Malnutrition Screening and Assessment in Hospitalised Older People: A Review

Dent, Elsa; Hoogendijk, Emiel O.; Visvanathan, Renuka; Wright, Olivia

doi:10.1007/s12603-019-1176-z

Cited by 126 publications

(97 citation statements)

References 165 publications

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“…If BMI was relied upon as a sole indicator of nutrition, it would fail to identify nutritional issues in these individuals. This has also been reported in other studies highlighting that older people can be at nutritional risk although they may be overweight or obese (6,43,47).…”

Section: Discussionsupporting

confidence: 85%

The Prevalence and Impact on Patient Outcomes of Malnutrition Among Older Adults Presenting at an Irish Emergency Department: A Secondary Analysis of the OPTIMEND Trial

Griffin

́Neill

́Connor

et al. 2020

Preprint

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BackgroundMalnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED. MethodsSecondary analysis of data collected from a randomised trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from baseline to 30-days and 6-month follow-up were used for statistical analysis.ResultsAmong 353 older adults (mean age 79.6 years (SD=7.0); 59.2% (n=209) female) the prevalence of malnutrition was 7.6% (n=27) and ‘risk of malnutrition’ was 28% (n=99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. At 6-months, a reported further decline in functional ability was more likely among those who were malnourished compared to those who had normal nutritional status. ConclusionOver one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to long-term care at 30 days. Trial registration: Protocol registered in ClinicalTrials.gov, ID: NCT03739515, first posted November 13, 2018. https://clinicaltrials.gov/ct2/show/NCT03739515

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Section: Discussionsupporting

confidence: 85%

The Prevalence and Impact on Patient Outcomes of Malnutrition Among Older Adults Presenting at an Irish Emergency Department: A Secondary Analysis of the OPTIMEND Trial

Griffin

́Neill

́Connor

et al. 2020

Preprint

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“…Our results show that nutritional status was within an acceptable range at the end of the intervention in both groups, suggesting that physical exercise might be a useful tool to improve nutritional status in older adults after hospitalization. The improvements in MNA are especially relevant, taking into account that good scores in both nutritional status and physical function are considered protective factors [57,58] related to a number of adverse outcomes that could induce restricted activity [12] and social isolation of the participants [59]. These can negatively affect the autonomy and QoL of older adults and often go undetected by medical staff.…”

Section: Discussionmentioning

confidence: 99%

Multicomponent Physical Exercise in Older Adults after Hospitalization: A Randomized Controlled Trial Comparing Short- vs. Long-Term Group-Based Interventions

Echeverria

Amasene

Urquiza

et al. 2020

IJERPH

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Multicomponent physical exercise is effective in curbing the effect of hospitalization in older adults. However, it is not well established which characteristics of the exercise interventions would optimize intervention sustainability and efficacy. This study compared the effects of two group-based multicomponent exercise interventions of different lengths in older adults after hospitalization. Fifty-five participants were randomly assigned to a short-term group-based branch (SGB, n = 27) or to a long-term group-based branch (LGB, n = 28). The SGB participated in a six-week multicomponent group-based exercise-training program followed by 18 weeks of home-based exercise. The LGB completed 12 weeks of each phase. Physical function, physical activity, quality of life, anthropometrics, and nutritional status were assessed at baseline, after 12 weeks, and after 24 weeks of intervention. Both groups improved physical function and nutritional status and increased physical activity after 12 weeks of intervention (paired student’s t-test, p < 0.01), and maintained the positive effects during the following 12 weeks. No group-by-time interaction was observed in any of the studied variables using mixed-model ANOVA. Based on these findings, we determined that 6 weeks of a group-based exercise intervention caused similar functional and nutritional benefits to a longer group-based intervention of 12 weeks when both are continued at home until 24 weeks.

