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Geary R, Mantik J, Moore V, Schuller J, Fedoruk R, Atkins M, Chan CB. COMmunity-Based Nutrition RISK Screening in Older Adults Living Independently (COMRISK): Feasibility, Acceptability, and Appropriateness of Community Partnership Models in Alberta, Canada. Can J Aging 2024; 43:287-296. [PMID: 37811554 DOI: 10.1017/s0714980823000582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
This feasibility study of routine nutrition risk screening in community-dwelling older adults using a partnership between health care and community-based organizations (CBO) aimed to (1) evaluate the ability of community-based partnerships to provide screening for nutrition risk, and appropriately refer at-risk individuals for follow-up care and (2) determine the barriers to and facilitators of screening. Adults 65 years of age and older were screened by staff in two primary care and one CBO setting using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN)-8 nutrition risk screening tool. Screeners, organization administrators, and registered dietitians responded to surveys regarding SCREEN-8 administration, referral processes, and partnership interactions. All found the SCREEN-8 initiative feasible, acceptable, and appropriate. Sustainability requires strengthening of community resources, referral processes, and telephone assessments. The partnership added value despite limitations in communications. We conclude that broader implementation of this program using community-based partnerships has the potential to aid in the prevention of malnutrition in older adults.
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Affiliation(s)
- Rebecca Geary
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Jessica Mantik
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Valerie Moore
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Jessica Schuller
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Rani Fedoruk
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Marlis Atkins
- Nutrition Services, Alberta Health Services, Edmonton, AB, Canada
| | - Catherine B Chan
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
- Department of Physiology, University of Alberta, Edmonton, AB, Canada
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Fedoruk R, Olstad H, Watts L, Morrison M, Ward J, Popeski N, Atkins M, Chan CB. Community-Based Nutrition Risk Screening in Older Adults (COMRISK): An Exploration of the Experience of Being Screened and Prevalence of Nutrition Risk in Alberta, Canada. Can J Aging 2023:1-11. [PMID: 37974476 DOI: 10.1017/s0714980823000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
The objectives of this feasibility study were to measure the prevalence of nutrition risk in community-dwelling older adults (CDOA, ages ≥ 65 years) and explore the perspectives of CDOA of the acceptability, value, and effectiveness of nutrition risk screening in primary care and community settings. Using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN)© eight-item tool (n = 276), results indicated that moderate and high nutrition risks affected 50 per cent and 8 per cent, respectively, of those screened. Interviewees (n = 16) agreed that screening is acceptable, important, and valuable (Theme One). Effectiveness was unclear, as only 3 of 16 respondents recalled being told their nutrition risk status. When articulating nutrition-related issues, a food security theme, expressed in the third person, was prominent (Theme Two). Screening for nutrition risk and receiving nutrition information in community-based settings are acceptable to CDOA and medically necessary, as evidenced by the high proportion of CDOA at moderate-high nutrition risk.
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Affiliation(s)
- Rani Fedoruk
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Heidi Olstad
- Nutrition Services, Alberta Health Services, Red Deer, AB, Canada
| | - Lori Watts
- Red Deer Primary Care Network, Red Deer, AB, Canada
| | - Monica Morrison
- Golden Circle Senior Resource Centre (retired), Red Deer, AB, Canada
| | - Jill Ward
- Peaks to Prairies Primary Care Network, Olds, AB, Canada
| | - Naomi Popeski
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
| | - Marlis Atkins
- Nutrition Services, Alberta Health Services, Edmonton, AB, Canada
| | - Catherine B Chan
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
- Department of Physiology, University of Alberta, Medical Sciences Building, Edmonton, AB, Canada
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Middleton LE, Freeman S, Pelletier C, Regan K, Donnelly R, Skinner K, Wei C, Rossnagel E, Nasir HJ, Albisser T, Ajwani F, Aziz S, Heibein W, Holmes A, Johannesson C, Romano I, Sanchez L, Butler A, Doggett A, Buchan MC, Keller H. Dementia resources for eating, activity, and meaningful inclusion (DREAM) toolkit co-development: process, output, and lessons learned. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:87. [PMID: 37775790 PMCID: PMC10542247 DOI: 10.1186/s40900-023-00497-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023]
Abstract
