Multi-Site Survey Using the Nutrition Screening Initiative's Determine Checklist Shows Evidence of Nutritional Risks in Outpatient Veterans

Abstract

In ambulatory care settings at many VA medical centers and outpatient clinics, current practice involves referral via consult of selected veterans for nutritional intervention and counseling. However, it is speculated that there are many more veterans with poor nutritional status who are not detected. As a result, a group of ambulatory care network dietitians implemented the use of the Nutrition Screenings Initiative's DETERMINE Checklist with a sample population of elderly veterans over the age of 65. During a period of nine months, seven ambulatory care nutrition clinics participated in this survey. Dietitians administered the survey along with clinic support staff and volunteers following specific guidelines developed by the participating dietitians. The DETERMINE Checklists were randomly distributed to ambulatory care veterans who had medical or surgical outpatient clinic appointments. The statistical program SYSTAT was used for data analysis. A total of 857 questionnaires were completed within the seven survey sites. Of this number, 30% were at “no nutritional risk” (scored 0–2 points), 36% were at “moderate nutritional risk” (scored 3–5 points), and 34% were at “high nutritional risk” (scored higher than 6 points). Sixty-five percent of the respondents had polyphar-macy and 55% had an illness or condition that caused the veteran to change the kind and/or amount of food eaten. Additional questions with nutritional implication showed the following responses: 25% lost or gained at least 10 pounds without trying in the last six months, 21% had tooth or mouth problems that made it hard to eat, 10% ate fewer than two meals a day, and 5% drank three or more alcoholic beverages per day. The results of this survey indicate that the DETERMINE Checklist can be used to identify outpatient veterans who are at risk for poor nutritional status. The authors suggest that an annual screening for all veterans should include an assessment of all medications by a qualified pharmacist. In addition, a screening tool for depression may be useful in determining a possible major cause for changes in the kind and/or amount of food eaten.