A Brief Intervention for Malnutrition among Older Adults: Stepping Up Your Nutrition

Despite a multitude of nutritional risk factors among older adults, there is a lack of community-based programs and activities that screen for malnutrition and address modifiable risk among this vulnerable population. Given the known association of protein and fluid consumption with fall-related risk among older adults and the high prevalence of falls among Americans age 65 years and older each year, a brief intervention was created. Stepping Up Your Nutrition (SUYN) is a 2.5 h workshop developed through a public/private partnership to motivate older adults to reduce their malnutrition risk. The purposes of this naturalistic workshop dissemination were to: (1) describe the SUYN brief intervention; (2) identify participant characteristics associated with malnutrition risk; and (3) identify participant characteristics associated with subsequent participation in Stepping On (SO), an evidence-based fall prevention program. Data were analyzed from 429 SUYN participants, of which 38% (n = 163) subsequently attended SO. As measured by the SCREEN II®, high and moderate malnutrition risk scores were reported among approximately 71% and 20% of SUYN participants, respectively. Of the SUYN participants with high malnutrition risk, a significantly larger proportion attended a subsequent SO workshop (79.1%) compared to SUYN participants who did not proceed to SO (65.8%) (χ2 = 8.73, p = 0.013). Findings suggest SUYN may help to identify malnutrition risk among community-dwelling older adults and link them to needed services like evidence-based programs. Efforts are needed to expand the delivery infrastructure of SUYN to reach more at-risk older adults.

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Prevalence and Determinants of Undernutrition in A Sample of Dutch Community-Dwelling Older Adults: Results from Two Online Screening Tools

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16091562 ◽

2019 ◽

Vol 16 (9) ◽

pp. 1562 ◽

Cited By ~ 5

Author(s):

Jos W. Borkent ◽

Elke Naumann ◽

Emmelyne Vasse ◽

Ellen van der Heijden ◽

Marian A. E. de van der Schueren

Keyword(s):

Risk Factors ◽

Older Adults ◽

Healthy Aging ◽

General Information ◽

Community Dwelling ◽

Screening Tools ◽

Nutritional Risk ◽

Cross Sectional ◽

Increased Risk ◽

Screen Ii

To stimulate undernutrition screening among Dutch community-dwelling adults, a website was developed with general information on healthy eating for healthy aging and self-tests. Based on cross-sectional data obtained from the self-tests, we studied nutritional risk factors (early determinants) as well as risk of undernutrition (late symptoms). SCREEN II (n = 2470) was used to asses nutritional risk factors. This tool consists of 16 items regarding nutritional intake, perception of body weight, appetite, oral health and meal preparation. An adjusted SNAQ65+ (n = 687) was used to assess risk of undernutrition. This four-item tool contains questions on weight loss, appetite, walking stairs and body mass index. Differences between age-groups (65–74, 75–84, ≥85) were tested by logistic regression. Overall prevalence of nutritional risk factors was 84.1%, and increased risk of undernutrition was 56.8%. Participants aged ≥85 scored worst on almost all items of the SCREEN II and the SNAQ65+. In conclusion: A large proportion of older adults reported early determinants for increased nutrition risk, while a smaller, yet remarkable proportion scored positive on undernutrition risk. Internet screening may be a useful, contemporary, and easy, accessible way to reach older adults who are at nutritional risk and may thus contribute to early identification and prevention of undernutrition.

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The relationship of nutritional risk with diet quality and health outcomes in community-dwelling older adults

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01824-z ◽

2021 ◽

Author(s):

Ilse Bloom ◽

Anna Pilgrim ◽

Karen A. Jameson ◽

Elaine M. Dennison ◽

Avan A. Sayer ◽

...

Keyword(s):