Promoting wellbeing of persons with dementia and their families is a priority of research and practice. Engaging diverse partners, including persons with dementia and their families, to co-develop interventions promotes relevant and impactful solutions. We describe the process, output, and lessons learned from the dementia resources for eating, activity, and meaningful inclusion (DREAM) project, which co-developed tools/resources with persons with dementia, care partners, community service providers, health care professionals, and researchers with the aim of increasing supports for physical activity, healthy eating, and wellbeing of persons with dementia. Our process included: (1) Engaging and maintaining the DREAM Steering Team; (2) Setting and navigating ways of engagement; (3) Selecting the priority audience and content; (4) Drafting the toolkit; (5) Iterative co-development of tools and resources; (6) Usability testing; and (7) Implementation and evaluation. In virtual meetings, the DREAM Steering Team confirmed the toolkit audiences (primary: community service providers; secondary: persons with dementia and care partners) and identified and evolved content areas. An environmental scan identified few existing, high-quality resources aligned with content areas. The Steering Team, additional multi-perspective partners, and external contractors iteratively co-developed new tools/resources to meet gaps over a 4-month virtual process that included virtual meetings, email exchange of documents and feedback, and one-on-one calls by telephone or email. The final DREAM toolkit includes a website with seven learning modules (on the diversity of dementia, rights and inclusion of persons living with dementia, physical activity, healthy eating, dementia-inclusive practices), a learning manual, six videos, nine handouts, and four wallet cards ( www.dementiawellness.ca ). Our co-development participants rated the process highly in relation to the principles and enablers of authentic partnership even though all engagement was virtual. Through use of the co-developed DREAM toolkit, we anticipate community service providers will gain the knowledge and confidence needed to provide dementia-inclusive wellness programs and services that benefit persons with dementia and their families.
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Affiliation(s)
- Laura E Middleton
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada.
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada.
| | - Shannon Freeman
- University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Chelsea Pelletier
- University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Kayla Regan
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Rachael Donnelly
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Kelly Skinner
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Cindy Wei
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Emma Rossnagel
- University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Huda Jamal Nasir
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Tracie Albisser
- Active Health Solutions, 150 - 556 North Nechako Road, Prince George, BC, V2K 1A1, Canada
| | - Fatim Ajwani
- University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada
| | - Sana Aziz
- Alzheimer Society of B.C., 828 W 8Th Ave Suite 300, Vancouver, BC, V5Z 1E2, Canada
| | - William Heibein
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Ann Holmes
- Active Health Solutions, 150 - 556 North Nechako Road, Prince George, BC, V2K 1A1, Canada
| | - Carole Johannesson
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Isabella Romano
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Louisa Sanchez
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Alexandra Butler
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Amanda Doggett
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - M Claire Buchan
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Heather Keller
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada
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Mills CM, Trinca V. The Evidence for Screening Older Adults for Nutrition Risk in Primary Care: An Umbrella Review. CAN J DIET PRACT RES 2023; 84:159-166. [PMID: 36920030 DOI: 10.3148/cjdpr-2022-043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
It is not known if nutrition risk screening of older adults should be a standard practice in primary care. The evidence in support of nutrition risk screening of older adults in primary care was examined and critically analyzed using an umbrella review. The peer reviewed and grey literature were searched for clinical practice guidelines (CPGs) and systematic reviews (SRs). Titles and abstracts were independently screened by the two authors. Resources were excluded if they did not apply to older adults, did not discuss nutrition/malnutrition risk screening, or were in settings other than primary care. Full texts were independently screened by both authors, resulting in the identification of six CPGs and three SRs that met the review criteria. Guidelines were appraised with the AGREE II tool and SRs with the AMSTAR 2 tool. The quality of the CPGs was high, while the quality of the SRs was low. The CPGs and SRs acknowledged a lack of high-quality research on the benefits of regular nutrition risk screening for older adults in primary care; however, CPGs recommended annual screening for older adults in primary care practices or other community settings. High-quality research investigating nutrition risk screening of older adults in primary care is needed.
