Reliability of a qualitative screening tool versus physical measurements in identifying undernutrition in an elderly population

Abstract

Background: This study aimed to assess the validity of a qualitative score derived from a nutritional screening tool when used by a dietitian or nurse against physical markers of nutritional status. Methods: A screening tool designed for elderly patients in use at St John's Hospital was evaluated. Using this, scores derived by dietitian and nurse were compared with physical measurements used in nutritional assessment. The agreement between scores in each of the five categories of the tool (clinical condition, body weight, dietary intake, ability to eat and mental condition) was determined. Results: Sixty-six subjects (19 male, 47 female, mean age 78.5 years) were recruited. Undernutrition was found in 23% (n=15) of the patient population (Ζ80% of reference values for one or more physical measurements of nutritional status). A significant correlation between the qualitative score derived by the dietitian using the screening tool and physical markers of nutritional status was evident (body weight expressed as ideal body weight r=0.36, P< 0.005 and arm muscle circumference r=0.53, P< 0.001). Using the screening tool 85% of the under-nourished patients were correctly classified as nutritionally 'at risk' by the dietitian; however, only 58% were correctly identified by the nurse. There was no agreement between scores from the dietitian and nurse in any of the five scoring categories. Conclusion: These results show that the nurse failed to identify over 40% of atrisk patients when using the screening tool. The lack of agreement between dietitian and nurse within each scoring category may suggest fundamental differences in assessing factors contributing to nutritional risk by these two professions.

Nutritional screening and assessment tools for older adults: literature review

“…These include weight (Cotton et al. 1996, Pattison et al. 1999, Mackintosh & Hankey 2001, McCall & Cotton 2001), weight change (Wolinsky et al.…”

“…Other frequently occurring components include factors associated with dietary intake, such as overall dietary intake (Wolinsky et al. 1985, RCN 1993, Pattison et al. 1999, Mackintosh & Hankey 2001, Söderhamn & Söderhamn 2001), intake of specific components (NAGE 1990, Keller et al.…”

The validation of a nursing nutritional assessment tool for use on acute elderly wards

“…Increasing training of other health professionals in nutrition may be the answer, but will it be cost effective and to what degree? Pattison et al . (1999) suggests that there are fundamental differences between dietitians’ and nurses’ in assessing factors contributing to nutritional risk, and therefore nutrition education programmes need to address the underpinning nutritional assessment knowledge.…”

A local nutritional screening tool compared to malnutrition universal screening tool

“…This may be owing to different definitions of undernutrition, use of different NSTs, changes in the prevalence of undernutrition (Elia and Stratton, 2000;Kelly et al, 2000), different study design or different case mix. The use of dietitians to screen patients may have increased the numbers judged to be 'at risk' (Pattison et al, 1999). Our study included only in-patients in four large city hospitals.…”