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.     

A critical evaluation of the use of nutrition screening tools by nurses

Malnutrition remains a problem in hospital and community patients, the consequences of which have deleterious effects on the sick individual and cost implications for healthcare providers. Provision of nutritional support has been shown to improve patient outcome in those at risk of malnutrition; therefore, the detection and treatment of malnutrition is paramount. Nurses have been identified as being in an ideal position to carry out routine nutritional screening to detect patients at risk of malnutrition and hence refer to the dietitian for detailed nutritional assessment and provision of nutritional support. Therefore, many nutritional screening tools have been developed to guide nurses in basic nutritional screening. However, for a tool to be effective certain criteria must be met including ease of use, cost-effectiveness, the presence of an action plan and prior testing for validity, reliability, sensitivity and specificity. Six such tools are critically evaluated in this article to establish whether they meet these criteria. Surprisingly, none of the screening tools demonstrated a beneficial effect on clinical outcome or met all of the above criteria. It is therefore essential that these tools are refined and retested before becoming part of established nursing practice.     

Validity of the malnutrition screening tool as an effective predictor of nutritional risk in oncology outpatients receiving chemotherapy

GOALS OF WORK: To determine the relative validity of the Malnutrition Screening Tool (MST) compared with a full nutrition assessment by the scored Patient Generated-Subjective Global Assessment (PG-SGA) and to assess MST inter-rater reliability in patients receiving chemotherapy. PATIENTS AND METHODS: An observational, cross-sectional study was conducted at an Australian public hospital in 50 oncology outpatients receiving chemotherapy. Inter-rater reliability was assessed in a subsample of 20 patients. MAIN RESULTS: According to PG-SGA global rating, the prevalence of malnutrition was 26%. The MST was a strong predictor of nutritional risk relative to the PG-SGA (100% sensitivity, 92% specificity, 0.8 positive predictive value, 1.0 negative predictive value). MST inter-rater reliability was acceptable with agreement by administration staff/nursing staff/patient and the dietitian in 18/20 cases (kappa=0.83; p0.001). CONCLUSION: The MST has acceptable relative validity, inter-rater reliability, sensitivity, and specificity to identify chemotherapy outpatients at risk of malnutrition and, hence, is an acceptable nutrition screening tool in this patient population.     

Malnutrition in acute care patients: a narrative review

OBJECTIVES: This narrative review assesses the current prevalence of malnutrition, the methods for detection of malnutrition, the factors associated with malnutrition, and the effects of malnutrition in the acute care patients. DESIGN: A narrative review methodology was employed. DATA SOURCES: CINAHL, Pub Med, and MEDLINE electronic databases were searched from 1996 to 2005, for English language articles. Search terms of malnutrition, acute care patients, nutrition assessment, and nutrition screening were used. REVIEW METHOD: The titles and abstracts of 857 articles were examined. Full text of the articles were obtained only when abstracts described undernutrition, malnutrition, protein-energy malnutrition, nutrition assessment, nutrition screening, factors contributing to malnutrition, or resultant outcomes of malnutrition in adult acute care patients. Additionally, a hand search through reference lists of retrieved articles was done. The articles reviewed included empirical reports (110), reviews (25), commentaries (4), and reports from professional associations (10). RESULTS: Currently, malnutrition ranges from 13-78% among acute care patients. Different methods of detecting malnutrition make it difficult to determine the prevalence among acute care patients. Additionally, many nutrition-screening tools used to detect malnutrition have not undergone rigorous testing for validity, reliability, sensitivity, and specificity. Numerous personal and organizational factors affect the nutritional status of acute care patients. Diminished nutritional status contributes to increased use of hospital resources and increased hospital costs. CONCLUSION: Malnutrition continues to be a significant problem among acute care patients. The Subjective Global Assessment tool has the most diagnostic value for acute care patients. Simple measures, like documenting height and weight on admission, and assessing patient's nutritional intake, weight status, and medications that alter nutritional intake could assist in early detection of malnutrition in the acute care patient.     