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Affiliation(s)
- Christine Marie Mills
- Aging & Health Program, School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Vanessa Trinca
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Keller HH, Trinca V. Determinants of a decline in a nutrition risk measure differ by baseline high nutrition risk status: targeting nutrition risk screening for frailty prevention in the Canadian Longitudinal Study on Aging (CLSA). CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:593-612. [PMID: 36947396 PMCID: PMC10349003 DOI: 10.17269/s41997-023-00745-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/13/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES Nutrition risk is a key component of frailty and screening, and treatment of nutrition risk is part of frailty management. This study identified the determinants of a 3-year decline in nutrition risk (measured by SCREEN-8) for older adults stratified by risk status at baseline. METHODS Secondary data analysis of the comprehensive cohort sample of the Canadian Longitudinal Study on Aging (CLSA) (n = 5031) with complete data for covariates at baseline and 3-year follow-up. Using a conceptual model to define covariates, determinants of a change in nutrition risk score as measured by SCREEN-8 (lower score indicates greater risk) were identified for those not at risk at baseline and those at high risk at baseline using multivariable regression. RESULTS Models stratified by baseline nutrition risk were significant. Notable factors associated with a decrease in SCREEN-8 for those not at risk at baseline were mental health diagnoses (- 0.83; CI [- 1.44, -0.22]), living alone at follow-up (- 1.98; CI [- 3.40, -0.56]), and lack of dental care at both timepoints (- 0.91; CI [- 1.62, -0.20]) and at follow-up only (- 1.32; CI [- 2.45, -0.19]). For those at high nutrition risk at baseline, decline in activities of daily living (- 2.56; CI [- 4.36, -0.77]) and low chair-rise scores (- 1.98; CI [- 3.33, - 0.63]) were associated with lower SCREEN-8 scores at follow-up. CONCLUSION Determinants of change in SCREEN-8 scores are different for those with no risk and those who are already at high risk, suggesting targeted approaches are needed for screening and treatment of nutrition risk in primary care.
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Affiliation(s)
- Heather H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada.
| | - Vanessa Trinca
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Mills CM, Keller HH, DePaul VG, Donnelly C. Nutrition risk varies according to social network type: data from the Canadian Longitudinal Study on Aging. Fam Med Community Health 2023; 11:fmch-2022-002112. [PMID: 36813466 PMCID: PMC9950914 DOI: 10.1136/fmch-2022-002112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE There were two primary objectives, namely: (1) to determine the social network types that Canadian adults aged 45 and older belong to and (2) to discover if social network type is associated with nutrition risk scores and the prevalence of high nutrition risk. DESIGN A retrospective cross-sectional study. SETTING Data from the Canadian Longitudinal Study on Aging (CLSA). PARTICIPANTS 17 051 Canadians aged 45 years and older with data from baseline and first follow-up of the CLSA. RESULTS CLSA participants could be classified into one of seven different social network types that varied from restricted to diverse. We found a statistically significant association between social network type and nutrition risk scores and percentage of individuals at high nutrition risk at both time points. Individuals with restricted social networks had lower nutrition risk scores and are more likely to be at nutrition risk, whereas individuals with diverse social networks had higher nutrition risk scores and are less likely to be at nutrition risk. CONCLUSIONS Social network type was associated with nutrition risk in this representative sample of Canadian middle-aged and older adults. Providing adults with opportunities to deepen and diversify their social networks may decrease the prevalence of nutrition risk. Individuals with more restricted networks should be proactively screened for nutrition risk.
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Affiliation(s)
| | - Heather H Keller
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada,Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Vincent Gerard DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada,Health Services and Policy Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada,Health Services and Policy Research Institute, Queen's University, Kingston, Ontario, Canada
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Donnelly R, Devlin K, Keller H. Letter to the Editor: Dietitian Perspectives: Are We Ready for Nutrition Risk Screening in Community and Primary Care? J Nutr Health Aging 2022; 26:211-212. [PMID: 35166318 PMCID: PMC8821858 DOI: 10.1007/s12603-022-1735-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- R Donnelly
- Dr. Heather Keller, University of Waterloo, 200 University Ave W., Waterloo, Ontario, N2L 3G1, Canada, ; 519-888-4567, ext. 31761
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Harnessing Stakeholder Perspectives and Experience to Address Nutrition Risk in Community-Dwelling Older Adults. Healthcare (Basel) 2021; 9:healthcare9040477. [PMID: 33923674 PMCID: PMC8074173 DOI: 10.3390/healthcare9040477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 01/10/2023] Open
Abstract
Community-dwelling, older adults have a high prevalence of nutrition risk but strategies to mitigate this risk are not routinely implemented. Our objective was to identify opportunities for the healthcare system and community organizations to combat nutrition risk in this population in the jurisdiction of Alberta, Canada. An intersectoral stakeholder group that included patient representatives was convened to share perspectives and experiences and to identify problems in need of solutions using a design thinking approach. Results: Two main themes emerged from the workshop: (1) lack of awareness and poor communication of the importance of nutrition risk between healthcare providers and from healthcare providers to patients and (2) the necessity to work in partnerships comprised of patients, community organizations, healthcare providers and the health system. Conclusion: Improving awareness, prevention and treatment of malnutrition in community-dwelling older adults requires intersectoral cooperation between patients, healthcare providers and community-based organizations.
