Nutrition Screening in Geriatric Rehabilitation: Criterion (Concurrent and Predictive) Validity of the Malnutrition Screening Tool and the Mini Nutritional Assessment−Short Form

      Abstract

      Background

      Nutrition screening is required for early identification and treatment of patients at risk for malnutrition so that clinical outcomes can be improved and health care costs reduced.

      Objective

      To determine the criterion (concurrent and predictive) validity of the Malnutrition Screening Tool (MST) and Mini Nutritional Assessment−Short Form (MNA-SF) in older adults admitted to inpatient rehabilitation facilities.

      Design

      Observational, prospective cohort.

      Participants/setting

      Participants were 57 adults aged 65 years and older (mean±standard deviation age=79.1±7.3 years) from two rural rehabilitation units in New South Wales, Australia.

      Main outcome measurements

      MST; MNA-SF; International Statistical Classification of Diseases and Health Related Problems, 10th revision, Australian Modification (ICD-10-AM) classification of malnutrition; rehospitalization; admission to a residential aged care facility (institutionalization); and discharge location.

      Statistical analysis performed

      Measures of diagnostic accuracy with 95% CIs generated from a contingency table, Mann-Whitney U test, and χ2 test.

      Results

      When compared with the ICD-10-AM criteria, the MST showed stronger diagnostic accuracy (sensitivity 80.8%, specificity 67.7%) than the MNA-SF (sensitivity 100%, specificity 22.6%). Neither the MST nor the MNA-SF was able to predict rehospitalization, institutionalization, or discharge location.

      Conclusions

      The MST showed good concurrent validity and can be considered an appropriate nutrition screening tool in geriatric rehabilitation. The MNA-SF may overestimate the risk of malnutrition in this population. The predictive validity could not be established for either screening tool.

      Keywords

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      References

        • Watterson C.
        • Fraser A.
        • Banks M.
        • et al.
        Evidence based practice guidelines for the nutritional management of malnutrition in patients across the continuum of care.
        Nutr Diet. 2009; 66: S1-S34
        • Field L.
        • Hand R.
        Differentiating Malnutrition Screening and Assessment: A Nutrition Care Process Perspective.
        J Acad Nutr Diet. 2015; 115: 824-828
        • Lacey K.
        • Prichett E.
        Nutrition Care Process and Model: ADA adopts road map to quality care and outcomes management.
        J Am Diet Assoc. 2003; 103: 1061-1072
        • Donini L.M.
        • De Bernardini L.
        • De Felice M.R.
        • Savina C.
        • Coletti C.
        • Cannella C.
        Effect of nutritional status on clinical outcome in a population of geriatric rehabilitation patients.
        Aging Clin Exp Res. 2004; 16: 132-138
        • Marshall S.
        • Bauer J.
        • Isenring E.
        The consequences of malnutrition following discharge from rehabilitation to the community: A systematic review of current evidence in older adults.
        J Hum Nutr Diet. 2014; 27: 133-141
      1. Marshall S, Young A, Bauer J, Isenring E. Malnourished older adults admitted to rehabilitation in rural New South Wales remain malnourished throughout rehabilitation and once discharged back to the community: A prospective cohort study J Aging Res Clin Practice. In press.

        • Skipper A.
        • Ferguson M.
        • Thompson K.
        • Castellanos V.H.
        • Porcari J.
        Nutrition screening tools.
        J Parenter Enteral Nutr. 2012; 36: 292-298
        • Ferguson M.
        • Capra S.
        • Bauer J.
        • Banks M.
        Development of a valid and reliable malnutrition screening tool for adult acute hospital patients.
        Nutrition. 1999; 15: 458-464
        • Ferguson M.
        • Bauer J.
        • Gallagher B.
        • Capra S.
        • Christie D.
        • Mason B.
        Validation of a malnutrition screening tool for patients receiving radiotherapy.
        Australas Radiol. 1999; 43: 325-327
        • Isenring E.A.
        • Banks M.
        • Ferguson M.
        • Bauer J.D.
        Beyond malnutrition screening: Appropriate methods to guide nutrition care for aged care residents.
        J Acad Nutr Diet. 2012; 112: 376-381
        • Rubenstein L.Z.
        • Harker J.O.
        • Salvà A.
        • Guigoz Y.
        • Vellas B.
        Screening for undernutrition in geriatric practice developing the Short-Form Mini-Nutritional Assessment (MNA-SF).
        Series. A: J Gerontol. 2001; 56: M366-M372
        • Visvanathan R.
        • Penhall R.
        • Chapman I.
        Nutritional screening of older people in a sub-acute care facility in Australia and its relation to discharge outcomes.
        Age Ageing. 2004; 33: 260-265
        • Kaiser M.J.
        • Bauer J.M.
        • Uter W.
        • et al.
        Prospective validation of the modified Mini Nutritional Assessment Short-Forms in the community, nursing home, and rehabilitation setting.
        J Am Geriatr Soc. 2011; 59: 2124-2128
      2. Australian Institute of Health and Welfare. Rural, regional and remote health: a guide to remoteness classifications. AIHW cat. no. PHE 53. Published 2004. Canberra: AIHW. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459567. Accessed June 21, 2015.