Assessment of malnutrition in mental health clients: nurses' judgement vs. a nutrition risk tool

BACKGROUND: The existence of malnutrition in general hospitals is well documented. Psychiatric patients are known to have increased risk of malnutrition, yet physical examinations and nutritional assessments rarely take place in psychiatric hospitals. AIM: The purpose of this study was to adapt an established nutrition risk score for use with psychiatric patients, using criteria previously agreed by the care team, and to assess whether the clinical judgement of ward staff alone identified a similar group of patients to be at risk. METHOD: The risk score assessment was compared with a subjective risk assessment made by nursing staff as patients were admitted to the unit. Data were collected for 112 patients. RESULTS: The comparison revealed that nurses did not identify malnutrition in the same patients as the risk score, overlooking 27 (29%) at risk patients. Nurses associated malnutrition with psychotic illness, suggesting that depressed patients are more likely to be overlooked. STUDY LIMITATIONS: Although the risk score was based on a validated tool and its content and face validity were established, it has not itself been validated against criteria of nutritional status (malnutrition). CONCLUSIONS: Implementing routine nutritional screening on such units would assist in identifying at risk patients, enabling referral for dietetic intervention to be made. Providing nutrition education for staff might help to improve knowledge and awareness of malnutrition for this patient group.     

Interrater reliability using Modified Norton Scale, Pressure Ulcer Card, Short Form-Mini Nutritional Assessment by registered and enrolled nurses in clinical practice

Aim. Examine the interrater reliability between and among registered and enrolled nurses using Modified Norton Scale, Pressure Ulcer Card and Short Form‐Mini Nutritional Assessment. Background. In Sweden, registered nurses and enrolled nurses usually co‐operate in patient care. National guidelines emphasize that reliable and valid assessment tools should be used. Interrater reliability for regular use of assessment tools is seldom studied. Design cross‐sectional. Registered nurses and enrolled nurses made 228 assessments of patients’ skin, risk for pressure ulcer and malnutrition, in patients with hip fracture and patients who had suffered a stroke. Results. The interrater reliability of the Modified Norton Score total score was very good among registered nurses, good among enrolled nurses and between both groups. There was good, moderate and fair agreement on the subscales. Interrater reliability of Short Form Mini‐Nutritional Assesment screening score was very good between both groups, good among registered nurses and moderate among enrolled nurses. There was good and moderate agreement on the items. There was good, moderate and fair agreement between and among registered nurses and enrolled nurses when using the Pressure Ulcer Card. Conclusion. The Modified Norton Scale and Short Form Mini‐Nutritional Assessment were reasonably understandable and easy to utilize in clinical care. Therefore, it seems possible for nurses to accomplish assessment using these tools. The agreement level was low for most skin sites except sacrum when nurses assessed patients’ skin with the Pressure Ulcer Card. Relevance to clinical practice. The utilize of reliable and valid assessment tools is important in clinical practice. The tools could be used as an aid to the clinical judgement and therefore identify patients at risk for pressure ulcers and malnutrition. Pressure ulcer grading is a difficult skill that requires training and time to develop.     

Screening and assessment of nutritional status following stroke: results from a national survey of registered dietitians in Canada

Abstract

Purpose: The objective of this study was to survey registered dietitians (RDs) at acute care hospitals across Canada to determine whether valid screening and assessment methods (i.e. those with formal evaluation of the psychometric and/or clinimetric properties of the tool) are used to identify protein-energy malnutrition following stroke. Methods: One hundred and twenty-five Canadian healthcare institutions admitting high volumes (≥100/year) of acute stroke patients were identified. RDs at these sites who provided services to patients recovering from acute stroke were contacted and invited to participate in an online survey. Results: Ninety-five RDs completed the survey. Sixty dietitians (63%) indicated that patients were screened routinely at their institution, which was conducted primarily by dietitians (n?=?64, 67.3%). Ten respondents (10.5%) stated they used a screening tool with previously-established validity, while 32 (33.7%) indicated they used a validated assessment tool. Among dietitians using validated tools, 40% and 64% indicated that they used modified versions of the original screening and assessment tools. The most frequently cited tools used for both screening and assessment purposes were Subjective Global Assessment and Mini Nutritional Assessment. Conclusions: The results of this national survey suggest that screening and assessment of nutritional status following acute stroke is conducted using tools that have not been validated previously.

