The nutrition screening initiative: a 5-year perspective

Malnutrition self-screening by using MUST in hospital outpatients: validity, reliability, and ease of use

BACKGROUND

Although nutritional screening with a tool such as the Malnutrition Universal Screening Tool (MUST) is recommended for outpatients, staff are under pressure to undertake a variety of other tasks. Little attention has been paid to the validity of patient self-screening with MUST.

OBJECTIVE

This study in 205 outpatients with a mean (±SD) age of 55 ± 17 y (56% male) assessed the practicalities of self-screening, its agreement with screening undertaken by a trained health care professional (HCP), and its test-retest reliability.

DESIGN

After the participants provided consent, screening was undertaken by the patients themselves and then by a trained HCP who was unaware of the self-screening results. All patients completed an ease-of-use questionnaire. Test-retest reliability of self-screening was established in a subset of 60 patients.

RESULTS

A total of 19.6% of patients categorized themselves as "at risk" of malnutrition (9.8% medium, 9.8% high). For the 3-category classification of MUST (low, medium, high), agreement between self-screening and HCP screening was 90% (κ = 0.70; SE = 0.058, P < 0.001). For the 2-category classification (low risk, medium + high risk), agreement was 93% (κ = 0.78, SE = 0.057, P < 0.001). Disagreements were not systematically under- or overcategorized. Test-retest reliability was almost perfect (κ = 0.94, P < 0.001). Most patients (71%) completed self-screening in <5 min. Patients found the tool easy or very easy to understand (96%) and complete (98%), with 94% reporting that they were happy to screen themselves.

CONCLUSION

Self-screening involving MUST in outpatients is acceptable to patients, user-friendly, reliable, and associated with good agreement with HCP screening. This trial was registered at clinicaltrials.gov as NCT00714324.

Ontario Older-Adult Programs: Self-Identified Interest in and Resources for Nutritional Risk Screening

Older-adult community programs are significant partners in the identification of need and delivery of health care for seniors. At present there is no systematic screening for nutritional risk in Ontario, and the interest and resources of community programs to screen is unknown. From three Ontario organizational membership lists, 200 programs were randomly selected; 136 key informants completed and returned the survey. A diverse sample of programs was included. Most were providing some form of nutrition programming, with the most common being meal provision. Two thirds (67.7%) were collecting some form of nutrition information: 56.4 per cent had an assessment questionnaire with nutrition information, and 21.8 per cent had clients subjectively assess their own nutritional risk. Most providers were interested in the nutritional health of their clients, and over half were interested in formally screening for nutritional risk. Barriers to screening were also identified. It is clear that nutrition is an area of priority for community programs and that nutrition screening is desired. Barriers to ethical screening need to be addressed prior to implementation of a systematic screening program.

Variations in nutritional risk among black and white women who receive home-delivered meals

The maintenance of good nutritional status is a cornerstone of health, function, and quality of life. To assess indicators and correlates of high levels of nutritional risk, sociodemographic, functional status, and nutritional data were collected from a diverse sample of 729 older women. Results from ordered logit analysis indicated that being Black, having an income < or = 125% of the federal poverty level, living alone, and being in the younger-old age group (ages 60 to 74 years) were associated with moderately high and very high levels of nutritional risk. An examination of individual and multiple nutritional risk indicators suggested a heightened vulnerability of Black women to inadequate dietary intake, even net of income and other influential variables. With demographic projections of an increasingly numerous and diverse older population who may face health and nutritional challenges, researchers must strengthen efforts to assist policymakers and service providers to properly target nutrition services.

Nutrition and quality of life in older adults

Good nutrition promotes health-related quality of life (HRQOL) by averting malnutrition, preventing dietary deficiency disease and promoting optimal functioning. However, definitions of quality of life also encompass life satisfaction and both physical and mental well-being. Nutrition and diet have not been a part of mainstream research on quality of life and are not included among key quality of life domains. This article explores connections between diet and nutritional status in relation to HRQOL measures and overall well-being among older adults.

Nutrition in gastroenterology and hepatology

Nutritional issues, sometimes obvious and sometimes not so obvious, confront the primary care practitioner on a daily basis. Understanding the multi-disciplinary nature of nutrition science and clinical nutrition and having a basic understanding of gastrointestinal tract digestive and absorptive physiology can only help sort out the many issues involved. The general practitioner needs a core understanding of the principles of nutrition assessment.

Preadmission nutrition screening: expanding hospital-based nutrition services by implementing earlier nutrition intervention

The need to screen patients earlier than within the first 24 hours of hospital admission has resulted in the development of preadmission nutrition screening. At Providence Saint Joseph Medical Center (PSJMC), a 455-bed acute-care facility, this procedure has been used since 1994. The preadmission screening method was developed because of the use of critical pathways for patients in specific diagnosis-related groups. Critical pathways specified that registered dietitians must assess these patients within 24 hours of admission at PSJMC. However, at that time there was minimal data in the chart from which to assess the patient's nutritional status and the ability to interview the patient was often limited as a result of intubation or postoperative pain. Family members were not always available at the hospital to discuss a patient's preadmission nutritional status. To address this problem, we developed a system to call people at home before their admission to the hospital to obtain specific nutrition information. To analyze the effectiveness of the procedure, the Food and Nutrition Services Department developed a process to assess this method of screening and to improve the system. Patients were enrolled in a study over a 1-month period, demographics were identified for this sample population, and patient satisfaction was determined via an interview conducted by a dietetic technician after the patient was admitted. Most patients found this to be a very helpful process and an example is presented here on the role of preadmission nutrition screening in improving patient outcome. To better define the population of the case study presented, additional information was gathered on a second study group of patients screened before admission who were admitted for hip and knee surgery, one of the specific diagnosis-related groups with a critical pathway. Our findings indicate that preadmission nutrition screening has the potential to improve patient outcomes by increasing nutrient intake before their hospital admission, reducing hospitalization length, and enhancing patient satisfaction during their hospital stay.

Nutrition screening and assessment

Both undernutrition and overnutrition contribute to increased risk of morbidity and mortality. Marasmus, kwashiorkor, and decreased micronutrient status are types of nutritional deficiencies, whereas obesity and problems resulting from dietary supplements are examples of overnutrition. Screening for malnutrition can be performed in the ambulatory, hospital, and institutional populations, each with methods appropriate for the target population. For patients determined to be at high risk, further nutrition assessment can be performed to help arrive at specific nutritional treatment goals. Identifying and treating malnutrition can potentially have an important impact on decreasing morbidity and mortality in the population.

The validity of nutritional status as a marker for future disability and depressive symptoms among high-risk older adults

OBJECTIVE

To measure the validity of the DETERMINE Checklist as a marker for future functional disability, depressive symptoms, and mortality among high-risk older adults.

DESIGN

A Cohort study.

SETTING

An Urban-suburban Midwestern community.

PARTICIPANTS

Community-dwelling Medicare beneficiaries at high risk for hospital admission who received geriatric evaluation and management (GEM) (n = 251).

MEASUREMENTS

Demographic, health-related, functional, psychosocial, survival, and nutritional data were collected through telephone and in-home interviews.

RESULTS

GEM recipients with baseline Checklist scores of four or higher were found to be significantly more likely than those with lower scores to have functional disability or high levels of depressive symptoms a year later. Checklist scores did not predict mortality.

CONCLUSIONS

The 10-item Checklist could be used as a secondary screen to identify older persons who, without treatment, are at especially high-risk to have disability or depression a year later.