Real World Application:  
                   Meeting Nutrition Screening 
                    Challenges in Older Adults
                         This webinar is supported by Nestlé Nutrition
                                 Moderator:
                                 Mary Pyper
                               Healthy Aging DPG
                                  Speaker:
                          Janet Skates, MS, RD, LDN, FADA
                             Nutrition Consulting Services
                                  Kingsport, TN
                               janetskates@yahoo.com
                               Objectives:
                    „ Identify the prevalence of 
                      malnutrition in older adults across 
                      different practice settings 
                    „ Describe the advantages of using a  
                      validated screening tool
                    „ Implement nutrition screening in 
                      individual practice settings
                                                                                                                            1
                                                 Malnutrition in Older Adults
                                       MG/RSA MRT/ 18.01.10                                           Kaiser et al. Clin Nutr 4( suppl 2):113; 2009       4
                                                              Ideal Nutrition Screen
                                                                                    Valid
                                                                                    Reliable
                                                                                    Accurate
                                                                                    Clearly Defined Thresholds
                                                                                    Relevant to Outcomes
                                                                                    Inexpensive
                                                                                    Acceptable to Clients
                                                                                    Easy and Quick to                 
                                                                                    Administer
                                                                                                                  Thomas DR, 
                                                                                              Nutr Clin Prac 2008;23:383-387
                                                                                     Validity 
                                                     What is it and why does it matter?
                                           „ Valid tools actually measure what they claim 
                                                to measure
                                           „ Screen for desired outcomes
                                           „ Components of validity 
                                                  „ Sensitivity
                                                  „ Specificity
                                                  „ Positive predictive value
                                                  „ Negative predictive value
                                                  „ Inter-rater reliability
                                                                                                                                                                                                                                                                                                                            2
                                                                                                          Common Screening Tools
                                                                                                                                                               Interactive question 
                                                                                                                             “Which screening tool do you currently use?”
                                                                                  „ Subjective Global Assessment (SGA)
                                                                                  „ DETERMINE Checklist
                                                                                  „ Malnutrition Screening Tool (MST)
                                                                                  „ Malnutrition Universal Screening Tool 
                                                                                           (MUST)
                                                                                  „ Geriatric Nutrition Risk Index
                                                                                  „ Nutritional Risk Screening Tool (NRS 2002)
                                                                                  „ Mini Nutrition Assessment (MNA)®
                                                                                                                                                                                                                                             MNMNAA
                                                                                                                                                                                                 „„       DDeeveloped iveloped inn 1990  1990 
                                                                                                                                                                                                 „„       VaValilidadated fted foor ar aggeess 6 65+5+
                                                                                                                                                                                                 „„       Simple, reliable, quiSimple, reliable, quicck k 
                                                                                                                                                                                                          & & nonon-n-iinnvasvasiiveve
                                                                                                                                                                                                 „„       VaValilidadated ated accrrossoss  ccaarre se seettittinnggss
                                                                                                                                                                                                 „„       Supported bySupported by > 400  > 400 
                                                                                                                                                                                                          pubpubllicationicationss
                                                                                                                                                                                                                                     MNMNA-A-SSFF
                                                                                                                                                                                                 „„       BasBased oed onn the ori the origgiinnaal MNAl MNA®®
                                                                                                                                                                                                 „„       UseUsess onl only 6 itemy 6 itemss
                                                                                                                                                                                                 „„       QuiQuiccker tool fker tool for clor cliinniical uscal usee
                                                                                                                                                                                                 „„       VaValilidadated ited inn a ambulambulattoryory  
                                                                                                                                                                                                          elderlyelderly pts pts
                                                                                                                                                                                                                       Guigoz et al., Nutr. Rev. 1996;54:S59-65
                                                                                                                                                                                                     Vellas et al., J Am Geriatr Soc 2000;48:1300-1309
                                                                                                                                                                                                      Rubenstein et al., J Gerontol 2001;56:M366-M372
                                                                                                                                                                       MNAMNAMNAMNA®®®®
                                                                                                                  PrPrPrProsososos
                                                                                                                  Pros                                                                                                                     Cons
                                                                                                  IIIdeadeadeal l l NutriNutriNutritttiiiooonnn   ScScScreereereennn                         Limited Use in Clinical Practice 
                                                                                    •••  Valid Valid Valid aaannnd d d reliablereliablereliable   ssscalecalecale                           „ Takes too long time
                                                                                    •••  AAAccurateccurateccurate                                                                           „ Height and/or weight not 
                                                                                    •••  CleaCleaClearly rly rly defdefdefiiinnnededed   ttthrehrehresssholdholdholdsss                             available
                                                                                    •••  IneIneInexxxpppeeensnsnsiveiveive                                                                  „ Nutrition screening of 
                                                                                                                                                                                                    elderly still not embedded in 
                                                                                    •••  Relevant Relevant Relevant ttto o o ouououtcomtcomtcomeeesss                                               standard clinical practice
                                                                                    •••  AAAcceccecceptabptabptablelele   ttto o o patiepatiepatiennnttt                                    „ Lack of awareness and use 
                                                                                                                                                                                                    in clinical settings
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         3
                                                                            The 2008 – 2009 
                                                             MNA®International Initiative
                                                                                                   Í
                                                                                                   Í
                                                                                                  Í
                                                                                               ÍÍÍ
                                                                                              ÍÍÍ
                                                                       D. Thomas               Í
                                                                  Í                           Í                                              M. Kuzuya
                                                                                             Í                                          Í
                                                                          B. Langkamp‐Henken
                                                                     Í                                                                   A. Tsai
                                                                                                                                    Í
                                                                                                           K. Charlton    R. Visvanathan
                                                                                                      Í                                  Í
                                                                                           Aim
                                                                            ®
                                                  „ Make MNA -Short Form more user-friendly           
                                                       and facilitate more widespread use in geriatric 
                                                       care 
                                                  „ Revalidate the MNA®
                                                        „ Compare with common nutrition assessment criteria
                                                        „ Revalidate MNA® scoring system (cut-off points) 
                                                                                          ®
                                                  „ Validate the MNA -SF as a stand alone tool
                                                        „ Determine best combination of questions for highest 
                                                            sensitivity and specificity 
                                                        „ Develop valid alternative for BMI  
                                                                                                                         ®
                                                        „ Create a scoring system for the MNA -SF to classify 
                                                            nutritional status identical to full MNA®
                                             The elderly were at widespread risk 
                                                                           for malnutrition. 
                                                                                                    23%
                                                                                                                                            69%
                                                                       k                                                 46%
                                                                                                           31%
                                                                                                                           n=4502
                                              Bauer, et al. 2009, IANA
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