Malnutrition in New Zealand is a real problem, especially in the older population. National studies illustrate malnutrition affects 20 to 50 percent of older adults in the health care setting [1-5], and up to 31 percent in the community [6]. It is an issue that is often underrecognized and undertreated [7].
It is associated with many adverse outcomes including the loss of muscle mass, reduced strength, impaired immune function, longer length of hospital stay, higher treatment costs and increased mortality [7-9].
Nutrition screening is therefore an important and effective measure that can identify those with characteristics commonly linked with nutritional problems, who may require comprehensive nutrition assessment. Validated nutrition screening tools are effective and easily administered tools that can predict malnutrition risk using a quantitative score generated as a result of a series of questions and/or physical assessments [10], and can be performed by any trained health professional.
For malnutrition screening tools to be effective and valid, they need to possess certain characteristics, including having high sensitivity (ability to detect malnutrition in those who actually are malnourished), high specificity (ability to give a negative result in those who are not malnourished), quick and easy to administer, relevant in the appropriate setting (e.g. acute hospital or community) and specific to client group (e.g. older adults, people with kidney disease, children etc.) [11-14].
Common Malnutrition Screening Tools
Many validated screening tools are used by hospitals and health care practices across NZ. Some of these tools are described below:
The Malnutrition Universal Screening Tool (MUST) [12]
Establishes malnutrition risk in adults in both acute and community settings. Includes three parameters around Body Mass Index (BMI), unintended weight loss and acute disease effect on nutrient intake.
Advantages: Establishes malnutrition risk in those whom weight and/or height cannot be measured. Can be administered within 5 minutes. Simple to use. Excellent reproducibility.
Mini-Nutritional Assessment-Short Form (MNA-SF) [13]
A single, rapid, six item questionnaire that assesses the nutrition status of older people, living in their own homes or in residential level care facilities. This tool includes parameters around oral intake, weight loss, acute disease or psychological stress, neurological problems and BMI.
Advantages: High sensitivity and specificity. Can be administered within 5 minutes. Can be used in a range of settings. Can use a calf circumference measure in place of BMI.
Seniors in the Community: Risk Evaluation for Eating and Nutrition
(SCREEN II) [14]
A 14-item questionnaire assessing malnutrition risk status of older people in the community setting. It covers food intake and physiological, adaptive and functional nutrition factors.
Advantages: High sensitivity, specificity and acceptability. Can be self-administered or interviewer administered. No anthropometric or biochemical measures required.
Integrating Technology in Malnutrition Screening
Technology can significantly enhance the effectiveness and efficiency of malnutrition screening processes.
- Digital Screening Tools: Digital tools, such as mobile apps and online platforms, streamline the screening process by allowing real-time data collection and analysis. These tools can make screening more accessible and less time-consuming for both healthcare providers and patients, facilitating the detection of physical signs of malnutrition in adults.
- Telehealth Services: Telehealth services offer remote consultations with dietitians and other healthcare professionals, providing continuous monitoring and follow-up care. This approach is particularly beneficial for elderly individuals with mobility issues or those living in remote areas, ensuring consistent monitoring of malnourishment symptoms.
What happens after being identified as ‘at risk of malnutrition’ or ‘malnourished’?
Those identified as at risk of malnutrition would have a care plan put in place according to the facilities policy. It is recommended for those identified as already having malnutrition to be referred to a dietitian for further nutritional assessment and an appropriate fortified diet plan.
The dietitian will investigate the possible causes of malnutrition, then set aims and objectives for treatment. Typical treatment options include education and support around nutrient dense food choices and eating and drinking practices. Oral nutritional supplements, if nutritional requirements cannot be met through normal food and fluid intake alone.
Training and Education for Healthcare Providers
Ensuring that healthcare providers are well-trained in recognising and addressing malnutrition is critical.
- Training Programs: Ongoing education and training for healthcare professionals are essential to keep them updated on the latest best practices in malnutrition screening and treatment. Programs and certifications focusing on geriatric nutrition can enhance the quality of care provided to the elderly, helping to identify and address the signs of malnutrition.
- Best Practices in Screening: Regular updates on best practices and guidelines ensure that healthcare providers use the most effective methods for malnutrition screening. Interdisciplinary collaboration among doctors, nurses, dietitians, and other healthcare professionals fosters a holistic approach to patient care, integrating the latest knowledge on the pathophysiology of malnutrition.
Policy and Advocacy for Malnutrition Prevention
Advocacy and policy changes can drive systemic improvements in malnutrition screening and prevention.
- National and Local Initiatives: Government and non-government initiatives play a vital role in raising awareness and promoting best practices for malnutrition prevention. Successful initiatives and case studies can serve as models for other regions and facilities.
- Policy Recommendations: Policy changes at both national and local levels can support more effective malnutrition screening and intervention strategies. Recommendations include mandating routine nutrition screening for the elderly, funding for nutrition programs, and supporting community-based nutrition services. This includes advocating for regular malnutrition tests to detect and address symptoms of malnutrition in adults early on.
Conclusion
As malnutrition is prevalent in New Zealand’s older population, nutritional assessment and screening tools can be useful in highlighting individuals in need of nutritional support. Health care providers need to ensure appropriate protocols such as routine screening and follow-up of a more comprehensive assessment and plan of care, are put in place to successfully treat those at nutrition risk.
As many malnutrition screening tools exist, the decision to use a particular tool should also be considered carefully. If in doubt as to what screening tool is right for your facility or service, check with your dietitian.
This situation happens every day in health and aged care facilities: older people need almost twice as much protein as elite athletes, but many only get about 60% of what they need. This leads to lower weight and muscle mass, more sickness, falls, hospital stays, and less ability to enjoy life.
At The Pure Food Co., we strive to tackle this issue head-on, by providing aged care facilities with convenient access to premium quality pureed and fortified snacks, smoothies, bulk bases and our texture modified range. Explore our solutions today.
