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Screening and assessment for the prevention of malnu- trition among older persons is complicated by the many settings in which older adults receive care: community dwelling (including home care), hospital- ization for acute care, postacute hospitalization, assisted living, extended-stay facilities (including nursing homes), and hospice. An older adult may move through many of these settings over the course of a single illness.

6 NUTRITION SCREENING

Nutrition screening is the process of identifying char- acteristics known to be associated with nutrition prob- lems. Its purpose is to pinpoint older adults who are malnourished or at nutritional risk. A member of the health care team, such as a registered dietitian nutri- tionist (RDN), nutrition and dietetics technician, regis- tered (NDTR), nurse, physician, or other qualified health care professional, can complete the nutrition screen. Screening occurs prior to the start of the Nutrition Care Process (NCP) (1) and leads to referral of at-risk individuals to the RDN for nutrition assess- ment (2).

All health care organizations should have protocols in place that identify those clients at nutritional risk and should have a process for referral to the RDN, or NDTR. A screening tool should be easily administered, easy to score, reliable, and validated for the population that is being screened. The tool must also be sensitive enough to identify all those at risk. The screening process has the following characteristics (1,3):

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It may be completed in any setting (eg, via per- sonal contact or on-site survey).

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It facilitates completion of early intervention goals.

Nutrition Assessment of Older Adults

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It includes the collection of relevant data on risk factors and the interpretation of data for interven- tion or treatment.

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It determines the need for nutrition assessment. It is cost-effective.

On most nutrition screens, an older adult with a high score is identified as at risk for malnutrition. The DETERMINE Your Nutritional Health checklist (Figure 6.1; see page 91), developed in 1991 by the Nutrition Screening Initiative (NSI) to determine those at nutritional risk, continues to be used across the United States to evaluate those requesting assistance from the Older Americans Act Nutrition Program (OAANP). Using DETERMINE, NSI suggests that scores be placed in the following risk groups for inter- vention (4):

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Scores of 0 to 2 indicate low risk of poor nutri- tional status. The organization may want to dis- tribute educational literature on nutrition and fitness.

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Scores of 3 to 5 indicate moderate risk. Clients may be directed to health education and wellness programs, selected health care professionals, or a case manager. It may be appropriate to direct older adults to services such as home-delivered meals/ Meals on Wheels or to counseling services. The checklist should be readministered in three months.

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Scores of 6 and above indicate high nutritional risk. Persons who score in this range need addi tional care.

Level I or II screens (Figures 6.2 and 6.3; see pages 92 and 93) are used for clients who need further interven- tion (5,6).

Several other screening tools have been developed for identifying older adults at risk for poor nutrition outcomes. Widely used screening tools include the