Defining malnutrition risk for older home care clients

The Resident Assessment Instrument-Home Care (RAI-HC) is widely used to assess needs of home care clients and includes five items used to screen for malnutrition. This study involved defining malnutrition risk and identifying other items within the RAI-HC that might improve malnutrition screening among adults aged 65 or older receiving home care.

A literature review, three focus groups of community care access centre case managers (n=29), and five key informant interviews with registered dietitians were used to identify malnutrition risk factors and indicators. A nominal group (n=5) was used to rank RAI-HC malnutrition risk items. Data were charted and integrated to create the final list of potential risk factors.

Seven malnutrition indicators (dietary intake, appetite, dysphagia, nutrition support, end-stage disease, weight status, and fluid intake) and seven risk factors (health status, functional ability, self-reported poor health, mood status, social function, cognitive performance, and trade-offs) were considered important concepts in the construct of malnutrition for older home care clients.

These items identified through divergent methods form the basis for developing a screening-for-malnutrition-risk tool for home care.