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Development of a novel nutrition screening tool for use in elderly South Africans

Published online by Cambridge University Press:  02 January 2007

KE Charlton ,
TL Kolbe-Alexander  and
JH Nel
KE Charlton*
Affiliation:
Chronic Diseases of Lifestyle Unit, South African Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa Nutrition & Dietetics Division, School of Health and Rehabilitation Sciences, University of Cape Town, South Africa
TL Kolbe-Alexander
Affiliation:
UCT/MRC Research Unit for Exercise Science and Sports Medicine, University of Cape Town, South Africa
JH Nel
Affiliation:
Department of Logistics, University of Stellenbosch, South Africa
*
*Corresponding author: Email [email protected]
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Abstract

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Objective

To develop a nutrition screening tool for use in older South Africans.

Design

A cross-sectional validation study in 283 free-living and institutionalised black South Africans (60+ years).

Methods

Trained fieldworkers administered a 24-hour recall and the Mini Nutritional Assessment (MNA) screening tool, and performed anthropometric measurements and physical function tests. Cognitive function was assessed using a validated version of the Six-Item Cognitive Impairment Test. Biochemical indicators assessed included serum albumin, haemoglobin, ferritin, vitamin B12, red-blood-cell folate, cholesterol and vitamin C. The MNA was used as the gold standard against which a novel screening tool was developed using a six-step systematic approach, namely: correspondence analysis; identification of key questions; determination of internal consistency; correlational analyses with objective measures; determination of reference cut-off values for categories of nutritional risk; and determination of sensitivity and specificity.

Results

The new screening tool includes nine separate concepts, comprising a total of 14 questions, as well as measurement of mid-upper arm circumference. The new tool score was positively associated with level of independence in either basic activities of daily living (r = 0.472) or the more complex instrumental activities of daily living (r = 0.233). A three-category scoring system of nutritional risk was developed and shown to significantly characterise subjects according to physical function tests, level of independence and cognitive function. The new tool has good sensitivity (87.5%) and specificity (95.0%) compared with the MNA scoring system. It has a very high negative predictive value (99.5%), which means that the tool is unlikely to falsely classify subjects as well nourished/at risk when they are in fact malnourished.

Conclusion

A novel screening tool has been shown to have content-, construct- and criterion-related validity, and the individual items have been shown to have good internal consistency. Further validation of the tool in a new population of elderly Africans is warranted.

Keywords

ElderlyNutrition screeningAfricansNutritional riskMini Nutritional Assessment
Type
Research Article
Information
Public Health Nutrition , Volume 8 , Issue 5 , August 2005 , pp. 468 - 479
Copyright
Copyright © The Authors 2005