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Keller H, Donnelly R, Laur C, Goharian L, Nasser R. Consensus-Based Nutrition Care Pathways for Hospital-to-Community Transitions and Older Adults in Primary and Community Care. JPEN J Parenter Enteral Nutr 2021; 46:141-152. [PMID: 33417240 DOI: 10.1002/jpen.2068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/10/2020] [Accepted: 01/05/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Practical guidance for providers on preventing, detecting, and treating malnutrition in primary care (PC) and the community is limited. The purpose of this study was to develop nutrition care pathways for adult patients (aged ≥18 years) transitioning from hospital to community and community-dwelling older adults (aged ≥65 years) who are at risk for malnutrition. METHODS A review of best-practice nutrition evidence and guidelines published between 2009 and 2019 was performed using PubMed and CINAHL. Findings were summarized into two draft care pathways by the Primary Care Working Group of the Canadian Malnutrition Task Force. Diverse stakeholders (n = 21) reviewed and suggested revisions at a 1-day meeting. Revisions were made and an online survey was conducted to determine the relevance and importance of discrete care practices, and to establish consensus for which practices should be retained in the pathways. Providers (e.g., dietitians, physicians, nurses; n = 291) across healthcare settings completed the survey. Consensus on relevance and importance of practices was set at ≥80%. RESULTS One hundred twenty-eight resources were identified and used to develop the draft pathways. Survey participants assigned ratings of ≥80% for relevance and importance for all nutrition care practices, except community service providers monitoring patient weight and appetite. CONCLUSION These evidence- and consensus-based nutrition pathways offer guidance to healthcare and service providers on how to deliver nutrition care during hospital-to-community transitions for malnourished adult patients and community-dwelling older adults at risk for malnutrition. These pathways are flexible for diverse PC and community models.
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Affiliation(s)
- Heather Keller
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2L 3G1, Canada.,Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Dr, Waterloo, Ontario, N2J 0E2, Canada
| | - Rachael Donnelly
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2L 3G1, Canada
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care and Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.,NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cowley Road, Cambridge, CB4 0WS, United Kingdom
| | - Leila Goharian
- Evergreen Community Health Centre, Vancouver Coastal Health, 3425 Crowley Dr, Vancouver, British Columbia, V5R 6G3, Canada
| | - Roseann Nasser
- Nutrition and Food Services, Pasqua Hospital, 4101 Dewdney Ave, Regina, Saskatchewan, S4T 1A5, Canada
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Fanelli Kuczmarski M, Stave Shupe E, Pohlig RT, Rawal R, Zonderman AB, Evans MK. A Longitudinal Assessment of Diet Quality and Risks Associated with Malnutrition in Socioeconomic and Racially Diverse Adults. Nutrients 2019; 11:nu11092046. [PMID: 31480661 PMCID: PMC6770204 DOI: 10.3390/nu11092046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 01/07/2023] Open
Abstract
Little is known about the effects of diet quality through adulthood and its association with malnutrition later in life. The first research objective was to evaluate diet quality assessed by Mean Adequacy Ratio (MAR) of United States African American and White adults (n = 2066), examined at baseline and two follow-up waves in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. The sample was split into cohorts by age at study baseline: Younger, <50, and older, ≥50 years. The second objective was to assess the association of MAR and risk for malnutrition in adults who were ≥60 years at wave 4 (n = 746). The Mini Nutritional Assessment was used to determine risk for malnutrition. At each of the three study waves, 17 micronutrients from two 24 h dietary recalls were used to calculate MAR. Over 13 years MAR changed minimally in the younger cohort as they aged from early to middle adulthood. In contrast, a statistically significant decline in MAR was observed for the older cohort between baseline (2004–2009) and wave 4 (2013–2017), with a greater degree of worsening at low energy levels. The risk for malnutrition was significantly associated with consuming a diet low in energy, lower protein as a percent of energy at baseline, as well as being food insecure, a current smoker, and having income <125% poverty. The risk for malnutrition was not associated with a change in protein intake in years prior to age 60, change in MAR scores across waves, MAR at wave 4, age, sex, race, or having hypertension or diabetes. These longitudinal study findings revealed that diet quality was not predictive of risk for malnutrition.
