Nutrition Screening Flashcards
Physiological cause of undernutrition in hospitalised and older people
Reduced appetite Reduced sell and taste Dental health GI changes Swallowing disorders Increased dependence Reduced mobility Polypharmacy Prolonged or reported fasting for procedures Dependence on others for eating
Psychological cause of undernutrition in hospitalised and older people
Depression Delirium Anxiety Grief Cognitive impairment
Social cause of undernutrition in hospitalised and older people
Social isolation
Inadequate knowledge about food, nutrition and food preparation
Poverty or food insecurity
Inability to access an adequate food upy
Inadequate assistance with meal set up or feeding
Mealtime interruptions in hospital/ rehab
Malnutrition
A state of nutrition in which a deficiency it excess or imbalance of energy, protein and other nutrients causes measurable adverse effects on tissue/ body form (body shape, size, composition), body function and clinical outcome.
High prevalence in hospitals (35-43%)
Can be present prior to hospital admission, higher rates in people who have had falls- often due to deconditioning after prior hospitalisation.
Can develop in hospitals/ rehab/ residential care
Most not referred to dietitian
Consequence of malnutrition
Functional decline Increased length of stay- slow wound healing, respiratory infections, poor food intake Increased complications eg. Infections Increased rehab time Increased mortality
Poor nutrition status, low BMI and weight loss:
Decreased mobility and stability leading to falls
Bone loss and hip fractures
Increased risk of pressure ulcers
Increased disability
Elements of a system for effective surveillance and management of malnutrition screening
- Screening
a. To identify those most at risk of malnutrition - Identification of those patients with malnutrition
a. Involves nutrition assessment- diagnosis - Systems and tools for treating malnutrition
a. Includes interventions such as oral nutritional supplements and enteral nutrition
b. Includes addressing the factors contributing to malnutrition - Evaluation and monitoring
a. Is the patients nutritional status improving over time?
Nutrition screening tool requirements
Simple
Quick to perform
Valid and reliable in target group for which it was developed:
High sensitivity: avoid false negatives (missed diagnosis)
High specificity: avoids false positives (unnecessary full assessment)
Acceptable to patients
Acceptable to health workers administering them - need to be simple enough to be used by range of workers
Feasible to conduct in sick, frail or confused patients
Eg wt and height cannot be measured in many ill patients
Nutrition screening vs nutrition assessment
Is an aid and should not replace clinical judgement and will not detect other nutrition problems
Range of staff can undertake (typically nurses in hospitals)
Recommended by ESPEN that all inpatients are screened
Results linked to action course - no action (low risk), resecreen eg in 1 week (moderates risk), nutrition assessment and plan (high risk)
Assessment is detailed and comprehensive
Undertaken by dietitian
Encompasses metabolic, biochemical, functional, anthropometric, dietary, social lifestyle data
Result (liked to nutrition care process)
- nutrition diagnosis
- individualised nutrition management plan
- monitoring of outcomes/ progress
Screening tool inclusions
Current weight for heigh status
Last changes in weight/ weight stability
Likely changes in future weight status- influenced by food intake, medical conditions
Impact on disease severity (in hospitalised patients)
MUST screening tool
Takes <10 mins
Easy, mid arm alternative to wt
Increased likelihood of complications in bed bound patients
1. BMI score >obese (0), 18.5-20 (1), <18.5 (2)
2. Unplanned weight loss in last 3-6 months <5% (0), 5-10 (1), >10% (2)
3. Acute disease effect score - is patient is ill and there has been or is like to be no nutritional intake for >5 days (2)
4. Add scores together 0- low risk, 1 medium risk, 2+ high risk
5. Management guidelines according to each risk level
How MUST performs
Sensitivity 89%
Specificity 82-88%
Advantages:
Good inter rate reliability
Does not need any lab tests
Alternatives for when height or weight cannot be taken
High sensitivity means few false negatives
Results clearly linked to an action plan
Limitations:
Not designed for sub acute or residential care setting
Show poor agreement with tools designated for those settings
Acute disease effect doesn’t reflect chronic poor intake- may miss at risk patient with chronic disease
Use may be limited in those with communication difficulties although less reliant on subjective info than other tools
MST
Three questions- does not include anthropometric or biochemical measurements Parameters selected were those correlated with SGA and objective measures (anthropometric and bulchdmical) Takes <5 min Easy to perform Does not require objective ht and wt measurements Sensitivity 93% Specificity 93% Advantages: Good inter rater reliability Does not need any lab tests Not reliability on height or weight High sensitivity means few false negs Results clearly linked to action plan
Limitations
Not designed for sub acute or residential care settings
Show poor agreement with tools designed for those settings
Information hard to obtain if patient/ cater cannot provide- may lead to poor completion rates. Use may be limited in those with communication difficulties.
MNA- mini nutrition assessment
Development sponsored by nestle Specifically designed for elderly population Aims to identify malnutrition and risk of developing malnutrition Screening (MNA-SF) plus assessment tool Recommended by ESPEN <10 mins Easy 6 items max score of 14 Screening score then determines likely risk and recommended whether to proceed to 2nd part (assessment) of dietitian referral 12 or more- normal/ not at risk 11 or below- possible malnutrition, complete full MNA or refer to dietitian Full MNA scored out of 30 >23.5 low risk 17-23.5 at risk <17 malnourished Sensitivity 90%, specificity 100%
MNA evaluation
Advantages Good inter rater reliability Does not need lab tests Quick Well accepted for use in older people across a range of settings
Limitations
Limited to elderly
Use may be limited to those with communication difficulties
Issues identified may be related to illness itself or psychosocial issues (not malnutrition), son may lead to own referrals or patients who do not actually have malnutrition
Required measurements to be taken- may be issue for some
Require higher level of training than other tools
NRS
Takes <10 mins Easy 2 parts- if answer yes to any of first 3, proceed to table 2 for scoring Advantages: Good interrate reliability High specificity Majority of patients able to be screened Good content validity Captures weight loss or low BMI Examples of disease severity given for limited range Results linked to action plan
Limitations
Validation limited to hospitals
Use may be limited in those with communication difficulties
Disease severity may be subjectively interpreted
Lower sensitive than other tools
Not widely used in Aus
