Model of nutritional care in older adults: improving the identification and management of malnutrition using the Mini Nutritional Assessment–Short Form (MNA®-SF) in general practice
Karen Charlton A B , Karen Walton A B , Kate Brumerskyj C , Elizabeth Halcomb
B D , Alycia Hull C , Teagan Comerford A and Vinicius Andre do Rosario A E
+ Author Affiliations
- Author Affiliations
A School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia.
B Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia.
C Grand Pacific Health, Wollongong, NSW 2500, Australia.
D School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia.
E Corresponding author. Email: vadr998@uowmail.edu.au
Australian Journal of Primary Health 28(1) 23-32 https://doi.org/10.1071/PY21053
Submitted: 4 March 2021 Accepted: 25 June 2021 Published: 16 December 2021
Abstract
Despite clinical guidelines recommending routine nutrition screening, malnutrition in community-living older adults remains under-recognised. This study evaluated the uptake of a model of nutritional care in older adults designed to improve the identification and management of malnutrition. A pragmatic quasi-experimental study was conducted in eight general practices in regional New South Wales between January 2017 and June 2018. Study participants comprised GPs and practice nurses who participated in a training event on the identification and management of malnutrition and patients (aged >65 years) attending the practices recruited to the study. Nutritional screening was conducted using the Mini Nutritional Assessment–Short Form. The specific objectives of the study were to: (1) evaluate the effects of the intervention on knowledge, attitudes and practices of staff related to malnutrition screening using questionnaires and in-depth interviews; and (2) identify patients’ experiences and outcome measures following malnutrition screening through self-completed surveys. Across the eight practices, 11 healthcare professionals completed in-depth interviews. Post-training knowledge surveys (n = 25) identified that knowledge increased in 96% of staff (P < 0.001). Fifty-five older adults who were screened (two malnourished, 10 ‘at risk of malnutrition’) reported an increased awareness of risk factors for malnutrition. This study provides proof-of-concept that a model of care that includes routine malnutrition screening and accompanying pathways for management is acceptable to general practice staff and has promising effects on patient outcomes. However, the low number of patients screened suggests that additional processes are required to improve feasibility (e.g. incorporation into Medicare-funded nurse-led consultations such as the 75+ Health Assessment).
Keywords: general practice, health services for the aged, malnourishment, Mini Nutritional Assessment, staff development.
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