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Recommendations Summary

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.


  • Recommendation(s)

    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.

    Rating: Strong
    Imperative

    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.

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      None.

    • Potential Costs Associated with Application

      Although medical nutrition therapy (MNT) costs and reimbursement vary, MNT is essential for improved outcomes.

    • Recommendation Narrative

      • 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.

    • Minority Opinions

      Consensus reached.