Unintended Weight Loss in Older Adults

UWL: Screening and Assessment Methods (2009)

• Assessment
  What is the evidence regarding assessment of dietary intake in older adults with unintended weight loss?

  • Conclusion

    Nine studies were evaluated regarding the assessment of dietary intake in older adults. Four studies reported decreased intake of energy and nutrients in older adults who are acutely/chronically ill and/or underweight. Two studies reported decreased intake of energy and nutrients in older adults with cognitive impairment. Two of three studies reported decreased intake of energy and nutrients in older adults with dysphagia.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Evidence to support assessment of dietary intake in older adults with unintended weight loss
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Dambach B, Salle A, Marteau C, Mouzet JB, Ghali A, Favreau AM, Berrut G, Ritz P.  Energy requirements are not greater in elderly patients suffering from pressure ulcers.  J Am Geriatr Soc 2005;53:478-482.
      • Foley N, Finestone H, Woodbury MG, Teasell R, Greene-Finestone L.  Energy and protein intakes of acute stroke patients.  J Nutr Health Aging 2006;10(3):171-5. 
      • Kulnik D, Elmadfa I. Assessment of the nutritional situation of elderly nursing home residents in Vienna. Ann Nutr Metab. 2008; 52 (suppl 1): 51-53.
      • Lammes E, Akner G. Repeated assessment of energy and nutrient intake in 52 nursing home residents. J Nutr Health Aging. 2006; 10 (3): 222-230.
      • Murphy MC, Brooks CN, New SA, Lumbers ML. The use of the Mini-Nutritional Assessment (MNA) tool in elderly orthopaedic patients. European Journal of Clinical Nutrition, 2000; 54: 555-562.
      • Nowson CA, Sherwin AJ, McPhee JG, Wark JD, Flicker L.  Energy, protein, calcium, vitamin D, and fibre intakes from meals in residential care establishments in Australia.  Asia Pacific J Clin Nutr 2003;12(2):172-77. 
      • Suominen M, Laine A, Routasalo P, Pitkala KH, Rasanen L. Nutrient content of served food, nutrient intake and nutritional status of residents with dementia in a Finnish nursing home. J Nutr Health Aging. 2004; 8 (4): 234-238.
      • Wright L, Cotter D, Hickson M, Frost G.  Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet.  J Hum Nutr Diet 2005;18(3):213-9. 
      • Young KWH, Greenwood CE. Shift in diurnal feeding patterns in nursing home residents with Alzheimer's disease. J Gerontol A Biol Sci Med Sci. 2001; 56 (11): M700-M706. 
  • Search Plan and Results: Dietary Assessment 2008
     
  What is the evidence regarding particular methodologies for the assessment of dietary intake in older adults with unintended weight loss?

  • Conclusion

    Five studies were evaluated regarding particular methodologies for the assessment of dietary intake in older adults. Two studies support multiple days of assessment of dietary intake; three studies reported that quantitative methods are necessary to provide estimations of energy intake. Further research on methods of assessment of dietary intake in older adults is needed.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Evidence supporting particular methodologies to assess dietary intake in older adults with unintended weight loss
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Andersson JC, Gustafsson K, Fjellstrom C, Sidenvall B, Nydahl M. Meals and energy intake among elderly women - an analysis of qualitative and quantitative dietary assessment methods. J Hum Nutr Diet. 2001;14 (6): 467-476.
      • Foley N, Finestone H, Woodbury MG, Teasell R, Greene-Finestone L.  Energy and protein intakes of acute stroke patients.  J Nutr Health Aging 2006;10(3):171-5. 
      • Nowson CA, Sherwin AJ, McPhee JG, Wark JD, Flicker L.  Energy, protein, calcium, vitamin D, and fibre intakes from meals in residential care establishments in Australia.  Asia Pacific J Clin Nutr 2003;12(2):172-77. 
      • St. Arnaud-McKenzie D, Paquet C, Kergoat MJ, Ferland G, Dube L. Hunger and aversion: drives that influence food intake of hospitalized geriatric patients. J Gerontol A Biol Sci Med Sci 2004;59(12):1304-1309.
      • Wright L, Cotter D, Hickson M, Frost G.  Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet.  J Hum Nutr Diet 2005;18(3):213-9. 
  • Search Plan and Results: Dietary Assessment 2008
     
  What is the evidence regarding the use of particular instruments for nutrition assessment of older adults with unintended weight loss?

