Comparison of tools for nutritional assessment in elderly patients: A pilot study

Abstract

Background: Malnutrition is a major health related concern associated with higher morbidity and mortality in the elderly compared to their younger counterparts. Malnutrition is not an inevitable side effect of ageing, but many changes related to ageing can cause malnutrition. The early recognition of patients at high risk of malnutrition is needed to timely manage the condition and avoid its adverse outcomes. Several types of nutrition screening tools have been developed for evaluating the nutritional status of elders; however, the Mini-Nutritional Assessment-Short Form (MNA-SF) is the most widely used tool. Aim: The aim of this study is to identify the most appropriate nutritional screening tool for use in hospitalized elderly population. Method: Mini-Nutritional Assessment-Short Form (MNA-SF), Malnutrition Universal Screening Tool (MUST), The Nutritional risk screening (NRS), Patient-Generated Subjective Global Assessment (PG-SGA) and Geriatric nutritional risk index (GNRI) were administered to 20 patients. All patients were 60 years and over. Results: Using the MNA-SF 12 (60%) of the studied sample were malnourished and 8 (40%) had normal nutritional status. Tools performance in predicting malnutrition was calculated. The sensitivity was 91%, 83%, 83% and 66% and specificity was 50%, 62%, 12% and 75% with the NRS, MUST, PG-SGA and GNRI, respectively. Combining different pairs of tools MUST and NRS together had better sensitivity 92.8% and specificity 66.6% then 2nd better two tools together is NRS and GNRI with sensitivity 91.6% and specificity 50% with accuracy 75% other tools showed high sensitivity but low specificity as PGSGA with NRS and PGSGA and GNRI. Conclusion: NRS had the highest sensitivity while GNRI had the highest specificity among different studied assessment tools. MUST and NRS together had better sensitivity but lower specificity than either tool alone. Combining the NRS and GNRI had better sensitivity than GNRI alone and better specificity than NRS alone. We recommend using NRS alone as the optimal screening tool.