Older Adults ◽

Grip Strength ◽

Risk Score ◽

Diet Quality ◽

Community Dwelling ◽

Nutritional Risk ◽

Risk Scores ◽

Cross Sectional ◽

Nutrition Risk

Abstract Objectives To identify early nutritional risk in older populations, simple screening approaches are needed. This study aimed to compare nutrition risk scores, calculated from a short checklist, with diet quality and health outcomes, both at baseline and prospectively over a 2.5-year follow-up period; the association between baseline scores and risk of mortality over the follow-up period was assessed. Methods The study included 86 community-dwelling older adults in Southampton, UK, recruited from outpatient clinics. At both assessments, hand grip strength was measured using a Jamar dynamometer. Diet was assessed using a short validated food frequency questionnaire; derived ‘prudent’ diet scores described diet quality. Body mass index (BMI) was calculated and weight loss was self-reported. Nutrition risk scores were calculated from a checklist adapted from the DETERMINE (range 0–17). Results The mean age of participants at baseline (n = 86) was 78 (SD 8) years; half (53%) scored ‘moderate’ or ‘high’ nutritional risk, using the checklist adapted from DETERMINE. In cross-sectional analyses, after adjusting for age, sex and education, higher nutrition risk scores were associated with lower grip strength [difference in grip strength: − 0.09, 95% CI (− 0.17, − 0.02) SD per unit increase in nutrition risk score, p = 0.017] and poorer diet quality [prudent diet score: − 0.12, 95% CI (− 0.21, − 0.02) SD, p = 0.013]. The association with diet quality was robust to further adjustment for number of comorbidities, whereas the association with grip strength was attenuated. Nutrition risk scores were not related to reported weight loss or BMI at baseline. In longitudinal analyses there was an association between baseline nutrition risk score and lower grip strength at follow-up [fully-adjusted model: − 0.12, 95% CI (− 0.23, − 0.02) SD, p = 0.024]. Baseline nutrition risk score was also associated with greater risk of mortality [unadjusted hazard ratio per unit increase in score: 1.29 (1.01, 1.63), p = 0.039]; however, this association was attenuated after adjustment for sex and age. Conclusions Cross-sectional associations between higher nutrition risk scores, assessed from a short checklist, and poorer diet quality suggest that this approach may hold promise as a simple way of screening older populations. Further larger prospective studies are needed to explore the predictive ability of this screening approach and its potential to detect nutritional risk in older adults.

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Cross-Country Differences and Similarities in Undernutrition Prevalence and Risk as Measured by SCREEN II in Community-Dwelling Older Adults

Healthcare ◽

10.3390/healthcare8020151 ◽

2020 ◽

Vol 8 (2) ◽

pp. 151

Author(s):

Jos W. Borkent ◽

Heather Keller ◽

Carol Wham ◽

Fleur Wijers ◽

Marian A. E. de van der Schueren

Keyword(s):

Risk Factors ◽

Older Adults ◽

Community Dwelling ◽

Nutritional Risk ◽

Sensitivity Analyses ◽

Data Sampling ◽

Prevalence Rates ◽

Nutrition Risk ◽

Screen Ii ◽

Community Dwelling Older Adults

Undernutrition is highly prevalent among community-dwelling older adults. Early identification of nutrition risk is important to prevent or treat undernutrition. This study describes the prevalence rates of nutrition risk in community-dwelling older adults (aged ≥ 65) using the same validated tool across different countries and aims to identify differences in nutritional risk factors. Cross-sectional data was obtained from three datasets including participants from the Netherlands (NL), Canada (CA) and New Zealand (NZ). Seniors in the Community Risk Evaluation for Eating and Nutrition II (SCREEN II) was used to assess nutritional risk factors and prevalence of risk. Differences between countries were tested with logistic and linear regression. Sensitivity analyses were conducted to test the influence of sampling strategy. A total of 13,340 participants were included, and 66.3% were found to be at high nutrition risk. After stratifying the data for method of data sampling, prevalence rates showed some differences across countries (NL: 61.5%, NZ: 68.2%, CA: 70.1%). Risk factor items that contributed to nutrition risk also differed among countries: NZ and CA participants scored higher for weight change, skipping meals, problems with meal preparation, use of meal replacements, problems with biting and chewing, low fluid intake and problems with doing groceries, as compared to participants in NL. Low intake of fruits and vegetables and meat were more prevalent in NL. In conclusion: nutrition risk is a worldwide, highly prevalent problem among community-dwelling older adults, but risk factors contributing to nutrition risk differ by country.