References

1Vellas, B, Garry, PJ, Guigoz, Y, eds. Mini Nutritional Assessment (MNA): Research and Practice in the Elderly. Nestle Nutrition Workshop Series, Clinical and Performance Programme, vol. 1. Basel: Nestle Nutrition Services, 1999.CrossRefGoogle Scholar
2Charlton, KE, Kolbe-Alexander, TL, Nel, JH. The MNA, but not the DETERMINE, screening tool is a valid indicator of nutritional status in elderly Africans. Journal of Nutrition, Health & Aging 2005: in press.Google ScholarPubMed
3Rubenstein, LZ, Harker, JO, Salva, A, Guigoz, Y, Vellas, B. Screening for undernutrition in geriatric practice. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2001; 56: M366–72.CrossRefGoogle ScholarPubMed
4Faul, AC, Hanekom, AJ, Hanekom, SM. Hunger and Food Security Assessment Scale. Silverton, OR: Perspective Training College, 1998.Google Scholar
5White, JV, Dwyer, JT, Posner, BM, Ham, RJ, Lipsdhitz, DA, Wellman, NS. Nutrition screening initiative: development and implementation of the public awareness checklist and screening tools. Journal of the American Dietetic Association. 1992; 92: 163–7.CrossRefGoogle ScholarPubMed
6Matthias, RE, Lubben, JE, Atchison, KA, Schweitzen, SO. Sexual activity and satisfaction among very old adults: results from a community-dwelling Medicare population survey. Gerontologist. 1997; 37: 6–14.CrossRefGoogle ScholarPubMed
7Katz, SC, Stroud, MW. Functional assessment in geriatrics: a review of progress and directions. Journal of the American Geriatrics Society 1989; 37: 267–71.CrossRefGoogle ScholarPubMed
8Mahoney, FI, Barthel, DW. Functional evaluation: the Barthel Index. Maryland State Medical Journal 1965; 14: 61–5.Google ScholarPubMed
9Lawton, MP, Brody, EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969; 9: 179–86.CrossRefGoogle ScholarPubMed
10Rantanen, T, Guralnick, JM, Sakari-Rantala, R, Leveille, S, Simonsick, EM, Ling, S, et al. Disability, physical activity and muscle strength in older women: The Women's Health and Aging Study. Archives of Physical Medicine and Rehabilitation 1990; 80: 130–5.CrossRefGoogle Scholar
11Broderick, K. Correlation between scores on two screening tools for dementia in Xhosa women. South African Journal of Occupational Therapy 2002; 32: 8–13.Google Scholar
12Brooke, P, Bullock, R. Validation of a 6-item cognitive impairment test with a view to primary care usage. International Journal of Geriatric Psychiatry. 1999; 14: 936–40.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
13Katzman, MD, Brown, T, Fuld, F, Peck, A, Scechter, R, Scimmel, H. Validation of a short orientation–memory–concentration test of cognitive impairment. American Journal of Psychiatry 1983; 140: 734–9.Google Scholar
14World Health Organization (WHO). Obesity: Preventing and Managing the Global Epidemic. Report on a Consultative Meeting. Geneva: WHO 1997.Google Scholar
15Louw, S. Geriatric medicine in South Africa – the onus is on medical schools. South African Medical Journal 1997; 87: 1099–100.Google ScholarPubMed
16United Nations Administrative Committee on Co-ordination/ Subcommittee on Nutrition (ACC/SCN). Update on the Nutrition Situation 1996. Geneva: ACC/SCN, 1996.Google Scholar
17Charlton, KE, Kolbe, T, Nel, H. Nutritional status of older black South Africans: towards the development of a nutrition screening tool for use in this population. Report submitted to the Minimum Data Set Project of the World Health Organization. Observatory: University of Cape Town, 2003 [unpublished].Google Scholar
18Rose, D, Charlton, KE. Prevalence of household food poverty in South Africa: results from a large nationally representative survey. Public Health Nutrition 2002; 5(3): 383–9.CrossRefGoogle Scholar
19Rose, D, Charlton, KE. Quantitative indicators from a food expenditure survey can be used to target the food insecure in South Africa. Journal of Nutrition 2002; 132: 3235–42.CrossRefGoogle ScholarPubMed
20Charlton, KE, Rose, D. Nutrition among older adults in Africa: the situation at the beginning of the millennium. Journal of Nutrition 2001; 131: 2424S–8S.CrossRefGoogle Scholar
21Murphy, SP, Davis, MA, Neuhaus, JM, Lenin, D. Actors influencing the dietary adequacy and energy intake of older Americans. Journal of Nutrition Education 1990; 22: 284–91.CrossRefGoogle Scholar
22Walker, D, Beauchene, RE. The relationship of loneliness, social isolation, and physical health to dietary adequacy of independently living elderly. Journal of the American Dietetic Association 1991; 91: 300–4.CrossRefGoogle ScholarPubMed
23Charlton, KE. Elderly men living alone: are they at high nutritional risk?. Journal of Nutrition, Health & Aging 1999; 3: 42–7.Google ScholarPubMed
24Ismail, S, Manandhar, M. Better Nutrition for Older People: Assessment and Action. London: HelpAge International and London School of Hygiene and Tropical Medicine, 1999.Google Scholar
25Chilima, DM, Ismail, SJ. Nutrition and handgrip strength of older adults in rural Malawi. Public Health Nutrition 2000; 4: 11–7.CrossRefGoogle Scholar
26Pieterse, S. Nutritional vulnerability of older refugees. PhD thesis, London School of Hygiene and Tropical Medicine, UK, 1999.Google Scholar
27Rubenstein, LZ, Harker, J, Guigoz, Y, Vellas, B. Comprehensive geriatric assessment (CGA) and the MNA: an overview of CGA, nutritional assessment, and development of a shortened version of the MNA. In Vellas, B, Garry, PJ, Guigoz, Y, eds. Mini Nutritional Assessment (MNA): Research and Practice in the Elderly. Nestle Nutrition Workshop Series, Clinical and Performance Programme, Vol. 1. Basel: Nestle Nutrition Services, 1999.Google Scholar