Which Malnutrition Screening Tool is Best?

September is Spotlight on Malnutrition Month. Malnutrition is a topic near and dear to our hearts. As such, a majority of the articles on this blog focus on stopping unintended weight loss, preventing and treating malnutrition, and focusing on high calorie foods.

In this article, we will address the question: Which Malnutrition Screening Tool is Best?

Malnutrition in Older Adults

Malnutrition is a significant problem among the older adult population. Unfortunately, older adults have less muscle and are at a higher risk for malnutrition than their younger counter parts.

Factors that contribute to malnutrition in older adults include unintended weight loss, disease and illness, depression, being on certain medications, changes in taste, being socially isolated, being unable to prepare meals or feed themselves (1).

It is estimated that 12-50% of older adults in the hospital are malnourished. And 23-60% of older adults living in long-term care settings are malnourished (1). The hard part about malnutrition in older adults is that it doesn’t just threaten those who are hungry or have limited access to food.

Any older adults can develop malnutrition. Up to 1 in 2 older adults are at risk for malnutrition (2).

Why is Matters

Malnutrition can increase risk of falls, hospitalization, loss of independence, and early death. It robs older adults of their “golden years” and has a significantly negative effect on quality of life.

Malnutrition also costs a lot. To older adults and our healthcare system. It is estimated that malnutrition in older adults costs the United States $51.3 billion per year (2). Yes, billion.

This is a serious issue. And, malnutrition must be stopped.

Why Should we Screen

The only way we can stop malnutrition is to identify it early and intervene. Screening for malnutrition allows us to tell which older adults are at risk. And malnutrition does not discriminate- it can affect anyone.

For this reason, it is important that we screen ALL older adults for malnutrition.

Common Malnutrition Screening Tools

There are many malnutrition screening tools available. Some are specific for older adults, some are not.

A malnutrition screening tool can be used in any medical setting or in the home. Anyone can complete the screen, just make a positive screen results in a QUICK referral to a physician or provider.

In this article we will look at 3 different malnutrition screening tools.

Malnutrition Screening Tool (MST)

The Malnutrition Screening Tool is also called the MST. This tool is published through Abbott Nutrition (3). It is a very simple tool and only involves two questions. Have you lost weight without trying (if so, how much) and have you been eating less because of poor appetite?

The focus of this tool is on unintended weight loss and appetite.

Mini Nutrition Assessment (MNA)

The Mini Nutrition Assessment is also known as the MNA. There is a long form and a short form for the MNA. The short form has been shown to be just as reliable as the long form. So, for this article, when we mention the MNA, we are referring to the short form.

This tool is published through Nestle Nutrition Institute (4). It was developed specifically for older adults ages 65 and older. The MNA Short form includes 6 questions. These questions assess decline in food intake, weight loss, mobility, illness, mental health, and Body Mass Index (BMI).

This tool is well known and loved among geriatric dietitians as a go-to for screening older adults for malnutrition.

The DETERMINE Checklist

The DETERMINE Your Nutrition Health Checklist is also known as the DETERMINE Checklist. This is another tool commonly seen in the geriatric nutrition world. However, this tool is more often used in community nutrition settings (often programs under the Older American Act).

DETERMINE is an acronym which stands for (4):

• Disease
• Eating Poorly
• Tooth Loss/mouth pain
• Economic Hardship
• Reduced Social Contact
• Multiple medicines
• Involuntary weight loss/gain
• Needs assistance in self care
• Elder years above age 80

This tool is published by The Nutrition Screening Initiative funded in part through Abbott Laboratories, Inc. It is the longest of the tools we are looking at with 10 yes-or-no questions.

Which Malnutrition Screening Tool is Best?

There are several factors to look at when determining the best malnutrition screening tool. Is it easy to administer? Is it reliable- has research shown it actually can identify the risk of malnutrition? And is it appropriate for older adults?

Comparison of Malnutrition Screening Tools

The Academy of Nutrition and Dietetics recommends using the MST to screen ALL adults for malnutrition in all settings (5). This recommendation was released in 2019.