• Implications for Rehabilitation

• Although the use of valid screening and assessment tools is considered part of evidence-based practice, and recommendations for their adoption are included in several national stroke-specific clinical practice guidelines, the results from an online survey suggest that they are not used in clinical practice by RDs in Canada caring for patients following stroke.

• There are associated risks with the use of screening and assessment tools, which have not been formally validated. The true nutritional status of patients may not be initially identified correctly, and the response to subsequent nutritional interventions may not be assessed accurately or reliably.

• While the results of this survey were stroke-specific, we suggest that the results are likely generalizable to dietitians working in other patient areas.

     

Evaluating the effectiveness of five screening tools used to identify malnutrition risk in hospitalized elderly: A systematic review

This systematic review investigated 5 frequently used nutrition screening tools (NSTs) used in hospitals and their effectiveness at identifying malnutrition risk in the elderly. A literature review was conducted to obtain research articles focused on malnutrition screening in hospitalized elderly and effectiveness of the NST used. Twenty six articles were reviewed and evaluated, resulting in 8 that met inclusion criteria. The Mini Nutritional Assessment-Short Form, designed for use in the elderly, resulted in overestimation of malnutrition. Four screening tools did demonstrate more effectiveness in identifying malnutrition risk; however, several different biochemical and anthropometric parameters were used, which prevented meaningful comparisons. There is a need for a universal NST “gold standard” for use in the elderly, and further research is indicated.     

Reliability and validity of the nutritional form for the elderly (NUFFE)

AIM: The aim of this study was to test the reliability and validity of the Nutritional Form for the Elderly (NUFFE). BACKGROUND: The prevalence of undernutrition among older people in nursing homes and hospitals reaches high levels. Assessment of older patients' nutritional status is an important task for nurses in clinical care. To use a simple nutritional assessment instrument for older people is one approach for nurses. Examples of such instruments are the well validated Mini Nutritional Assessment (MNA) and the newly developed NUFFE. METHODS: A total of 114 consecutively chosen, newly admitted older patients in an elder care rehabilitation ward in western Sweden were interviewed using the NUFFE and MNA. Arm and calf circumferences, body mass index (BMI), and presence of pressure sores and skin ulcers were noted as part of the MNA on admission. Weight was monitored and BMI calculated on discharge. Serum albumin levels on admission and discharge were used if these were available in the records. Reliability of the NUFFE was measured as homogeneity. Criterion related validity, concurrent validity, construct validity, and predictive validity were assessed with different statistical methods. The regional research ethics committee approved the study. RESULTS: The results showed that the NUFFE is a fairly reliable and valid instrument for identifying actual and potential undernutrition among older patients. CONCLUSION: The NUFFE is a simple tool for nurses to use to assess older patients with the aim of detecting undernourished individuals and those at risk for undernutrition. When doing a nutritional assessment with the NUFFE, the BMI ought also to be calculated. The assessment could also be combined with food intake recording for a period of time.     

Falls risk screening tools intended to reduce fall risk among independent community-dwelling older adults: A systematic review

Aims

The aim of this study is to evaluate an evidence-based fall risk screening tool to predict the risk of falls suitable for independent community-dwelling older adults guided by the World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) components, and to examine the reliability and validity of the fall risk screening tool to predict fall risks, and to examine the feasibility of tools among independent community-dwelling older adults.

Methods

A systematic literature search guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed using the EBSCOHost® platform, ScienceDirect, Scopus and Google Scholar between July and August 2021. Studies from January 2010 to January 2021 were eligible for review. Nine articles were eligible and included in this systematic review. The risk of bias assessment used the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. The WHO-ICF helped to guide the categorization of fall risk factors.

Results

Seven screening tools adequately predicted fall risk among community-dwelling older adults. Six screening tools covered most of the components of the WHO-ICF, and three screening tools omitted the environmental factors. The modified 18-item Stay Independent Brochure demonstrated most of the predictive values in predicting fall risk. All tools are brief and easy to use in community or outpatient settings.

