|dc.description.abstract||Background: Increased proportions of older adults are choosing to live independently into their advanced years and can be at risk of malnutrition. Adverse effects of malnutrition include: functional decline, an increase in inpatient stay due to prolonged wound recovery, and an overall increase in preventable hospitalisations. Therefore, accurate detection of malnutrition in the community is crucial. In New Zealand, the national implementation of the International Residential Assessment Instrument-Home Care (InterRAI-HC), a holistic home-based assessment, has been underway since 2008. InterRAI-HC aims to identify the necessary support services required by free-living elderly adults based on identified warning signs, called Clinical Assessment Proctocols (CAPs). The potential CAPs triggered by the “Oral and Nutritional status” section of InterRAI-HC include the “undernutrition”, “dehydration”, or the “feeding tube” CAPs. This section is the only nutrition-specific section and therefore the undernutrition CAP trigger rate should be similar to malnutrition detection rates of established and validated nutrition screening tools.
Objective: Compare the oral and nutrition section of InterRAI-HC with validated nutrition screening tools, MNA-SF and SCREEN II.
Design: An observational study of free-living older adults living in Dunedin, New Zealand recruited from retirement villages or the community. A questionnaire was developed and administered which obtained information on general socio-demographic characteristics and additional information required for risk categorisation using InterRAI-HC, SCREEN II, and the MNA-SF tools.
Results: A total of 181 participants were visited in their own homes by two researchers, 91 were from the community and 90 were from two retirement villages. A SCREEN II score <50 is considered a high nutrition risk and an individual with a MNA-SF score between 0-7 is considered malnourished. The overall mean SCREEN II and MNA-SF scores of participants were 54 and 13, respectively, and indicative of low/normal nutritional risk. SCREEN II identified 40.4% of participants who were at nutritional risk, MNA-SF detected 12.4% and InterRAI-HC detected 4.4% at risk. Participants who reported “excellent” health had a significantly higher SCREEN II and MNA-SF score compared to those who reported “poor” health (55 vs 50; p= 0.023, 14 vs 13; p=0.019) indicating that these participants were at a lower nutritional risk. Those that were married/partnered had a significantly higher SCREEN II score compared to those who were widowed or divorced/separated/single (56 vs 52 and 49; p=0.001), which is related to those currently married being more likely to have company during meal times (p=0.001). Participant’s that lived in the community, versus the retirement village, had a higher SCREEN II score (56 vs 52; p=0.001). Overall chronic disease diagnosis was low but participants diagnosed with heart disease (34.8%) had a lower SCREEN II score compared to those who did not have heart disease (52 vs 54; p= 0.0215). Participants consuming the Ministry of Health recommended three or more servings of milk and milk products and alternatives a day (1) were less likely to have been diagnosed with osteoporosis (p=0.054).
Conclusion: This study found the following variables were associated with decreased nutrition risk in the elderly: increased perception of health, being free of heart disease, and marital status. These results highlight the importance of a holistic approach to improving overall health, and therefore support the national implementation of a comprehensive geriatric assessment for malnutrition detection. This study recognises interRAI-HC is not a nutrition-specific screening tool so the malnutrition detection rate of one section cannot be compared to that of SCREEN II or MNA-SF. However, the undernutrition CAP trigger rate of the “Oral and Nutritional status” section was low and potential improvements were identified with the aim to increase the trigger rate to that of the malnutrition detection rate of SCREEN II or MNA-SF.
Recommendations to increase the InterRAI-HC malnutrition trigger rate included: Revising the cut-offs required to trigger the high or medium risk CAPs, using dehydration indicators appropriate for free-living older adults, ensuring uniform assessment, and making weight and height measurements mandatory.
Overall recommendations included: Meeting Ministry of Health food and nutrition guidelines for healthy older adults (1), and adopting a holistic approach to wellbeing to improve physical, mental and spiritual variables associated to malnutrition risk.||