Assessing Intake of Food and Dietary Supplements in Older Adults Proceedings of a Workshop Series (2023) / Chapter Skim
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4 Nutritional Screening of Older Adults
4 Nutritional Screening of Older Adults
Pages 49-68
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From page 49... ...
(van der Schueren) • Since the 1990s, key milestones in the evolution of malnutrition screening in clude developing tools specifically designed for this purpose, most notably the Nutrition Screening Initiative (incorporating the Determine Your Health Checklist and Level I and II screens)
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From page 50... ...
Furthermore, a number of screening tools have been used to evaluate nutritional status, and several nutrition assessment tools have been used to screen for malnutrition, thus blurring the line between screening and assessment. (van der Schueren)
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From page 51... ...
Screening approaches have incorporated these risk factors; he clarified the clear differences between screening for risk of malnutrition and assessment of the condition. Nutrition screening identifies risk for a specific outcome related to nutritional status, such as functional decline, health care resource use, or malnutrition, whereas nutrition assessment is an in-depth, specific, detailed evaluation to clarify etiology, severity, and appropriate intervention and the intervention outcomes that require monitoring thereafter.
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From page 52... ...
52 FIGURE 4-1 Determine Your Nutritional Health checklist from the Nutrition Screening Initiative. SOURCE: Presented by Gordon Jensen on April 29, 2022.
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From page 53... ...
Jensen shared results from an evaluation of malnutrition screening focused on older adults (the Mini Nutrional Assessment [MNA]
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From page 54... ...
systematic review that examined malnutrition risk screening tools for older adults with COVID-19. It included studies that examined a variety of different screening and assessment tools.
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From page 55... ...
She discussed her experience as a collaborator on the European Malnutrition in the Elderly project (MaNuEL) .8 She described three of the project studies: a review of the validity of malnutrition screening tools used in older adults, development of a scoring system to rate these tools in older adults, and a systematic review of malnutrition risk among older adults in Europe.
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From page 56... ...
. Moving onto the third study, de van der Schueren explained that the systematic review of malnutrition risk in older adults in Europe was based on studies that had used the 22 best-rated malnutrition screening tools (according to the prior MaNuEL studies)
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From page 57... ...
The key steps in the framework are to conduct malnutrition risk screening using validated tools, perform a diagnostic assessment consisting of phenotypic and etiologic criteria, and determine if the patient meets criteria for a malnutrition diagnosis. She noted that GLIM continues to be refined, highlighting that one challenge in this process is that different tools have different goals (are screening for different things)
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From page 58... ...
Low income is defined by federal poverty guidelines, which are based on official poverty thresholds that vary by family size and composition and are updated annually (Figure 4-2)
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From page 59... ...
Populations that experience food insecurity and low income have poorer nutrient intakes and dietary quality and higher prevalence of overweight, obesity, and chronic diseases, such as diabetes, heart disease, and cancer, compared to populations that are food secure (Bailey et al., 2017; Cowan et al., 2019; Hiza et al., 2013; Holben and Pheley, 2006; Pan et al., 2012; Seligman et al., 2010)
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From page 60... ...
Recent changes to the Farm Bill will allow SNAP benefits to be used for dietary supplements, which she believes may help meet known nutrient gaps among older adults but could divert this population's limited food-purchasing resources to products that do not provide energy. More information about the characteristics of dietary supplement users and nonusers and their effect on dietary quality in older adults with low incomes is required to inform decision-making for SNAP benefits.
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From page 61... ...
Healthy foods are promoted and malnutrition risk assessed during the home visits. Buhl stated that the issue with this advanced age group is that little is known about their nutritional challenges, because adults over 75 are not included in the Danish national dietary survey, and this self-reliant, community-dwelling population is not systematically screened for nutritional status.
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From page 62... ...
Participants completed a 4-day food record in detail, which was used to calculate protein intake, and underwent assessment of risk factors associated with malnutrition via validated screening tools. Of the 126 participants with completed food records, 54 percent had average protein intake below the European minimum recommended level of 1.0 gram per kilogram of body weight.
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From page 63... ...
PANEL DISCUSSION WITH SPEAKERS The four speakers answered questions from the workshop's planning committee members and attendees about best practices, knowledge gaps, and research priorities for nutritional screening of older adults. Topics included food insecurity among older adults during the COVID-19 pandemic, screening for malnutrition in federal food assistance programs, stigma associated with participation in those programs, calf circumference as a surrogate for lean body mass, choice of screening tool for different settings, follow-up actions for individuals identified at home visits as having nutritional risks, and gaps and research priorities for screening.
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From page 64... ...
It is important that screening tools can detect these factors, and she echoed van der Schueren's observation that most screening tools focus on significant weight loss, underweight, and the like, which do not capture the full breadth of upstream factors driving malnutrition. Stigma Associated with Participation in Federal Food Assistance Programs Carol Boushey, University of Hawai‘i Cancer Center and chair of the workshop planning committee, and Eicher-Miller agreed that they think federal food assistance program participants generally appreciate the opportunity.
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From page 65... ...
Jensen said that he was not aware of any fully validated malnutrition risk screening tools for older adults with overweight or obesity. The GLIM approach is one of few that readily facilitates malnutrition diagnosis among overweight or obese individuals.
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From page 66... ...
Many municipalities have clinical dietitians or other professionals with nutritional expertise, who visit affected individuals to provide dietary advice. Gaps and Research Priorities for Nutritional Screening In this era of multiple screening tool options, de van der Schueren said, the next steps are to determine what are the goals of screening, which tools fit those goals, and how screening can best be implemented and connected to interventions to address any abnormalities.
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From page 67... ...
de van der Schueren, S Siltharm, P
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From page 68... ...
2019. Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults ≥65 years: A systematic review and meta analysis.
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