Prevalence of Malnutrition or Risk in Residents in Long Term Care: Comparison of Four Tools

Abstract

The ideal tool for determination of malnutrition risk or malnutrition in long term care (LTC) is elusive. This study compares prevalence, association with resident risk factors and sensitivity (SE) and specificity (SP) of malnutrition or risk categorization in 638 residents from 32 LTC homes in Canada using four tools: the Mini-Nutritional Assessment Short Form (MNA-SF); Patient-Generated Subjective Global Assessment (PG-SGA) Global Category Rating and the Pt-Global webtool; and the interRAI Long Term Care Facility undernutrition trigger. Prevalence was most common with MNA-SF (53.7%) and lowest with InterRAI (28.9%), while the PG-SGA Global Category Rating (44%) was higher than the Pt-Global webtool (33.4%). Tools were consistently associated with resident covariates with few exceptions. The PG-SGA Global Category Rating demonstrated the best sensitivity and specificity when compared to all other tools. Further work to determine the predictive validity of this tool in LTC residents is required.

Keywords:

• Assessment
• malnutrition
• risk
• long term care

Acknowledgments

The study would not have been possible without the expertise and dedication of project managers (Hilary Dunn, Carla Ickert who have provided permission to be acknowledged), the provincial site coordinators, research assistants, the dental hygienists, and the interest and cooperation of participating homes, residents and families. We greatly appreciate their efforts and contributions to the M3 prevalence study.

Author contributions

HK conceived the research question, design of the study and wrote the first draft of the manuscript. SS, CL, HK, NC were responsible for the data collection in their respective province. VV completed analyses and displayed analyses in draft tables. FO and HHJ provided guidance on the interpretation of results. All authors reviewed drafts of the paper, providing editorial suggestions and reviewed the final submitted draft.

Disclosure statement

HHJ was co-developer of the PG-SGA-based Pt Global app/web tool. FO is copyright holder of the PG-SGA and co-owner and co-developer of the PG-SGA-based Pt-Global app/web tool. Other authors have no competing interests that are in conflict of interest with this research.

Data availability

Data from this study will be made available in 2019 at a repository at University of Waterloo.

Additional information

Funding

Funding for this project was received from the Canadian Institutes of Health Research (CIHR) (2014 Operating Grant #326892), a federally mandated organization to peer review and select high-quality health research. CIHR had no involvement in the study design, collection, analysis or interpretation of data post the approval of this study for funding.