Conclusion

The review explores the literature evaluating fall risk screening tools for nurses and other healthcare providers to assess fall risk among independent community-dwelling older adults. A fall risk screening tool consisting of risk factors alone might be able to predict fall risk. However, further refinements and validations of the tools before use are recommended.     

Malnutrition and pressure ulcers: nutritional assessment tools

Good nutrition is essential throughout life and often patients have a poor understanding of what a balanced diet comprises. Nurses need to have a good comprehension of malnutrition. Where malnutrition is evident it can be resolved by working with the patient to encourage a healthy diet. One way to improve patient nutrition is by a nutrition audit of patient food. Numerous nutritional assessment tools exist which help to identify a patient's nutritional status. No nationally standardized nutritional assessment tool exists and there is a danger of assessment methods becoming as proliferate as pressure ulcer risk assessment tools. A solution to this problem may be to use a pressure ulcer risk assessment tool with a nutritional risk assessment tool such as the Burton Score. Pressure ulcers and malnutrition have been demonstrated to be strongly correlated with each other. Malnutrition is not just present in hospitals but also in nursing homes. A solution to this problem is to use nutritional tools to highlight nutritional deficiency in a patient's diet not only in hospitals but also in the community and in nursing homes.     

护理人员在营养风险筛查中的作用

营养风险筛查是临床营养支持治疗的基础。护理人员在营养风险筛查中应扮演重要角色。应建立护士主导的多学科营养支持小组,实现住院患者营养筛查与干预的常规化。对存在营养风险的患者,通过营养支持治疗可改善患者临床结局和成本效果比。     

营养风险及发育不良筛查工具在住院新生儿营养风险筛查中的应用

目的选择合适的营养风险筛查工具对新生儿进行营养风险评估。方法使用营养风险及发育不良筛查工具STRONGkid对98例住院新生儿进行营养风险筛查,并通过Fenton 2013生长曲线图从身长、体质量及头围等方面进行对比监测,评估新生儿的营养状况。结果总的营养风险检出率为67.3%(66/98),早产新生儿营养高风险的发生率较足月新生儿高(P0.05);总的营养不良检出率为52.0%(51/98),早产新生儿出营养不良的概率高于足月新生儿(P0.05)。营养风险检出率越高,则营养不良检出率也越高。结论营养风险及发育不良筛查工具STRONGkid的筛查结果可以为早期存在营养不良风险的新生儿进行营养干预提供参考。     

Patients’ needs assessment in cancer care: a review of assessment tools

Background The assessment of patients’ needs for care is a critical step in achieving patient-centred cancer care. Tools can be used to assess needs and inform care planning. This review discusses the importance of systematic assessment of needs in routine care and the contribution tools can make to this process. Method A rapid appraisal was undertaken to identify currently available tools for patient assessment in cancer care through searches conducted with Medline and CINHAL databases. It focused on tools for the systematic assessment of individual patients’ needs for help, care or support, to be used for clinical purposes—not for research or other purposes. Tools that focused on a single domain of care such as psychosocial needs were excluded, as were studies of patient satisfaction. A wide list of search terms was used, with references stored and managed using bibliographic software. Results In all, 1,803 papers were identified from the initial search, with 91 papers found to be relevant; although 36 tools were identified, only 15 tools were found to fit our criteria. These were appraised for their validity, reliability, responsiveness to change and feasibility, including acceptability to patients. The process of their development and psychometric properties were reasonably well documented, but data on how feasible they were to use in practice was scarce. Each tool met some but not all the widely accepted criteria for validity, reliability, responsiveness and burden. None were found to be complete for all dimensions of needs assessment. Most have not been sufficiently well tested for use in routine care. Conclusion There is a need to continue to develop and test tools that have the attributes necessary for effective practice and to research their effects on the quality of supportive cancer care.     

