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Nutritional Screening of Older Patients: Developing, Testing and Using the Nutritional Form For the Elderly (NUFFE)
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to develop, test and use a simple, clinically useful instrument for the nutritional screening of older patients. Four studies were performed, with a quantitative approach, in a geriatric rehabilitation ward in western Sweden. The number of patients who par-ticipated was: 56 (I), 114 (II), 147 (III) and 144 (IV) older patients.

A nutritional screening instrument, the Nutritional Form For the Elderly (NUFFE), was constructed (I) and tested regarding reliability and validity (I, II). NUFFE was used in a screening, and the screening results were related to the patients’ perceived health and compared to the nurses’ nutritional notes in the nursing documentation (III). The screened patients’ self-care ability and sense of coherence (SOC) were investigated and the patients’ perceived health was related to selfcare ability and SOC (IV). The collection of data was done through interviews with the instruments NUFFE (I-IV), the Selfcare Ability Scale for the Elderly (SASE) (IV), Antonovsky’s SOC scale (IV), a question about perceived health, healthrelated ques-tions (III, IV) and background variables (I-IV). Weight and height were measured (I-III). The nurses’ nutritional notes in the nursing documentation were collected (III).

The screening instrument contains 15 threepoint items on ordinal level. The total score ranges between zero and 30 and a higher score indicates higher risk for undernutrition. Evidence of reliability and validity was shown (I, II). The determined cut-off points of NUFFE for identification of patients at low, medium and high risk for undernutrition were set to scores of <6, ≥6 and ≥13 (III). The screening results showed that 31% of the patients were identified to be at low risk for undernutrition, 55% at medium risk and 14% at high risk. When the screening results were compared to nurses’ nutritional notes in the nursing documentation, it was shown that important nutritional issues were absent in many patient records (III). The patients at high risk were more likely to perceive ill health than were those at low risk for undernutrition (p=0.03) (III). Those at medium or high risk were more likely to perceive ill health (p=0.014) and to have lower self-care ability (p<0.001) and weaker SOC (p=0.007) than were those at low risk for undernutrition. To perceive good health was associated with higher self-care ability (p<0.001) and stronger SOC (p<0.001). Lower self-care ability, being single and having been admitted from another hospital ward were three obtained predictors for being at medium or high risk for undernutrition (IV).

In conclusion, NUFFE is a simple, useful screening instrument for identification of older nutritional at-risk patients. The instrument has sufficient evidence of reliability and validity. Using NUFFE in a screening of older patients, the prevalence of patients at medium or high risk for undernutrition was found to be high. Nurses’ nutritional notes showed deficiencies, indicating that all medium or high risk patients were not identified. Using NUFFE, associations were found between older patients’ nutritional risk and their perceived health, and their self-care ability and SOC, respectively. These associations indicate that being at low risk for undernutrition is concomitant with perceived good health, higher self-care ability and stronger SOC. Conversely, being at medium or high risk for undernutrition is concomitant with perceived ill health, lower self-care ability and weaker SOC.

Place, publisher, year, edition, pages
Institutionen för medicin och vård , 2006.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 957
Keyword [en]
ageing, health, instrument testing, nursing documentation, self- care ability, sense of coherence, undernutrition
National Category
Nursing
Identifiers
URN: urn:nbn:se:liu:diva-7335ISBN: 91-85523-13-5 (print)OAI: oai:DiVA.org:liu-7335DiVA: diva2:22346
Public defence
2006-10-06, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2006-09-13 Created: 2006-09-13 Last updated: 2009-08-23
List of papers
1. Developing and testing the nutritional form for the elderly
Open this publication in new window or tab >>Developing and testing the nutritional form for the elderly
2001 (English)In: International Journal of Nursing Practice, ISSN 1322-7114, Vol. 7, no 5, 336-341 p.Article in journal (Refereed) Published
Abstract [en]

Undernutrition among elderly patients is a significant problem in nursing care. The aims of this study were to develop and test an instrument for identifying actual and potential undernutrition among elderly patients in clinical nursing care. A Likert-type scale consisting of 15 items was constructed. A consecutive sample of 56 elderly patients (>65 years) in a geriatric rehabilitation ward in western Sweden were interviewed with the instrument. The data were mainly analysed with non-parametric statistical methods. The results showed that the instrument was a fairly reliable scale with a Cronbach's alpha coefficient of 0.72. Evidence of validity concerning face validity, criterion-related validity—including concurrent and predictive validity—and construct validity was shown in the study group. Further testing is required if the instrument is to be used in clinical nursing care and research.

Keyword
aged, nursing, nutrition, scale-testing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13961 (URN)10.1046/j.1440-172X.2001.00296.x (DOI)
Available from: 2006-09-13 Created: 2006-09-13
2. Reliability and validity of the nutritional form for the elderly
Open this publication in new window or tab >>Reliability and validity of the nutritional form for the elderly
2002 (English)In: Journal of Advanced Nursing, Vol. 37, no 1, 28-34 p.Article in journal (Refereed) Published
Abstract [en]

Aim. The aim of this study was to test the reliability and validity of the Nutritional Form for the Elderly (NUFFE).