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Affiliation(s)
- Marie Fanelli Kuczmarski
- Department of Behavioral Health and Nutrition, University of Delaware, 206C McDowell Hall, Newark, DE 19716, USA.
| | - Emily Stave Shupe
- Department of Behavioral Health and Nutrition, University of Delaware, 206C McDowell Hall, Newark, DE 19716, USA
| | - Ryan T Pohlig
- College of Health Sciences, University of Delaware, STAR, Newark, DE 19716, USA
| | - Rita Rawal
- Department of Medical Laboratory Sciences, University of Delaware, 206C McDowell Hall, Newark, DE 19716, USA
| | - Alan B Zonderman
- National Institute on Aging, Laboratory of Epidemiology and Population Sciences, NIH, 251 Bayview Blvd, Baltimore, MD 21224, USA
| | - Michele K Evans
- National Institute on Aging, Laboratory of Epidemiology and Population Sciences, NIH, 251 Bayview Blvd, Baltimore, MD 21224, USA
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SCREEN III: working towards a condensed screening tool to detect nutrition risk in community-dwelling older adults using CLSA data. Eur J Clin Nutr 2019; 73:1260-1269. [PMID: 30820028 DOI: 10.1038/s41430-019-0411-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/12/2019] [Accepted: 02/15/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES Screening for nutrition risk in community-dwelling older adults increases the likelihood of early intervention to improve nutritional status, with short screening tools preferred. SCREEN-II-AB is a valid 8-item tool. The current study determines whether SCREEN-III, a proposed 3-item version, adequately classifies nutrition risk in comparison. SUBJECTS/METHODS Baseline data from the Canadian Longitudinal Study on Aging were used. Seventy-two percent (n = 24,456) of eligible participants (>55 years, complete SCREEN-II-AB) were included. Sensitivity and specificity of various SCREEN-III values compared with SCREEN-II-AB risk determined a nutrition risk cut-point and the proportion misclassified (False[-]) was calculated. Construct validity was tested against a composite variable summarizing outcomes associated with nutrition risk (e.g., self-reported health, hospitalization) using logistic regression adjusted for individual factors (e.g., marital status). RESULTS A SCREEN-III cut-point of <22 performed best on sensitivity (0.83 [95% CI = 0.82, 0.84]) and specificity (0.73 [95% CI = 0.72, 0.74]) compared to SCREEN-II-AB (Cramer's V = 0.53). Of those at-risk using SCREEN-II-AB, 16.7% were misclassified as False(-) by SCREEN-III. The False(-) group did not differ significantly from the True(-) group. Based on SCREEN-III, 45.3% of individuals were at nutrition risk, 44% of whom reported the outcome composite. SCREEN-III nutrition risk was associated with greater odds of the outcome composite compared to those not at-risk (OR = 1.40, 95% CI = 1.33, 1.48, P < 0.0001). CONCLUSION The proposed version of SCREEN-III demonstrated construct validity, but misclassification of risk may be problematic; further validation of a 3-item version is recommended.
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Abstract
The increasing older adult population guarantees that healthcare providers are more likely to encounter patients requiring treatment for unintended weight loss. Due to physiologic changes that occur in the older adult, it is important to know how to assess for, and diagnose unintended weight loss, as well as understand the treatment options. In addition to the use of enteral and parenteral nutrition, appetite stimulants have been used in older adults. Understanding the dosage, side effects, and proper usage of appetite stimulants, such megestrol acetate, mirtazapine, and dronabinol, is crucial in order to provide safe and effective patient care.
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Affiliation(s)
- Avi Levitt
- Avi Levitt, BSN, RN, is an MSN Student, Family Nurse Practitioner Program, Patricia A. Chin School of Nursing, California State University, Los Angeles, California. Jean O'Neil, DNP, RN, FNP-BC, is an Assistant Professor of Nursing, MSN Program, Patricia A. Chin School of Nursing, California State University, Los Angeles, California
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