Nutritional screening of older people in a sub-acute care facility in Australia and its relation to discharge outcomes

Abstract

Objectives: to determine the prevalence of under-nutrition using brief screening methods and to determine the relation between these results and (1) those of a more standard nutritional assessment and (2) discharge outcomes. Design: prospective study. Subjects: 65 (21 males) patients older than 65 years. Setting: sub-acute care facility. Measurements: the Mini Nutritional Assessment, standard nutritional assessment, ‘rapid screen’ and discharge outcome. Results: the prevalence of under-nutrition was high, ranging from 35.4% to 43.1%, depending on the screening method used. Compared to the standard nutritional assessment the ‘rapid screen’ consisting of (1) body mass index <22 kg/m2; and/or (2) reported weight loss of > 7.5% over the previous 3 months and the two-tiered Mini Nutritional Assessment process (at risk subjects (46% of total) further evaluated using standard nutritional assessment) had sensitivities of 78.6 and 89.5% and specificities of 97.3 and 87.5% respectively in diagnosing under-nutrition. Under-nourished patients as identified by the standard nutritional assessment (50.0% (under-nourished) versus 21.6% (nourished); P = 0.017), the two-tiered Mini Nutritional Assessment process (50.0% (under-nourished) versus 21.6% (nourished); P = 0.017) and the rapid screen (56.5% (under-nourished) versus 21.4% (nourished); P =0.004) were more likely to be discharged to an acute hospital or an accommodation with increased support (poor discharge outcomes) than nourished patients. Conclusion: all screening methods identified patients more likely to have a poor discharge outcome. The highly specific but less sensitive ‘rapid screen’ may be the best method in facilities with limited resources as it can be easily incorporated into nursing/medical admissions and avoids biochemical investigations in all patients. The more sensitive two-tiered Mini Nutritional Assessment is better if resources permit.