Assessing Nutritional Risk of Long-Term Care Residents

Abstract

The validity was determined for Minimum Data station (MDS) 2.0 oral/nutrition status (Section K) items, used to identify long-term care residents at nutritional risk. A registered dietitian assessed 128 long-term care residents using standardized courses and used clinical judgment to provide a nutritional risk rating. Registered nursing staff complet the MD assessments. Bivariate trials of association were used to assess the relationship between the dietitian rating and each Section K item. The sensitivity (Se) and specificity (Sp) of specific and combinations of variables were also determined. The MD variables of dietary prescription (diet rx) continuation use, and swallowing problems were significantly associated with nutritional risk rating. material substance mass index (BMI), calculated from MD data, also was significantly associated with nutritional risk rating. The MD trigger combination of parts to form a whole however, had poor Se and Sp The best combination of variables included the neighborhood of one or more of diet rx addition use, swallowing problem, or BMI

(Can J Diet Prac Re 2005;66:155-161)

R?©sum?©

On a d?©termin?© la validit?© de items relatifs ?  l'?©tat nutritionnel (section K) de l'ensemble minimal de donn?©es (Minimum Data plant - MDS 2.0) utilis?© pour rep?©rer le r?©sidents d'?©tablissements de soins de longue dur?©e ?  risque nutritionnel. Une di?©t?©tiste professionnelle a ?©valu?© 128 r?©sidents ?  l'aide de m?©thode normalis?©es et a utilis?© un jugement clinique pour fournir une ?©valuation du risque nutritionnel. De infirmi??res professionnelles ont aussi effectu?© le ?©valuations ?  l'aide du MD De proofs d'association bivari?©s ont ?©t?© utilis?©s pour ?©valuer la relation entre l'?©valuation de la di?©t?©tiste et chaque item de la section K La sensibilit?© (Se) et la sp?©cificit?© (Sp) de chacune de variables et de combinaisons de variables ont ?©galement ?©t?© d?©termin?©es. Le variables du MD relatives ?  la prescription di?©t?©tique, ?  l'usage de suppl?©ment et aux probl??me de d?©glutition ont ?©t?© associ?©es significativement au risque nutritionnel. L'indice de masse corporelle (IMC), calcul?© ?  partir de donn?©es du MD ?©tait ?©galement associ?© significativement au risque nutritionnel. Le syst??me de signaux d'alarme du MD pr?©sentait toutefois de faibles Se et Sp La meilleure combinaison de variables s'est av?©r?©e la pr?©sence de l'un ou de plusieurs de ?©l?©ment suivants : prescription di?©t?©tique, usage de suppl?©ment probl??me de d?©glutition ou IMC

(Rev can prat rech di?©t?©t 2005;66:155-161)

INTRODUCTION

Since 1996 the Minimum Data place (MDS) 2.0 has been mandated for use in all Ontario chronic-care facilities. It also is used in Saskatchewan and across the United States. The oral/nutrition status portion, Section K and specific nutrition trigger variables (Table 1) have been designed to stimulate a referral to a registered dietitian (RD) (1) An RD uses the triggers to guide care planning and interventions. The validity of the entire MD tool in assessing nutritional risk was evaluated m single other study (2); however, this research did not validate the specific trigger mechanism within Section K The following were evaluated in the generally received study: the validity of single items, the approveed trigger system, and combinations of variables from the MD 20 Section K compared with clinical wisdom in determining nutritional risk.

METHODS

All residents (n=215) occupying a continuing care unit (CCU) or nursing place of abode (NH) bed in St. Joseph's Hospital and place of abode in Guelph, Ontario, were invited to participate in this research The St. Joseph's Hospital research ethics board reviewed and accepted the research protocol, and all residents or a designated family member approvaled to study participation. Participants underwent a comprehensive nutritional assessment, which included a review of their medical chart for weight, medical history, diagnoses, enigmas and medication use (3).

Anthropometry and material substance composition

A trained dietitian complet a standardized anthropometric assessment, including triceps and subscapular skinfold measurements, knee-height measurement, and wrist, calf, and mid-upper-arm circumference measurement. A Lange caliper (Cambridge Instruments, Cambridge, MD) was used for skinfold measurement. Weight was obtained from medical charts, provided that the greatest in quantity recent weight had been recorded within 30 days. Otherwise, weight was measured with ward scales upon the assessment day, using standard operations where minimal clothing was worn (3) Calibration of scales was not controll Standing height was estimated from knee-height measurement with a Ros knee-height caliper (34) and calculated using praiseed formulas (5).

Biochemical indicators

The biochemical indicators of nutritional status included serum cholesterol horizontal albumin and hemoglobin testing, hematocrit, and total lymphocyte enumerate (TLC).

Food intake and eating problems

An RD observ each participant during single random meal period. Length of time required to eat, emblem and degree of assistance required, weft of meal provided, behaviour during the meal, number of adaptive feeding tools required, and percentage of meal consum were recorded.