTERPRETATION

Women aged 55-74 who do not exercise and eat nutritiously are most receptive to a variety of health-promoting community interventions.

Nutritional screening and assessment tools for older adults: literature review

AIM

This paper reports a literature review to examine the range of published tools available for use by nurses to screen or assess nutritional status of older adults, and the extent to which validity, reliability, sensitivity, specificity and acceptability of the tools has been addressed.

BACKGROUND

The incidence of malnutrition in older adults is high. One method by which malnutrition or risk of malnutrition can be detected is by the use of nutritional screening or assessment tools.

METHODS

A comprehensive literature review methodology was employed. A variety of electronic databases were searched for the period 1982-2002. Search terms incorporating nutrition, screening, validity, reliability and sensitivity and specificity were combined to retrieve relevant literature. In addition, manual searches were conducted and articles retrieved from those listed in key papers. In this paper, nutritional screening or assessment tools are described as tools which use a questionnaire-type format containing more than one risk factor for malnutrition, and give a quantitative or categorical assessment of risk.

RESULTS

Seventy-one nutritional tools were located, 21 of which were identified as designated for use with an older population. A wide variety of risk factors for malnutrition are used with the tools, ranging from objective measurements to subjective assessment. Some tools identify an action plan based on the score obtained. Many tools appear not to have been subjected to validity and/or reliability testing but are used clinically.

CONCLUSIONS

As malnutrition is present in the older adult population, nutritional assessment and screening tools can be useful to highlight those in need of a nutritional care plan. However, many have not been subjected to evaluation and consequently may not demonstrate sensitivity and/or specificity in clinical use. The decision to use a particular tool should therefore be considered carefully.

Perceived stress as a predictor of the self-reported new diagnosis of symptomatic CHD in older women

This article describes one aspect of a prospective cohort study of 10,432 women aged between 70 and 75 years. After a 3-year period, 503 women self-reported a new diagnosis by a doctor of angina or myocardial infarction (symptomatic coronary heart disease [CHD]). Time one psychosocial variables (Duke Social Support Index, time pressure, Perceived Stress Scale, Mental Health Index, having a partner, educational attainment, and location of residence) were analyzed using univariate binary logistic regression for their ability to predict subsequent symptomatic CHD. Of these variables, the Duke Social Support Index, Perceived Stress Scale and the Mental Health Index were found to be significant predictors of symptomatic CHD diagnosis. Only the Perceived Stress Scale, however, proved to be a significant independent predictor. After controlling for time one nonpsychosocial variables, as well as the frequency of family doctor visits, perceived stress remained a significant predictor of the new diagnosis of symptomatic CHD in this cohort of older women over a 3-year period.