Reliability of a qualitative screening tool versus physical measurements in identifying undernutrition in an elderly population

Background: This study aimed to assess the validity of a qualitative score derived from a nutritional screening tool when used by a dietitian or nurse against physical markers of nutritional status. Methods: A screening tool designed for elderly patients in use at St John's Hospital was evaluated. Using this, scores derived by dietitian and nurse were compared with physical measurements used in nutritional assessment. Th e agreement between scores in each of the five categories of the tool (clin ical condition, body weight, dietary intake, ability to eat and mental cond ition) was determined. Results: Sixty-six subjects (19 male, 47 female, mean age 78.5 years) were recruited. Undernutrition was found in 23% (n=15) of the patient population (less than or equal to 80% of reference values for one or more physical me asurements of nutritional status). A significant correlation between the qu alitative score derived by the dietitian using the screening tool and physi cal markers of nutritional status was evident (body weight expressed as ide al body weight r=0.36, P<0.005 and arm muscle circumference r=0.53, P<0.001 ). Using the screening tool 85% of the under-nourished patients were correc tly classified as nutritionally 'at risk' by the dietitian; however, only 5 8% were correctly identified by the nurse. There was no agreement between s cores from the dietitian and nurse in any of the five scoring categories. Conclusion: These results show that the nurse failed to identify over 40% o f at-risk patients when using the screening tool. The lack of agreement bet ween dietitian and nurse within each scoring category may suggest fundament al differences in assessing factors contributing to nutritional risk by the se two professions.