It is derived from synthesis of the results of the five tools. If a patient was evaluated as malnourished to any degree or at risk of malnutrition according to at least four out of the five tools, the patient was finally determined to be malnourished. In this study, when compared with the combined index, the sensitivity of MUST was The K value was 0. This shows similarity to a previous study [ 27 ] in which the malnutrition group obtained significantly lower scores than the normal group on the anthropometric and biochemical measurements reflecting nutritional status.
Therefore, MUST seems not only to have high statistical efficacy to predict malnutrition, but also to adequately reflect the nutritional status of elderly patients.
Nutritional screening tools should be comparatively rapid, simple and economical by including data from patients that can easily be obtained upon admission to hospital [ 8 ]. The MUST was primarily developed for use in the community and includes a BMI score, a weight loss score, and an acute disease score [ 12 ].
Therefore, the MUST appears to be a valuable and useful tool for the elderly at care hospitals. Further, the K value was 0. The higher the sensitivity of a tool the less likely malnutrition patients will be missed; however, since it can also raise the false positive rate to detect even those who are not malnourished, this method can be determined as one resulting in excessive nutritional intervention [ 20 ].
Our study showed that of the five nutritional screening tools, the MNA-SF had the lowest positive predictive value Even in studies conducted abroad, the MNA-SF showed high sensitivity but low specificity when comparing an assessment by a professional [ 28 ] and nutrition-related indicators [ 29 ] as the standard reference, indicating that the tool classifies too many patients as being at risk of malnutrition, while, in fact, they are not malnourished.
Therefore, if the nation's geriatric care hospitals were to use the MNA and MNA-SF to assess the nutritional status and care for malnourished patients, it would be time consuming and burdensome on personnel. The limitation of our study is that nutritional screening should be done against every patient hospitalized, meaning that all patients hospitalized should have been analyzed.
Since the reference standard used herein was derived from a synthesis of the results of the five tools, patients who couldn't be assessed by all five tools were inevitably excluded. Another limitation is that when selecting the subjects, although not limited to a particular disease, a high percentage was made up of cancer patients.
Evaluation of a nutritional screening tool's efficacy should not be limited to a certain disease, but rather include patients with a variety of diseases to produce results with high validity. Therefore, it must be verified whether many of the patients have specific diseases when conduced analysis.
National Center for Biotechnology Information , U. Journal List Nutr Res Pract v. Nutr Res Pract. Published online Nov Find articles by Myoung-Ha Baek. Find articles by Young-Ran Heo. Author information Article notes Copyright and License information Disclaimer. Corresponding author.
This article has been cited by other articles in PMC. Keywords: Nutritional screening, malnutrition, elderly, efficacy, validity. Table 1 Presentation of nutritional screening tools. Open in a separate window. Data collection This study used the general, anthropometric and biochemical data of the subjects from medical records.
Table 2 Scores of malnutrition and assessment of nutritional status according to the nutritional screening tools. Reference standard : Combined index There is no gold standard for evaluating malnutrition upon admission to geriatric care hospitals for elderly patients.
Evaluation of the efficacy of nutritional screening tools Evaluation to determine the most valid screening tool to predict malnutrition was carried out by calculating the sensitivity, specificity, and positive and negative predictive values. Table 3 General characteristics of the subjects. Anthropometric and biochemical characteristics of the subjects The average height of participants was Table 4 Anthropometric and biochemical characteristics of the subjects. Assessment of nutritional status The frequency of any degree of malnutrition or risk of developing malnutrition upon admission to the geriatric care hospital herein varied greatly, depending on the nutritional screening tool used.
Distribution of nutritional status according to the screening tools used. Table 5 Differences of nutritional parameters between malnutrition and normal status as assessed by the nutritional screening tools and the combined index.
Evaluation of the efficacy of nutritional screening tools Assessing validity of the tools according to the combined index revealed MUST to have good validity sensitivity se Table 6 Statistical evaluation of the nutritional screening tools compared to the combined index.
References 1. Statistics Korea. Brownie S. Why are elderly individuals at risk of nutritional deficiency? Int J Nurs Pract. Ahmed T, Haboubi N. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging. Malnutrition prevalence in The Netherlands: results of the annual dutch national prevalence measurement of care problems. Br J Nutr.
The German hospital malnutrition study. Older people may develop constipation because they are not healthy, take medication that can cause constipation, eat a diet low in fibre and are inactive. The commonest causes of constipation are insufficient fluids, insufficient dietary fibre, insufficient mobility, insufficient attention to toileting habits and medication.