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Curricula Innovation to Positively Influence Preference for Working With Older Adults: A Review of the Literature

Innovation in Aging ◽

10.1093/geroni/igaa057.1780 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 546-546

Author(s):

Christine Brewer

Keyword(s):

Older Adults ◽

Nursing Education ◽

Nursing Students ◽

Service Learning ◽

Community Dwelling ◽

Evidence Based ◽

Clinical Experiences ◽

Search Terms ◽

Education Interventions ◽

Community Dwelling Older Adults

Abstract Few nursing students show preference in working with older adults. The purpose of this study was to review the U.S. nursing education evidence-based literature to determine curricula innovation to positively influence preference for working with older adults. CINAHL, Medline, Ovid Emcare, PsychInfo, and PubMed databases were searched for relevant U.S studies published between 2009 and 2020 using the search terms “nursing students”, “geriatrics OR gerontology OR older adults OR elderly OR aging”, “career OR work”, and “choice OR preference OR attitude”. Nine studies were eligible for inclusion. Nursing education may play a role in influencing how students perceive and prefer to work with older adults. Promising interventions include stand-alone gerontology courses, intergenerational service-learning experiences, and clinical experiences with community dwelling older adults. More evidence-based research with larger sample sizes are needed to determine effective nursing education interventions to improve nursing students’ attitude and preference for working with older adults.

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A Modified CAIDE Risk Score as a Screening Tool for Cognitive Impairment in Older Adults

Journal of Alzheimer s Disease ◽

10.3233/jad-210269 ◽

2021 ◽

pp. 1-14

Author(s):

Magdalena I. Tolea ◽

Jaeyeong Heo ◽

Stephanie Chrisphonte ◽

James E. Galvin

Keyword(s):

Risk Factors ◽

Older Adults ◽

Cognitive Impairment ◽

Risk Score ◽

Clinical Sample ◽

Community Sample ◽

Community Dwelling ◽

Cognitive Testing ◽

Risk Scores ◽

Predictive Values

Background: Although an efficacious dementia-risk score system, Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) was derived using midlife risk factors in a population with low educational attainment that does not reflect today’s US population, and requires laboratory biomarkers, which are not always available. Objective: Develop and validate a modified CAIDE (mCAIDE) system and test its ability to predict presence, severity, and etiology of cognitive impairment in older adults. Methods: Population consisted of 449 participants in dementia research (N = 230; community sample; 67.9±10.0 years old, 29.6%male, 13.7±4.1 years education) or receiving dementia clinical services (N = 219; clinical sample; 74.3±9.8 years old, 50.2%male, 15.5±2.6 years education). The mCAIDE, which includes self-reported and performance-based rather than blood-derived measures, was developed in the community sample and tested in the independent clinical sample. Validity against Framingham, Hachinski, and CAIDE risk scores was assessed. Results: Higher mCAIDE quartiles were associated with lower performance on global and domain-specific cognitive tests. Each one-point increase in mCAIDE increased the odds of mild cognitive impairment (MCI) by up to 65%, those of AD by 69%, and those for non-AD dementia by > 85%, with highest scores in cases with vascular etiologies. Being in the highest mCAIDE risk group improved ability to discriminate dementia from MCI and controls and MCI from controls, with a cut-off of ≥7 points offering the highest sensitivity, specificity, and positive and negative predictive values. Conclusion: mCAIDE is a robust indicator of cognitive impairment in community-dwelling seniors, which can discriminate well between dementia severity including MCI versus controls. The mCAIDE may be a valuable tool for case ascertainment in research studies, helping flag primary care patients for cognitive testing, and identify those in need of lifestyle interventions for symptomatic control.

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Polish Translation and Validation of the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire to Assess Nutritional and Non-Nutritional Risk Factors of Sarcopenia in Older Adults

Nutrients ◽

10.3390/nu13041061 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1061

Author(s):

Roma Krzymińska-Siemaszko ◽

Ewa Deskur-Śmielecka ◽

Arkadiusz Styszyński ◽

Katarzyna Wieczorowska-Tobis

Keyword(s):

