UWL: Nutrition Screening 2009
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
UWL: Nutrition Screening
The registered dietitian (RD) should collaborate with other health care professionals, administrators and public policy decision makers to ensure that all older adults are screened for unintended weight loss, regardless of setting. Weight change is included in virtually all validated and unvalidated instruments for nutrition risk screening in older adults. Studies support an association between unintended weight loss and increased morbidity and mortality.
UWL: Instruments for Nutrition Screening
The registered dietitian (RD) should collaborate with other health care team members and policy makers to ensure that nutrition screening tools have been validated in the older population. The Mini Nutritional Assessment Short Form and the Nutrition Screening Initiative DETERMINE Your Nutritional Health (DETERMINE) instruments are the most widely studied and validated in this population; several other nutrition screening instruments have been developed but not validated in older adults.
Risks/Harms of Implementing This Recommendation
Conditions of Application
Potential Costs Associated with Application
Although medical nutrition therapy (MNT) costs and reimbursement vary, MNT is essential for improved outcomes.
- Regarding the UWL: Nutrition Screening recommendation, eight studies were evaluated regarding nutritional status and increasing age. Studies reported evidence or risk of malnutrition, declining nutritional status or adverse health effects in elderly subjects. These were associated with female gender, cognitive decline, loss of appetite, swallowing problems, low activity level, eating dependency, recent hospitalization and admission to healthcare communities (Bedard et al, 2000; Laporte, Villalon and Payette, 2001; Laporte, Villalon and Thibodeau, 2001; Zuliani et al, 2001; Margetts et al, 2003; Bowman and Keller, 2005; Nakamura et al, 2006; Lou et al, 2007).
- Regarding the UWL: Nutrition Screening recommendation, two studies report that weight loss was associated with a two- to 10-fold increased risk for death (Sullivan et al, 2002; Sullivan et al, 2004) and one study reported that those who were severely underweight were four times more likely to have unintentional weight loss of 10 pounds in six months (Martin et al, 2007).
- Regarding the UWL: Instruments for Nutrition Screening recommendation, 20 studies were evaluated regarding the use of particular instruments for nutrition screening in older adults. The Mini Nutritional Assessment, Mini Nutritional Assessment Short Form and the Nutrition Screening Initiative instruments are the most widely studied in this population (Vellas et al, 2000; Rubenstein et al, 2001; Callen et al, 2004; Sharkey et al, 2004; Charlton et al, 2005; Langkamp-Henken et al, 2005; Neumann et al, 2005; Ranhoff et al, 2005; Thorsdottir et al, 2005; Coelho et al, 2006). Several other nutrition screening instruments have also been developed but not validated (Burden et al, 2001; Mackintosh and Hankey, 2001; Soderhamn and Soderhamn, 2001; Donini et al, 2004; Weekes et al, 2004; Kruizenga et al, 2005; Woo et al, 2005; Brownie et al, 2007). Further validation research on these nutrition screening instruments is needed (Bauer et al, 2005; Formiga et al, 2005).
Recommendation Strength Rationale
- Conclusion statements in support of the UWL: Nutrition Screening recommendation received Grades I and II
- Conclusion statement in support of the UWL: Instruments for Nutrition Screening recommendation received Grade I.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
What is the evidence regarding the use of particular instruments for nutrition screening in older adults?
Is there a relationship between nutritional status and increasing age?
What is the evidence that underweight or unintended weight loss is associated with increased mortality in adults over age 65?
Bauer JM, Vogl T, Wicklein S, Trögner J, Mühlberg W, Sieber CC. Comparison of the Mini Nutritional Assessment, Subjective Global Assessment, and Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients. Z Gerontol Geriatr. 2005 Oct; 38 (5): 322-327. PMID: 16244816
Brownie S, Myers SP, Stevens J. The value of the Australian Nutrition Screening Initiative for older Australians - results from a national survey. J Nutr Health Aging. 2007;11(1):20-25.
Burden ST, Bodey S, Bradburn YJ, Murdoch S, Thompson AL, Sim JM, Sowerbutts AM. Validation of a nutrition screening tool: testing the reliability and validity. J Hum Nutr Diet 2001;14(4):269-275.
Callen B. Understanding nutritional health in older adults. A pilot study. Journal of Gerontological Nursing. 2004; 30(1): 36-43.
Charlton KE, Kolbe-Alexander TL, Nel JH. Development of a novel nutrition screening tool for use in elderly South Africans. Public Health Nutrition. 2005; 8 (5): 468-479.
Coelho AK, Rocha FL, Fausto MA. Prevalence of undernutrition in elderly patients hospitalized in a geriatric unit in Belo Horizonte, MG, Brazil. Nutrition. 2006; 22: 1,005-1,011.
Donini LM, De Bernardini L, De Felice MR, Savina C, Coletti C, Cannella C. Effect of nutritional status on clinical outcome in a population of geriatric rehabilitation patients. Aging Clin Exp Res. 2004; 16(2): 132-138.
Formiga F, Chivite D, Mascaro J, Ramon JP, Pujol R. No correlation between Mini Nutritional Assessment (short form) scale and clinical outcomes in 73 elderly patients admitted for hip fracture. Aging Clin Exp Res. 2005; 17: 343-346.