普外科医护人员对营养风险筛查认知现状调查

目的:了解普外科医护人员对营养风险筛查的认知状况。方法:采用自设问卷调查北京市2所"三甲"医院普外科医护人员对营养风险筛查相关问题的知识和态度。结果:共有127名医护人员参加调查,医护人员对病人营养问题均较为关注;在营养评估和营养筛查方法、营养支持有效性等方面的知识掌握和执行状况均较差,医生略好于护士;医护人员都对相关培训有较高需求。结论:应加强对医护人员营养风险筛查相关知识培训,推广合理的营养评估和营养筛查方法,促进对肠外肠内营养临床指南的执行。     

NRS2002在胃癌新辅助化疗患者术前营养筛查的应用

目的：探讨NRS2002营养不良风险筛查法对于接受新辅助治疗胃癌患者进行术前营养评估的应用价值 方法：选取63例接受新辅助治疗的胃癌患者,应用NRS2002营养筛查工具对其进行营养风险评估,按NRS2002评分≥3定义为存在营养风险组,<3分为营养正常组。测定患者各项临床指标及术后感染并发症、平均住院天数等与NRS评分的关系,同时以前白蛋白水平为指标,测定NRS2002在胃癌新辅助治疗患者中营养筛查的敏感度、特异度及准确率 结果：经NRS2002评分后发现23例患者存在营养风险（63.5%）,营养正常组40例（36.5%）,化疗-手术间期在4周以内的患者容易出现营养不良,营养风险组的患者BMI指数、白蛋白、前白蛋白水平、淋巴细胞计数均低于营养正常组,营养风险组住院天数较营养正常组延长,腹腔感染的发生率高于营养组。以前白蛋白为指标,NRS2002筛选营养不良的特异度为87.8%;灵敏度为81.8%;准确率为85.7% 结论：接受新辅助治疗的胃癌患者容易合并营养不良,营养不良可能对患者术后恢复造成不利影响,而NRS2002是一个相对简便快速的营养筛查工具,有一定的实用价值。     

Nutritional screening in community dwelling older adults

callen b.l. (2010) Nutritional screening in community dwelling older adults. International Journal of Older People Nursing 6 , 272–281
doi: 10.1111/j.1748‐3743.2010.00241.x Aims and objectives. The purpose of this study was to test whether a combination of validated tools, one for each of five leading nutritional risk factors, could predict unintentional weight loss in community dwelling older adults. Background. Non‐invasive, easily administered nutritional screening tools for community dwelling older adults are few and those that are available are problematic. Method. Convenience samples of 115 adults ≥65 were interviewed. Height, weight and measures of the five nutritional risk factors were collected at interviews 6 months apart. Design. Repeated measures. Results. 91 subjects completing T2 were largely white (95.6%), female (69%), well educated and in good health. Multiple regression was conducted with unintentional weight loss as the dependent variable and depression (the GDS‐SF), the Lubben Social Networking Scale, food security, food intake and Independent Activities of Daily Living as the predictor variables. The regression model was statistically significant (F (5, 85) = 0.30852, P = 0.003) with an adjusted r² of 0.137. Conclusions. Five validated tools can be administered by nurses or non‐professionals to screen for nutritional risk factors leading to unintentional weight loss. Implications for practice. Early screening has the potential to identify either nutritional risk or nutritional decline in older adults.     

NRS2002在胰腺癌患者术前营养风险筛查中的应用效果观察

目的:探讨营养风险筛查(NRS2002)在胰腺癌患者术前营养风险筛查中的应用效果。方法:应用NRS2002对74例胰腺癌手术患者进行营养风险筛查,并以血清白蛋白和前白蛋白作为标准,评价其敏感性和特异性。观察NRS2002筛查出营养不良患者的手术并发症发生率及平均住院天数,与无营养不良风险的患者进行比较。结果:以前白蛋白为标准,NRS2002的敏感性为58.3%,特异性为86.0%;以白蛋白为标准,NRS2002的敏感性为66.7%,特异性为93.6%;NRS评分≥3分术后并发症的总发生率高于NRS评分<3分者,其中腹腔感染并发症发生率显著增高,并且平均住院时间较NRS评分<3分者长(P<0.05)。结论:应用NRS2002对胰腺癌患者营养风险筛查简便易行,具有较高的特异性和准确性以及敏感性,能够作为胰腺癌营养不良的筛查工具之一。