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Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps

Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for e...

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Autores principales: Dwyer, Johanna T., Gahche, Jaime J., Weiler, Mary, Arensberg, Mary Beth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188699/
https://www.ncbi.nlm.nih.gov/pubmed/31571022
http://dx.doi.org/10.1007/s10900-019-00739-1
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author Dwyer, Johanna T.
Gahche, Jaime J.
Weiler, Mary
Arensberg, Mary Beth
author_facet Dwyer, Johanna T.
Gahche, Jaime J.
Weiler, Mary
Arensberg, Mary Beth
author_sort Dwyer, Johanna T.
collection PubMed
description Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m(2) or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.
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spelling pubmed-71886992020-05-04 Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps Dwyer, Johanna T. Gahche, Jaime J. Weiler, Mary Arensberg, Mary Beth J Community Health Review Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m(2) or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available. Springer US 2019-09-30 2020 /pmc/articles/PMC7188699/ /pubmed/31571022 http://dx.doi.org/10.1007/s10900-019-00739-1 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Review
Dwyer, Johanna T.
Gahche, Jaime J.
Weiler, Mary
Arensberg, Mary Beth
Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps
title Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps
title_full Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps
title_fullStr Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps
title_full_unstemmed Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps
title_short Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps
title_sort screening community-living older adults for protein energy malnutrition and frailty: update and next steps
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188699/
https://www.ncbi.nlm.nih.gov/pubmed/31571022
http://dx.doi.org/10.1007/s10900-019-00739-1
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