Kruizenga HM, Seidell JC, de Vet HC, Wierdsma NJ, van Bokhorst-de van der Schueren MA. Development and validation of a hospital screening tool for malnutrition: The short nutritional assessment questionnaire (SNAQ). Clin Nutr. 2005 Feb; 24(1): 75-82. PMID: 15681104
Langkamp-Henken B, Hudgens J, Stechmiller JK, Herrlinger-Garcia KA. Mini nutritional assessment and screening scores are associated with nutritional indicators in elderly people with pressure ulcers. J Am Diet Assoc. 2005; 105: 1,590-1,596.
Mackintosh MA, Hankey CR. Reliability of a nutrition screening tool for use in elderly day hospitals. J Hum Nutr Diet. 2001 Apr; 14(2): 129-136.
Neumann SA, Miller MD, Daniels L, Crotty M. Nutritional status and clinical outcomes of older patients in rehabilitation. Journal of Human Nutrition and Dietetics. 2005; 18(2): 129-136.
Ranhoff AH, Gjøen AU, Mowé M. Screening for malnutrition in elderly acute medical patients: The usefulness of MNA-SF. J Nutr Health Aging. 2005 Jul-Aug; 9(4): 221-225.
Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: Developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001 Jun; 56 (6): M366-M372.
Sharkey JR. Nutrition risk screening: The interrelationship of food insecurity, food intake, and unintentional weight change among homebound elders. J Nutr Elder. 2004; 24(1): 19-34.
Soderhamn U, Soderhamn O. Developing and testing the Nutritional Form for the Elderly. Int J Nurs Pract. 2001; 7(5): 336-341.
Thorsdottir I, Jonsson PV, Asgeirsdottir AE, Hjaltadottir I, Bjornsson S, Ramel A. Fast and simple screening for nutritional status in hospitalized, elderly people. J Hum Nutr Diet. 2005; 18: 53-60.
Vellas B, Guigoz Y, Baumgartner M, Garry PJ, Lauque S, Albarede J-L. Relationships between nutritional markers and the Mini-Nutritional Assessment in 155 older persons. J Am Geriatr Soc. 2000; 48 (10): 1,300-1,309.
Weekes CE, Elia M, Emery PW. The development, validation and reliability of a nutrition screening tool based on the recommendations of the British Association for Parenteral and Enteral Nutrition (BAPEN). Clin Nutr. 2004 Oct; 23(5): 1104-1112. PMID: 15380902
Woo J, Chumlea WC, Sun SS, Kwok T, Lui HH, Hui E, Fang NY, Fan YP. Development of the Chinese Nutrition Screen (CNS) for use in institutional settings. J Nutr Health Aging. 2005; 9(4): 203-210.
Bedard M, Molloy DW, Bell R, Lever JA. Determinants and detection of low body mass index in community-dwelling adults with Alzheimer's disease. International Psychogeriatrics. 2000; 12(1): 87-98.
Bowman JJ, Keller HH. Assessing nutritional risk of long-term care residents. Can J Diet Prac Res. 2005; 66: 155-161.
Laporte M, Villalon L, Payette H. Simple nutrition screening tools for healthcare facilities: Development and validity assessment. Can J Diet Pract Res. 2001 Spring; 62(1): 26-34.
Laporte M, Villalon L, Thibodeau J, Payette H. Validity and reliability of simple nutrition screening tools adapted to the elderly population in healthcare facilities. J Nutr Health Aging. 2001; 5 (4): 292-294.
Lou MF, Dai YT, Huang GS, Yu PJ. Nutritional status and health outcomes for older people with dementia living in institutions. J Adv Nurs. 2007; 60(5): 470-477.
Margetts BM, Thompson RL, Elia M, Jackson AA. Prevalence of risk of undernutiriton is associated with poor health status in older people in the UK. Eur J Clin Nutr. 2003; 57: 69-74.
Nakamura H, Fukushima H, Miwa Y, Shiraki M, Gomi I, Saito M, Mawatari K, Kobayashi H, Kato M, Moriwaki H. A longitudinal study on the nutritional state of elderly women at a nursing home in Japan. Intern Med. 2006; 45(20): 1,113-1,120.
Zuliani G, Romagnoni F, Soattin L, Leoci V, Volpato S, Fellin R. Predictors of two-year mortality in older nursing home residents. The IRA study. Aging Clin Exp Res. 2001; 13: 3-7.
Martin CT, Kayser-Jones J, Stotts NA, Porter C, Froelicher ES. Risk for low weight in community-dwelling, older adults. Clinical Nurse Specialist. 2007; 21: 203-211.
Saletti A, Johansson L, Yifter-Lindgren E, Wissing U, Osterberg K, Cederholm T. Nutritional status and a 3-year follow-up in elderly receiving support at home. Gerontology, 2005; 51 (3): 192-198.
Sanchez-Garcia S, Garcia-Pena C, Duque-Lopez MX, Juarez-Cedillo T, Cortes-Nunez AR, Reyes-Beaman S. Anthropometric measures and nutritional status in a healthy elderly population. BMC Public Health. 2007; 7: 2-11.
Sullivan DH, Morley JE, Johnson LE, Barber A, Olson JS, Stevens MR, Yamashita BD, Reinhart SP, Trotter JP, Olave XE. The GAIN (Geriatric Anorexia Nutrition) Registry: The impact of appetite and weight on mortality in a long-term care population. J Nutrition Health and Aging. 2002; 6 (4): 275-281.
Sullivan DH, Johnson LE, Bopp MM, Roberson PK. Prognostic significance of monthly weight fluctuations among older nursing home residents. J Gerontol A Biol Sci Med Sci. 2004; 59(6): M633-M639.