In most cases, treating the causes is all that is required to restore normal bowel habit 10 Table 2. An adult requires ml of fluid per kilo per day, so a person with an ideal body weight of 60kg requires 2. Insufficient fluid intake leads to stools becoming drier, harder and more difficult to pass. Increasing the amount of fibre in the diet improves propulsion times.
The fibre helps speed up the passage of faeces through the colon. This improves bowel habit and reduces discomfort. It is possible to offer even the frailest older person an appetising diet rich in fibre. Fruit can be cut up into small pieces, poached, pureed or juiced. Vegetables can be added to soups, casseroles and stews. Oats, wheat and dried fruit can be added to puddings, cakes and flapjacks.
Walking and moving stimulates peristaltic waves in the colon. Encouraging people to remain as active as possible encourages normal bowel function, improves appetite and contributes to well being. Defecation is an intensely private activity and many adults prefer to defecate at home rather than in toilets that they may share with workmates.
Adults may develop habits that contribute to constipation such as eating breakfast whilst travelling to work on the train or bus and then putting off defecation until they return home. Developing healthy habits such as getting up a little earlier, having breakfast at home and defecating after breakfast when the gastrocolic reflex is strongest at home in private can help a person to establish a healthy bowel habit.
The most natural position for defecation is squatting, however this is not how most adults in Western Europe defecate. People with defecatory difficulty need to push down and use their abdominal muscles. Adapting the way we use a toilet can help people to defecate. The person can use a stool so that the knees are higher than the hips. This increases the ano-rectal angle and makes it easier to defecate.
Leaning forward and putting the elbows on the knees makes it easier to use the abdominal muscles to push. Medication can cause constipation. Table 3 provides details of medication that can cause constipation. The length of time it takes for food to move from mouth to anus is known as gut transit time. Transit times vary according to the amount of exercise, fluid and fibre a person takes. In Africans eating a high fibre, diet transit times can be hours. In Europeans eating a typical British diet, transit times of up to 70 hours are considered normal.
Frail older people living in institutions can have transit times of 14 days. The myenteric plexus is the nerve supply to the gastrointestinal tract and controls movement throughout the gastrointestinal tract. Generally propulsion disorders resolve when a person has sufficient fluids, fibre and activity levels. Some people with constipation have normal transit times but have difficulty expelling stools. The character of the stool can contribute to defecatory difficulty.
Hard stools are harder to pass than soft stools. The Bristol stool chart Figure 1 can be used to assess the characteristics of the stool. Normally the internal and external anal sphincter muscles and the puborectalis muscles relax during defecation. In some people these muscles tighten rather than relax and this is termed anismus. Few people with defecatory difficulty have this problem.
People with defecatory difficulty need to push down using their abdominal muscles. If these are weak, it makes defecation more difficult. People who are very frail and people who have breathing problems perhaps because of chronic pulmonary obstructive airways disease can develop this problem.
Some people postpone having their bowels open. This can in time lead to the rectum being less sensitive to fullness. The person may be unaware of the need to defecate. Some diseases such as Multiple Sclerosis and spinal cord injury can lead to a person losing sensation. Some people feel as though they cannot fully empty their bowels. Rectal examination reveals that there is no stool in the rectum.
This condition is known as rectal tenesmus. The person strains in an effort to empty a bowel that has no stool in it. There are many reasons for this uncomfortable condition, including an enlarged prostate gland, a vaginal prolapse, haemorrhoids or a rectal tumour.
People who are cognitively impaired may have normal sensation but are not able to interpret the sensation of rectal fullness. Constipation is a symptom, and the practice nurse should determine the reasons why the symptom has developed in order to work out a management plan Figure 2.
These are:. The practice nurse should enquire about fluid and fibre intake, activity levels, and any prescribed and over-the-counter medication the person is taking. The management plan is based on history, examination and diagnosis of the causes of constipation and severity of constipation. It should include advice on diet, fluids, activity and toilet habits.
Any medication that could be causing constipation should be reviewed, discontinued or changed whenever possible. If, for example, the person is having codeine-based analgesia such as co-codamol, it may be possible to control pain with medication that does not constipate. If the person is taking iron tablets, a blood test can establish if these are still required. If the person has faecal loading or impaction, suppositories or mini enemas may be needed. If faecal loading is severe, the person may need a phosphate or an arachis peanut oil enema.
Glia, A. Scandinavian Journal of Gastroenterology; 11, — Kyle, G. Continence UK; 1: 1, 38— Thompson, D. British Journal of Nursing; 8, — The copyright of the Norgine risk assessment tool belongs to Norgine Pharmaceuticals Ltd. The Norgine risk assessment tool updates and replaces the Eton risk assessment tool. Sign in or Register a new account to join the discussion.
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