Background. The prevalence of undernutrition among older people in nursing homes and hospitals reaches high levels. Assessment of older patients' nutritional status is an important task for nurses in clinical care. To use a simple nutritional assessment instrument for older people is one approach for nurses. Examples of such instruments are the well validated Mini Nutritional Assessment (MNA) and the newly developed NUFFE.

Methods. A total of 114 consecutively chosen, newly admitted older patients in an elder care rehabilitation ward in western Sweden were interviewed using the NUFFE and MNA. Arm and calf circumferences, body mass index (BMI), and presence of pressure sores and skin ulcers were noted as part of the MNA on admission. Weight was monitored and BMI calculated on discharge. Serum albumin levels on admission and discharge were used if these were available in the records. Reliability of the NUFFE was measured as homogeneity. Criterion related validity, concurrent validity, construct validity, and predictive validity were assessed with different statistical methods. The regional research ethics committee approved the study.

Results. The results showed that the NUFFE is a fairly reliable and valid instrument for identifying actual and potential undernutrition among older patients.

Conclusion. The NUFFE is a simple tool for nurses to use to assess older patients with the aim of detecting undernourished individuals and those at risk for undernutrition. When doing a nutritional assessment with the NUFFE, the BMI ought also to be calculated. The assessment could also be combined with food intake recording for a period of time.

Keyword
care of older people, nutritional assessment, scale testing, undernutrition
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13962 (URN)10.1046/j.1365-2648.2002.02048.x (DOI)
Available from: 2006-09-13 Created: 2006-09-13
3. Nutritional screening and perceived health in a group of geriatric rehabilitation patients
Open this publication in new window or tab >>Nutritional screening and perceived health in a group of geriatric rehabilitation patients
2006 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 11, 1997-2006 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. (i) To perform a nutritional screening using the Nutritional Form For the Elderly and relate the results to perceived health in a group of geriatric rehabilitation patients; and (ii) to compare the screening results and nurses' nutritional notes in the nursing documentation.

Background. Undernutrition is an under-recognized problem among older patients. Using a screening instrument is a way to detect patients at risk for undernutrition.

Design. A cross-sectional study conducted in Sweden.

Methods. A sample of 147 geriatric rehabilitation patients was consecutively included and was interviewed with the screening instrument, questions about background variables, perceived health and health-related issues. Higher screening scores indicate higher risk for undernutrition. Parametric and nonparametric statistical tests were used. When nurses' nutritional notes in the nursing documentation were corresponding to the content in any of the response alternatives for each screening item, the notes were marked as existent.

Results. The screening results showed that 55% of the patients were at medium risk and 14% at high risk for undernutrition. Patients in perceived ill health had higher screening scores than those in perceived good health. Associations were also found between receiving help, perceiving helplessness, not being active and not feeling satisfied and higher screening scores. The content of nine of 15 items in the instrument was mentioned in a number of nursing records.

Conclusions. The prevalence of older patients at medium or high risk for undernutrition was high. To be at high risk for undernutrition was associated with perceived ill health. Nurses' nutritional notes in the nursing documentation showed deficiencies, indicating that all patients at medium or high risk for undernutrition were not identified.

Relevance to clinical practice. The results suggest that nurses need a screening instrument to highlight older nutritional at-risk patients in need of further awareness and investigation.

Keyword
nurses, nursing, nutritional risk, older people, patients, undernutrition
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13963 (URN)10.1111/j.1365-2702.2006.01805.x (DOI)
Available from: 2006-09-13 Created: 2006-09-13 Last updated: 2017-12-13
4. Self-care ability and sense of coherence in older nutritional at-risk patients
Open this publication in new window or tab >>Self-care ability and sense of coherence in older nutritional at-risk patients
2008 (English)In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 62, 96-103 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate self-care ability and sense of coherence in geriatric rehabilitation patients nutritionally screened using the Nutritional Form For the Elderly and to relate the patients' perceived health to self-care ability and sense of coherence.

Design: Cross-sectional study.

Setting: A geriatric rehabilitation ward in a hospital in western Sweden.

Subjects: A sample of 172 consecutively recruited patients (65+ years) fulfilled the inclusion criteria. One hundred forty-four patients were included in the study because 16 patients refused to take part and 12 could not complete the entire data collection procedure.

Methods: Interviews, using one instrument for nutritional screening and other instruments measuring self-care ability and sense of coherence and one question about perceived health, were performed.

Results: Patients at medium or high risk for undernutrition had lower self-care ability (P<0.001) and weaker sense of coherence (P=0.007) than patients at low risk for undernutrition. Lower self-care ability, being single and admitted from another hospital ward was found to be predictors for being at medium or high risk for undernutrition. Patients who perceived good health had higher self-care ability (P<0.001) and stronger sense of coherence (P<0.001) than patients who perceived ill health.

Conclusions: There is an indication that older patients at low risk for undernutrition have a greater capability to care for themselves than patients at medium or high risk for undernutrition. Perceived ill health in older patients is associated with lower self-care ability and weaker sense of coherence.

Sponsorship: Supported by grants from The Research and Development Council Fyrbodal, Trollhättan; The Lions Research Foundation, Linköping, Sweden.

Keyword
aged, geriatric rehabilitation care, health, nutritional screening, salutogenic perspective
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13964 (URN)10.1038/sj.ejcn.1602691 (DOI)
Available from: 2006-09-13 Created: 2006-09-13 Last updated: 2017-12-13

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