Many geriatric dietitians still hold onto the MNA because this has been the primary screening tool we’ve known and loved for years. It is a tool that was made specifically for older adults and addresses key issues that contribute to malnutrition.

The DETERMINE Checklist is primarily used in Community Nutrition settings. Primarily in programs under the Older Americans Act like Meals on Wheels. It is a long tool and not appropriate for all settings (particularly long-term care).

Let’s compare malnutrition screening tools:

Our Recommendation

I want every older adult to be screened for malnutrition. Because of this, I am fine with you using any of these 3 tools (as long as it’s in the right setting). However, I will share my top pick for the best malnutrition screening tool for the elderly…

Malnutrition Screening Tool (MST)

The MST is simple. It’s short. To the point. And, it addresses unintended weight loss. While it is not just for older adults, research has shown that it is a strong and reliable screening tool regardless of age (5).

While my top pick is the MST, the MNA isn’t far behind. Again, the most important thing is that we are screening older adults for malnutrition.

What if an Older Adult Screens Positive for Malnutrition?

If an older adult screen positive for malnutrition it is important to act quickly. Defeat Malnutrition Today breaks down the process in an easy to understand model (2):

Screen + Assess + Diagnose + Intervene= Improve Older Adult Malnutrition

A referral to a physician and/or a geriatric dietitian to assess for nutrition status is needed ASAP. They can then determine if the older adult meets the diagnostic criteria for malnutrition. Any older adult with malnutrition needs nutrition intervention.

Nutrition Intervention for Malnutrition

Working with a geriatric dietitian is the best bet for preventing and treating malnutrition.

But I know not everyone has access to a geriatric dietitian. The key point for nutrition intervention for malnutrition is getting enough calories and protein. We must stop unintended weight loss. Provide a high calorie diet. One that is specific to the needs of the individual older adult.

Examples of high calorie foods include:

• Whole fat dairy
• Nuts and nut butters
• Butter
• Soft spread margarines
• Heart healthy oils
• Avocado
• Dried fruit
• Gravy
• Sweets

My High Calorie Foods SERIES on RD2RD includes a high calorie food list, grocery list, and meal planner to help prevent and treat malnutrition. There is also a High Protein Foods SERIES available.

For More Information

To learn more about malnutrition, be sure to check out our other articles:

• Weight Loss in Elderly Must be Stopped
• Chronic Malnutrition in Older Adults
• Stopping Unintended Weight Loss in Older Adults
• Malnutrition Article Archive
• High Calorie Article Archive

Also, be sure to visit the Defeat Malnutrition Today website. They offer so much information from Toolkits to Infographics to Clinical Studies and Papers and more.

https://www.defeatmalnutrition.today/resources

Conclusion

Malnutrition is a serious issue in the older adult population. Screening for malnutrition is the best way to identify potential issues and to STOP malnutrition in its tracks. The MST is the best malnutrition screening tool for the elderly… with the MNA right on its heels.

Let’s stop malnutrition and unintended weight loss in older adults. And help older adults live the lives they deserve.

References

1. Evans C. Malnutrition in the elderly: a multifactorial failure to thrive. The Permanente Journal. 2005;9(3):38.
2. Defeat Malnutrition Today website. https://www.defeatmalnutrition.today/sites/default/files/images/DMT_Malnutrition_Info_Graphic_OnePage_Update_2.pdf. Accessed September 26, 2020.
3. Malnutrition Screening Tool. Abbott Nutrition Website. https://static.abbottnutrition.com/cms-prod/abbottnutrition-2016.com/img/Malnutrition%20Screening%20Tool_FINAL_tcm1226-57900.pdf. Accessed September 26, 2020.
4. Mini Nutrition Assessment. Nestle Nutrition Institute. https://www.mna-elderly.com/forms/mini/mna_mini_english.pdf. Accessed September 26, 2020.
5. The DETERMINE Checklist. https://nutritionandaging.org/wp-content/uploads/2017/01/DetermineNutritionChecklist.pdf. Accessed September 26, 2020.