Risk Factors ◽

Older Adults ◽

Risk Assessment ◽

Predictive Value ◽

High Sensitivity ◽

Community Dwelling ◽

Nutritional Risk ◽

Polish Language ◽

Community Dwelling Older Adults ◽

Translation And Validation

A simple, short, cheap, and reasonably sensitive and specific screening tool assessing both nutritional and non-nutritional risk factors for sarcopenia is needed. Potentially, such a tool may be the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire, which is available in a seven-item (MSRA-7) and five-item (MSRA-5) version. The study’s aim was Polish translation and validation of both MSRA versions in 160 volunteers aged ≥60 years. MSRA was validated against the six sets of international diagnostic criteria for sarcopenia used as the reference standards. PL-MSRA-7 and PL-MSRA-5 both had high sensitivity (≥84.9%), regardless of the reference standard. The PL-MSRA-5 had better specificity (44.7–47.2%) than the PL-MSRA-7 (33.1–34.7%). Both questionnaires had similarly low positive predictive value (PL-MSRA-5: 17.9–29.5%; PL-MSRA-7: 14.4–25.2%). The negative predictive value was generally high for both questionnaires (PL-MSRA-7: 89.8–95.9%; PL-MSRA-5: 92.3–98.5%). PL-MSRA-5 had higher accuracy than the PL-MSRA-7 (50.0–55% vs. 39.4–45%, respectively). Based on the results, the Mini Sarcopenia Risk Assessment questionnaire was successfully adopted to the Polish language and validated in community-dwelling older adults from Poland. When compared with PL-MSRA-7, PL-MSRA-5 is a better tool for sarcopenia risk assessment.

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Falls Efficacy Among Older Adults Enrolled in an Evidence-Based Program to Reduce Fall-Related Risk

Family & Community Health ◽

10.1097/fch.0b013e318250bdb8 ◽

2012 ◽

Vol 35 (3) ◽

pp. 256-263 ◽

Cited By ~ 19

Author(s):

Matthew Lee Smith ◽

Luohua Jiang ◽

Marcia G. Ory

Keyword(s):

Older Adults ◽

Evidence Based ◽

Related Risk

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Single-Session Evidence-Based Intervention and Fall Risk Awareness in Community-Dwelling Older Adults

Topics in Geriatric Rehabilitation ◽

10.1097/tgr.0000000000000317 ◽

2021 ◽

Vol 37 (3) ◽

pp. 198-206

Author(s):

Brenda S. Howard ◽

Fiona Brown Jones ◽

Aundrea Sellers Steenblock ◽

Kiersten Ham Butler ◽

Ellen Thomas Laub ◽

...

Keyword(s):

Older Adults ◽

Fall Risk ◽

Community Dwelling ◽

Evidence Based ◽

Risk Awareness ◽

Single Session ◽

Community Dwelling Older Adults

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Barriers and facilitators to nutritional risk screening of older adults in primary care

Proceedings of The Nutrition Society ◽

10.1017/s0029665120004255 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Christine Mills

Keyword(s):

Older Adults ◽

Primary Care ◽

Grey Literature ◽

Community Dwelling ◽

Barriers And Facilitators ◽

Nutritional Risk ◽

Term Care ◽

Risk Screening ◽

Google Search ◽

Nutritional Risk Screening

AbstractIntroduction:Over one-third of these community-dwelling older adults in Canada are at increased nutritional risk. Worldwide, two-thirds of older adults are at increased nutritional risk, although this figure includes those who are hospitalized or in long term care. Nutritional risk can lead to malnutrition; this occurs when an individual's food intake has an imbalance of energy, protein, or other nutrients. Nutritional risk and malnutrition are associated with poor quality of life, increased hospitalization, and premature mortality. Since malnutrition starts in the community, primary care is the ideal location for nutritional risk screening. If nutritional risk is identified early, before it progresses to malnutrition, it can be more easily treated. It is therefore important to understand barriers and facilitators to nutritional risk screening in primary care.Materials and Methods:The peer-reviewed and grey literature were searched. The databases CINAHL, Embase, Medline, and Google Scholar were used to identify articles related to barriers and facilitators to nutritional risk screening of older adults in primary care. A Google search identified publications from the grey literature related to nutritional risk screening of older adults. Key informants consisting of health care professionals working in primary care were asked to identify additional barriers. The Theoretical Domains Framework (TDF) was used to classify the barriers and facilitators.Results:Nine barriers and nine facilitators relating to nutritional risk screening of older adults in primary care were identified. These barriers and facilitators were located within the following domains of the TDF: knowledge; skills; social/professional role and identity; beliefs about capabilities; beliefs about consequences; motivation and goals; memory, attention and decision processes; environmental context and resources; social influences; emotions; behavioural regulation; and nature of the behaviours.Discussion:The TDF can be used to examine the barriers and facilitators to nutritional risk screening of older adults in primary care. Identification and classification of these barriers and facilitators can aid in the development and implementation of interventions designed to improve rates of nutritional risk screening in primary care. Identifying older adults at nutritional risk can help to prevent malnutrition, by intervening early when poor dietary intake may still be relatively easy and inexpensive to address. Screening is the first step in this identification.

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