Prevalence of Malnutrition or Risk in Residents in Long Term Care: Comparison of Four Tools

Keller, Heather; Vucea, Vanessa; Slaughter, Sarah; Jager‐Wittenaar, Harriët; Lengyel, Christina; Carrier, Natalie

doi:10.1080/21551197.2019.1640165

Cited by 27 publications

(23 citation statements)

References 32 publications

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“…This study reports the prevalence of both malnutrition and frailty at admission to residential aged care in the Waitemata DHB. The prevalence of malnutrition (48%) and frailty (76%) in the current study is similar to other observations among residential aged care residents, where up to 50% of older adults have been reported to be malnourished [19][20][21] and up to 76% as frail. 27 We also found nearly half (45%) of the participants were at risk of malnutrition and approximately one-quarter (24%) were at risk of frailty (pre-frail).…”

Section: Discussionsupporting

confidence: 90%

“…Among older adults who live in residential care, a high prevalence (30-50%) of malnutrition (inadequate nutrient and energy intake) has been reported. [19][20][21] Malnourished older adults tend to have more comorbidities than their peers who are well nourished, and the prevalence of malnutrition is likely to increase with increasing frailty. 22 Age-related loss of muscle mass and strength (sarcopenia) is considered to be both a component 23 and an additional cause of physical frailty with advancing age.…”

Section: Introductionmentioning

confidence: 99%

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High prevalence of malnutrition and frailty among older adults at admission to residential aged care

et al. 2020

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INTRODUCTIONMalnutrition is an under-recognised and under-treated problem often affecting older adults. AIMThe aim of this study was to evaluate the prevalence of and factors associated with malnutrition and frailty among older adults at early admission to residential aged care. METHODSA cross-sectional study was undertaken among eligible older adults within the first week of admission to residential aged care. Participants were assessed for malnutrition risk using the Mini Nutritional Assessment Short Form, frailty using the Fried phenotype criterion, muscle strength using a grip strength dynamometer and gait speed using a 2.4-m walk test. A Cox regression analysis was conducted to identify factors associated with malnutrition risk and frailty status. RESULTSOf 174 participants (mean age 85.5 years, 61% women), two-thirds (66%) were admitted to residential aged care from the community. Most (93%) were either malnourished (48%) or at risk of malnutrition (45%). A total of 76% of participants were frail and 24% were pre-frail. Forty-three percent were both malnourished and frail. Low risk of malnutrition was associated with increases in muscle strength [0.96 (0.93–0.99)], gait speed [0.27 (0.10–0.73)] and pre-frailty status [0.32 (0.12–0.83)]. DISCUSSIONThis study provides preliminary evidence for high prevalence of malnutrition and frailty at admission to residential aged care. Almost all participants were malnourished or at nutrition risk. Findings highlight the need for strategies to prevent, detect and treat malnutrition in community health care and support nutrition screening at admission to residential aged care.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

High prevalence of malnutrition and frailty among older adults at admission to residential aged care

et al. 2020

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“…Comparable to other studies conducted in LTC, approximately half of residents were malnourished or at risk of malnutrition according to the PG-SGA and MNA-SF [1][2][3]. The percentage of residents found to have low CC was similar to the percentage of residents at risk for malnutrition; CC is highly associated with malnutrition, as demonstrated in prior analyses of this data set [35]. Diet quality as assessed by MAR and several NARs was associated with lower risk of malnutrition when adjusting for ONS, MTD and eating assistance, confirming the importance of a nutrient dense diet in LTC facilities.…”

Section: Discussionsupporting

confidence: 55%

Diet quality is associated with malnutrition and low calf circumference in Canadian long-term care residents

et al. 2019

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Background: Older adults living in long-term care (LTC) are nutritionally vulnerable. The purpose of this study was to determine diet quality of Canadian LTC residents and its association with malnutrition and low calf circumference. Methods: A cross-sectional study was undertaken in 32 LTC homes across four Canadian provinces. Nutrient adequacy ratios (NARs) were calculated for seventeen nutrients; mean adequacy ratio (MAR) was calculated to describe overall diet quality. Malnutrition risk was assessed with the Mini Nutritional Assessment-Short Form (MNA-SF) and diagnosis of protein/energy malnutrition with the Patient-Generated Subjective Global Assessment (PG-SGA). Calf circumference (CC) was also assessed. Linear and logistic regressions for these outcomes with diet quality as the predictor were conducted adjusting for covariates. Results: Average MNA-SF score was 10.7 ± 2.5. Residents (43.5%) had mild/moderate to severe malnutrition based on the PG-SGA and 32.6% had a CC of < 31 cm. Mean MAR score was 0.79 ± 0.09 with significant differences between those requiring eating assistance (0.77 ± 0.11) and those that did not require assistance (0.80 ± 0.07) (p < .05). MAR score was significantly associated with malnutrition in fully adjusted models: MNA-SF scores [β = 5.34, 95% Confidence interval (CI) (2.81, 7.85)] and PG-SGA [Odds ratio (OR) = 0.49, 95% CI (0.38, 0.64)]. Those who had better diet quality were more likely to be well nourished or not at risk. Although several individual nutrients were associated with low CC (< 31 cm), there was no association between overall diet quality (MAR) and low CC. Conclusions: Diet quality is associated with malnutrition and individual nutrients (NARs) with a low CC. In addition to calories and protein, nutrient dense diets that promote adequate micronutrient intake are required in LTC.