        • Ferguson M.
        • Capra S.
        • Bauer J.
        • Banks M.
        Malnutrition. Is Your Patient at Risk?.
        Nutrition Support Resources: NEMO Nutrition Support Group, Queensland Government, Queensland Health, Brisbane, Queensland, Australia1999
        • Isenring E.A.
        • Bauer J.D.
        • Banks M.
        • Gaskill D.
        The Malnutrition Screening Tool is a useful tool for identifying malnutrition risk in residential aged care.
        J Hum Nutr Diet. 2009; 22: 545-550
        • Vellas B.
        • Villars H.
        • Abellan G.
        • et al.
        Overview of the MNA—Its history and challenges.
        J Nutr Health Aging. 2006; 10: 456-465
        • National Centre for Classification in Health
        Australian Coding Standards for I.C.D.-10-AM.
        National Centre for Classification in Health, Sydney, Australia2008
        • Bell J.
        • Bauer J.
        • Capra S.
        • Pulle R.
        Concurrent and predictive evaluation of malnutrition diagnostic measures in hip fracture inpatients: A diagnostic accuracy study.
        Eur J Clin Nutr. 2014; 68: 358-362
        • Bell J.J.
        • Bauer J.D.
        • Capra S.
        • Pulle R.C.
        quick and easy is not without cost: Implications of poorly performing nutrition screening tools in hip fracture.
        J Am Geriatr Soc. 2014; 62: 237-243
        • Agarwal E.
        • Ferguson M.
        • Banks M.
        • Bauer J.
        • Capra S.
        • Isenring E.
        Malnutrition coding shortfalls in Australian and New Zealand hospitals.
        Nutr Diet. 2015; 72: 69-73
      3. Nutrition Screening As Easy As MNA: A Guide To Completing The Mini Nutritional Assessment (MNA). Lausanne, Switzerland: Nestlé Nutrition Institute. http://www.mna-elderly.com/forms/mna_guide_english_sf.pdf. Accessed July 2, 2015.

      4. Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes. National Health and Medical Resarch Council, Canberra, Australia2005
        • Perissinotto E.
        • Pisent C.
        • Sergi G.
        • Grigoletto F.
        • Enzi G.
        Anthropometric measurements in the elderly: age and gender differences.
        Br J Nutr. 2002; 87: 177-186
      5. Laerd Statistics, Lund Research. Criterion validity (concurrent and predictive validity). http://dissertation.laerd.com/criterion-validity-concurrent-and-predictive-validity.php. Published 2012. Accessed November 8, 2014.

        • Šimundić A.-M.
        Measures of diagnostic accuracy: Basic definitions.
        Med Biol Sci. 2008; 22: 61-65
        • Pagano M.
        • Gauvreau K.
        • Pagano M.
        Principles of Biostatistics. Vol. 2. Duxbury Press, Pacific Grove, CA2000
        • Deeks J.J.
        • Higgins J.P.
        Statistical Algorithms in Review Manager 5.
        Statistical Methods Group of The Cochrane Collaboration, Oxford, UK2010: 1-11
        • Glas A.S.
        • Lijmer J.G.
        • Prins M.H.
        • Bonsel G.J.
        • Bossuyt P.M.
        The diagnostic odds ratio: A single indicator of test performance.
        J Clin Epidemiol. 2003; 56: 1129-1135
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Marshall S.
        • Young A.
        • Bauer J.
        • Isenring E.
        Malnutrition in geriatric rehabilitation: Prevalence, patient outcomes, and criterion validity of the Scored Patient-Generated Subjective Global Assessment and the Mini Nutritional Assessment.
        J Acad Nutr Diet. 2016; 116: 785-794
        • Young A.M.
        • Kidston S.
        • Banks M.D.
        • Mudge A.M.
        • Isenring E.A.
        Malnutrition screening tools: Comparison against two validated nutrition assessment methods in older medical inpatients.
        Nutrition. 2013; 29: 101-106
        • Persson M.D.
        • Brismar K.E.
        • Katzarski K.S.
        • Nordenström J.
        • Cederholm T.E.
        Nutritional status using Mini Nutritional Assessment and Subjective Global Assessment predict mortality in geriatric patients.
        J Am Geriatr Soc. 2002; 50: 1996-2002
        • Martins C.P.A.L.
        • Correia J.R.
        • do Amaral T.F.
        Undernutrition risk screening and length of stay of hospitalized elderly.
        J Nutr Elder. 2006; 25: 5-21
        • Neumann S.A.
        • Miller M.D.
        • Daniels L.
        • Crotty M.
        Nutritional status and clinical outcomes of older patients in rehabilitation.
        J Hum Nutr Diet. 2005; 18: 129-136

      Biography

      S. Marshall is a PhD candidate, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia.

      Biography

      A. Young is an accredited practising dietitian, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia.

      Biography

      J. Bauer is an associate professor, Nutrition and Dietetics, School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia.

      Biography

      E. Isenring is a professor, Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Bond Institute of Health and Sport, Robina, Queensland, Australia.