A.S.P.E.N. Clinical Guidelines

Mueller, Charles; Compher, Charlene; Ellen, Druyan Mary

doi:10.1177/0148607110389335

Cited by 610 publications

(185 citation statements)

References 43 publications

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“…The Mini Nutritional Assessment Short-Form, (MNA®-SF) is a validated tool for assessment of malnutrition risk in older adults in multiple settings, including the hospital [24]. The MNA®-SF is used globally and has a sensitivity of 89% and specificity of 82% for assessing malnutrition risk in older adults [22, 25]. …”

Section: Introductionmentioning

confidence: 99%

Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults at hospital admission

et al. 2018

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BackgroundMalnutrition in patients admitted to hospital may have detrimental effects on recovery and healing. Malnutrition is preceded by a state of malnutrition risk, yet malnutrition risk is often not detected during admission. The aim of the current study was to investigate the magnitude and potential predictors of malnutrition risk in older adults, at hospital admission.MethodsA cross-sectional was study conducted in 234 older adults (age ≥ 65 or ≥ 55 for Māori or Pacific ethnicity) at admission to hospital in Auckland, New Zealand. Assessment of malnutrition risk status was performed using the Mini Nutritional Assessment Short-Form (MNA®-SF), dysphagia risk by the Eating Assessment Tool (EAT-10), muscle strength by hand grip strength and cognitive status by the Montreal Cognitive Assessment (MoCA) tool.ResultsAmong 234 participants, mean age 83.6 ± 7.6 years, 46.6% were identified as at malnutrition risk and 26.9% malnourished. After adjusting for age, gender and ethnicity, the study identified [prevalence ratio (95% confidence interval)] high dysphagia risk [EAT-10 score: 0.98 (0.97–0.99)], low body mass index [kg/m2: 1.02 (1.02–1.03)], low muscle strength [hand grip strength, kg: 1.01 (1.00–1.02)] and decline in cognition [MoCA score: 1.01 (1.00–1.02)] as significant predictors of malnutrition risk in older adults at hospital admission.ConclusionAmong older adults recently admitted to the hospital, almost three-quarters were malnourished or at malnutrition risk. As the majority (88%) of participants were admitted from the community, this illustrates the need for routine nutrition screening both at hospital admission and in community-dwelling older adults. Factors such as dysphagia, unintentional weight loss, decline in muscle strength, and poor cognition may indicate increased risk of malnutrition.

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Section: Introductionmentioning

confidence: 99%

Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults at hospital admission

et al. 2018

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“…To promote best practice, guidelines have been developed that recommend nutrition screening on admission followed with a comprehensive assessment for those at risk [16–19]. The European Society for Parenteral and Enteral Nutrition (ESPEN) guideline emphasizes screening and choice of screening tools; assessment, monitoring, and communication, including transitions out of hospital, are also discussed [18].…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) guideline states that screening should always be followed by a comprehensive assessment to diagnose malnutrition and determine if interventions are required [16]. The ESPEN and A.S.P.E.N.…”

Section: Introductionmentioning

confidence: 99%

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The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi

Keller

McCullough

Davidson

et al. 2015

Nutr J

110

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BackgroundMalnutrition is commonly underdiagnosed and undertreated in acute care patients. Implementation of current pathways of care is limited, potentially as a result of the perception that they are not feasible with current resources. There is a need for a pathway based on expert consensus, best practice and evidence that addresses this crisis in acute care, while still being feasible for implementation.MethodsA modified Delphi was used to develop consensus on a new pathway. Extant literature and other resources were reviewed to develop an evidence-informed background document and draft pathway, which were considered at a stakeholder meeting of 24 experts. Two rounds of an on-line Delphi survey were completed (n = 28 and 26 participants respectively). Diverse clinicians from four hospitals participated in focus groups to face validate the draft pathway and a final stakeholder meeting confirmed format changes to make the pathway conceptually clear and easy to follow for end-users. Experts involved in this process were researchers and clinicians from dietetics, medicine and nursing, including management and frontline personnel.Results80 % of stakeholders who were invited, participated in the first Delphi survey. The two rounds of the Delphi resulted in consensus for all but two minor components of the Integrated Nutrition Pathway for Acute Care (INPAC). The format of the INPAC was revised based on the input of focus group participants, stakeholders and investigators.ConclusionsThis evidence-informed, consensus based pathway for nutrition care has greater depth and breadth than prior guidelines that were commonly based on systematic reviews. As extant evidence for many best practices is absent, the modified Delphi process has allowed for consensus to be developed based on better practices. Attention to feasibility during development has created a pathway that has greater implementation potential. External validation specifically with practitioner groups promoted a conceptually easy to use format. Test site implementation and evaluation is needed to identify resource requirements and demonstrate process and patient reported outcomes resulting from embedding INPAC into clinical practice.

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“…The European Society for Clinical Nutrition and Metabolism (ESPEN) and the American Society for Parenteral and Enteral Nutrition (ASPEN) recommend that nutritional screening should be performed using conventional nutrition screening tools, such as the NRS-2002, MNA, and SGA. The condition in South Korea is assumed to be similar, although a report providing evidence to support this has yet to be published [20,21]. …”

Section: Introductionmentioning

confidence: 99%

Comparison of Nursing Records and the Catholic Medical Center Nutritional Risk Screening as a Nutrition Screening Tool for Intensive Care Unit Patients

2015

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In the present study, we aimed to compare the results from nutritional risk screening based on nursing records with those using the Catholic Medical Center Nutritional Risk Screening (CMCNRS) tool. A cross-sectional study was performed involving 91 patients aged ≥ 18 years from an intensive care unit. We collected general characteristics of the patients and nutrition screening was conducted for each patient by using computerized hospital program for the nursing records as well as the CMCNRS conducted by clinical dietitians. The subjects were aged 64.0 ± 17.5 years, and 52 (57.1%) patients had a NPO (nothing by mouth) status. Neurological disease was the most common diagnosis (25.3%). Compared with the CMCNRS results from the clinical dietitians, the results for the nursing records had a sensitivity of 40.5% (95% CI 32.0-40.5) and a specificity of 100.0% (95% CI 92.8-100.0). The agreement was fair between the CMCNRS results obtained by clinical dietitians and the nursing records (k = 0.423). Analysis of the errors from the screening using the nursing records revealed significant differences for all subjective indicators (p < 0.001), compared with the CMCNRS by the clinical dietitians. Thus, after assessing the methods used for nutrition screening and the differences in the search results regarding malnourished status, we noted that the nursing records had a lower sensitivity than the screening by the CMCNRS.

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A.S.P.E.N. Clinical Guidelines

Cited by 610 publications

References 43 publications

Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults at hospital admission

Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults at hospital admission

The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi

Comparison of Nursing Records and the Catholic Medical Center Nutritional Risk Screening as a Nutrition Screening Tool for Intensive Care Unit Patients

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