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“…Roughly 24% of this sample triggered the nutrition CAP at either level, consistent with the work of Freeman et al, which found that roughly 25% triggered the nutrition CAP 2 . Keller et al (2019) compared the interRAI long term care facility (LTCF) instrument to 3 other validated tools used to assess risk of malnutrition (the PG‐SGA, 41 the Pt‐Global Webtool, 42 and the Mini Nutritional Assessment–Short Form [MNA‐SF]) 43 among a sample of 638 residents from long‐term care across Canada 44 . However, the trigger criteria for the interRAI LTCF nutrition CAP specifies that a nutrition problem is suggested if ≥1 of following is present: weight loss, dehydration, or reduced food intake 45 .…”

Section: Discussionmentioning

confidence: 99%

“…2 Keller et al (2019) compared the interRAI long term care facility (LTCF) instrument to 3 other validated tools used to assess risk of malnutrition (the PG-SGA, 41 the Pt-Global Webtool, 42 and the Mini Nutritional Assessment-Short Form [MNA-SF]) 43 among a sample of 638 residents from long-term care across Canada. 44 However, the trigger criteria for the interRAI LTCF nutrition CAP specifies that a nutrition problem is suggested if ≥1 of following is present: weight loss, dehydration, or reduced food intake. 45 Results of this study showed that the interRAI LTCF detected the lowest prevalence of malnutrition and had low sensitivity (<70%) across all comparisons with the other tools, 44 indicating that the interRAI LTCF is inadequate for detecting malnutrition in long-term care compared with other validated tools.…”

Section: Discussionmentioning

confidence: 99%

Cross‐Sectional Nutrition Profile of Palliative Home Care Clients in Ontario and Performance of the interRAI Palliative Care Nutrition Clinical Assessment Protocol

Stevens

Keller

Williams

et al. 2020

J Parenter Enteral Nutr

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Background The nutrition profile of palliative home care clients is unknown. This study describes this group and their nutrition issues and evaluates the performance of the interRAI nutrition Clinical Assessment Protocol (CAP). Methods This was a cross‐sectional secondary analysis using Ontario interRAI Palliative Care (interRAI PC) Assessment data. The sample represents 74,963 unique Ontario home care clients assessed between 2011 and 2018. Frequencies and standardized differences (stdiffs) of nutrition characteristics were presented for cancer (n = 62,394) and noncancer (n = 12,569) diagnostic subgroups. Rates of triggering the nutrition CAP were presented by nutrition issue to evaluate its performance. Results Of this sample, 16.7% were ≥85 years of age, 52.6% had a prognosis between 6 weeks and 6 months, and 41.4% required assistance with eating. The prevalence was higher among those with nervous/mental/behavioral disorders (72.6%) compared with those with cancer (37.6%; stdiff = 0.75). However, most nutrition issues experienced were similar (stdiff < 0.20) across diagnostic groups. Of the entire sample, 21% triggered the nutrition CAP, indicating a need for further evaluation or intervention. Yet, 73.4% of those who experienced dry mouth, 71.8% of those who required assistance with eating, and 68.4% of those who received a nutrition consult within the last 3 days did not trigger the nutrition CAP. Conclusions Nutrition issues are prevalent in palliative home care clients, regardless of diagnosis; yet the nutrition CAP identified a small fraction of this group. There is a need to focus research and care guidelines toward life‐limiting illnesses beyond cancer and address nutrition‐related issues in this population.

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Prevalence of Malnutrition or Risk in Residents in Long Term Care: Comparison of Four Tools

Cited by 27 publications

References 32 publications

High prevalence of malnutrition and frailty among older adults at admission to residential aged care

High prevalence of malnutrition and frailty among older adults at admission to residential aged care

Diet quality is associated with malnutrition and low calf circumference in Canadian long-term care residents

Cross‐Sectional Nutrition Profile of Palliative Home Care Clients in Ontario and Performance of the interRAI Palliative Care Nutrition Clinical Assessment Protocol

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