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“…Construct validity was analyzed for studies that compared the nutritional screening results with reference standards considered to have less validity, which have differences in comparison with nutritional screening instruments [ 9 , 36 , 38 ]. Evaluation was conducted of the relationship between the problem diagnosis (nutritional risk) and related variables not included in the instrument, for example, by analyzing in comparison to other nutritional screening instruments, such as the MNA-sf, MUST, NRS-2002, NRI, or modified NUTRIC (mNUTRIC) score, or the results of laboratory tests, including albumin, pre-albumin, creatinine, and total lymphocyte count (TLC) [ 39 ].…”

Section: Methodsmentioning

confidence: 99%

“…In most cases, nutritional risk is researched via screening tools, typically applied by nutritionists, doctors, or other professionals, preceding a full nutritional assessment [ 9 , 10 ]. Tools such as the Mini Nutritional Assessment-short form (MNA-sf) [ 11 , 12 ], the Geriatric Nutrition Risk Index (GNRI) [ 13 ], the Nutritional Risk Screening 2002 (NRS-2002) [ 14 ], the Malnutrition Universal Screening Tool (MUST) [ 15 ], the Nutritional Risk Index (NRI) [ 16 ], the Short Nutritional Assessment Questionnaire (SNAQ) [ 17 ], and Nutrition Risk in the Critically Ill (NUTRIC) scores [ 18 ] are practical and inexpensive to apply and can predict clinical outcomes [ 9 ]. Nutritional assessment instruments, such as the Global Assessment Subjective (SGA) and the Mini Nutritional Assessment (MNA), also assess biochemical and laboratory parameters and clinical and dietetical factors [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Tools such as the Mini Nutritional Assessment-short form (MNA-sf) [ 11 , 12 ], the Geriatric Nutrition Risk Index (GNRI) [ 13 ], the Nutritional Risk Screening 2002 (NRS-2002) [ 14 ], the Malnutrition Universal Screening Tool (MUST) [ 15 ], the Nutritional Risk Index (NRI) [ 16 ], the Short Nutritional Assessment Questionnaire (SNAQ) [ 17 ], and Nutrition Risk in the Critically Ill (NUTRIC) scores [ 18 ] are practical and inexpensive to apply and can predict clinical outcomes [ 9 ]. Nutritional assessment instruments, such as the Global Assessment Subjective (SGA) and the Mini Nutritional Assessment (MNA), also assess biochemical and laboratory parameters and clinical and dietetical factors [ 9 , 10 ]. The instruments MNA [ 19 , 20 ], MNA-sf [ 11 , 12 , 21 ], GNRI [ 13 , 21 ], MUST [ 15 , 21 ], and NRI [ 16 , 21 ] were developed specifically to identify nutritional risk or malnutrition in older adults, and others are also used to evaluate this target population [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Nutritional Risk Screening Tools for Older Adults with COVID-19: A Systematic Review

et al. 2020

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Coronavirus disease 2019 (COVID-19) is associated with high risk of malnutrition, primarily in older people; assessing nutritional risk using appropriate screening tools is critical. This systematic review identified applicable tools and assessed their measurement properties. Literature was searched in the MEDLINE, Embase, and LILACS databases. Four studies conducted in China met the eligibility criteria. Sample sizes ranged from six to 182, and participants’ ages from 65 to 87 years. Seven nutritional screening and assessment tools were used: the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment (MNA), the MNA-short form (MNA-sf), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Index (NRI), the Geriatric NRI (GNRI), and modified Nutrition Risk in the Critically ill (mNUTRIC) score. Nutritional risk was identified in 27.5% to 100% of participants. The NRS-2002, MNA, MNA-sf, NRI, and MUST demonstrated high sensitivity; the MUST had better specificity. The MNA and MUST demonstrated better criterion validity. The MNA-sf demonstrated better predictive validity for poor appetite and weight loss; the NRS-2002 demonstrated better predictive validity for prolonged hospitalization. mNUTRIC score demonstrated good predictive validity for hospital mortality. Most instruments demonstrate high sensitivity for identifying nutritional risk, but none are acknowledged as the best for nutritional screening in older adults with COVID-19.

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Malnutrition Screening and Assessment in Hospitalised Older People: A Review

Cited by 126 publications

References 165 publications

The Prevalence and Impact on Patient Outcomes of Malnutrition Among Older Adults Presenting at an Irish Emergency Department: A Secondary Analysis of the OPTIMEND Trial

The Prevalence and Impact on Patient Outcomes of Malnutrition Among Older Adults Presenting at an Irish Emergency Department: A Secondary Analysis of the OPTIMEND Trial

Multicomponent Physical Exercise in Older Adults after Hospitalization: A Randomized Controlled Trial Comparing Short- vs. Long-Term Group-Based Interventions

Nutritional Risk Screening Tools for Older Adults with COVID-19: A Systematic Review

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