  • Conclusion

    20 studies were evaluated regarding the use of particular instruments for nutrition assessment of older adults with unintended weight loss. The Mini-Nutritional Assessment is the most widely studied instrument in this population. Several other nutrition assessment instruments have also been developed but not validated. Further validation research on these nutrition assessment instruments is needed.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the evidence to support the use of particular instruments for nutrition assessment of older adults with unintended weight loss?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Andrieu S, Reynish W, Nourhashemi F, Ousset PJ, Grandjean H, Grand A, Albarede JL, Vellas B. Nutritional risk factors for institutional placement in Alzheimer's disease after one-year follow-up. J Nutr Health Aging. 2001; 5(2): 113-117.
      • Arellano M, Garcia-Caselles MP, Pi-Figueras M, Miralles R, Torres RM, Aguilera A, Cervera AM. Clinical impact of different scores of the Mini Nutritional Assessment (MNA) in the diagnosis of malnutrition in patients with cognitive impairment. Arch Gerontol Geriatr Suppl. 2004; (9): 27-31.
      • 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
      • Crogan NL, Alvine C. Testing of the Individual Nutrition Rx assessment process among nursing home residents. Appl Nurs Res. 2006; 19(2): 102-104. 
      • 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.
      • Gerber V, Krieg MA, Cornuz J, Guigoz Y, Burckhardt P. Nutritional status using the Mini Nutritional Assessment questionnaire and its relationship with bone quality in a population of institutionalized elderly women. J Nutr Health Aging. 2003; 7 (3): 140-145.
      • Kucukerdonmez O, Koksal E, Rakicioglu N, Pekcan G.  Assessment and evaluation of the nutritional status of the elderly using two different instruments. Saudi Med J. 2005; 26(10): 1,611-1,616.
      • Kulnik D, Elmadfa I. Assessment of the nutritional situation of elderly nursing home residents in Vienna. Ann Nutr Metab. 2008; 52 (suppl 1): 51-53.
      • Kuzuya M, Kanda S, Koike T, Suzuki Y, Satake S, Iguchi A. Evaluation of Mini-Nutritional Assessment for Japanese frail elderly. Nutrition 2005; 21(4): 498-503. 
      • 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.
      • Magri F, Borza A, del Vecchio S, Chytiris S, Cuzzoni G, Busconi L, Rebesco A, Ferrari E. Nutritional assessment of demented patients: a descriptive study. Aging Clin Exp. 2003; 15(2): 148-153.   
      • Murphy MC, Brooks CN, New SA, Lumbers ML. The use of the Mini-Nutritional Assessment (MNA) tool in elderly orthopaedic patients. European Journal of Clinical Nutrition, 2000; 54: 555-562.
      • Norman K, Schutz T, Kemps M, Lubke HJ, Lochs H, Pirlich M. The Subjective Global Assessment reliably identifies malnutrition-related muscle dysfunction. Clin Nutr. 2005; 24 (1): 143-150.
      • Nursal TZ, Noyan T, Tarim A, Karakayali H. A new weighted scoring system for Subjective Global Assessment. Nutrition 2005; 21 (6): 666-671.
      • Nursal TZ, Noyan T, Atalay BG, Köz N, Karakayali H. Simple two-part tool for screening of malnutrition. Nutrition. 2005 Jun; 21(6): 659-665.
      • Ruiz-Lopez MD, Artacho R, Oliva P, Moreno-Torres R, Bolanos J, de Teresa C, Lopez MC. Nutritional risk in institutionalized older women determined by the Mini Nutritional Assessment test: What are the main factors? Nutrition 2003; 19 (9): 767-771.
      • Saletti A, Lindgren EY, Johansson L, Cederholm T. Nutritional status according to Mini Nutritional Assessment in an institutionalized elderly population in Sweden. Gerontology. 2000;46(3):139-145.
      • Soini H, Routasalo P, Lagstrom H. Characteristics of the Mini-Nutritional Assessment in elderly home care patients. Eur J Clin Nutr. 2004; 58 (1): 64-70.
      • Van Nes MC, Herrmann FR, Gold G, Michel JP, Rizzoli R. Does the Mini Nutritional Assessment predict hospitalization outcomes in older people? Age and Ageing. 2001; 30: 221-226.
      • Wojszel ZB. Determinants of nutritional status of older people in long-term care settings on the example of the nursing home in Bialystok. Adv Med Sci. 2006; 51: 168-173.
  • Search Plan and Results: Nutrition Assessment 2008
     
  What is the evidence regarding the use of particular instruments for nutrition screening in older adults?

  • Conclusion

    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 and validated in this population. Several other nutrition screening instruments have also been developed but not validated. Further validation research on these nutrition screening instruments is needed.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the evidence to support the use of particular instruments for nutrition screening in older adults?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • 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.
  • Search Plan and Results: Nutrition Screening 2008