Assessment of nutritional risk in the elderly

To enhance physicians' awareness of nutritional problems in the elderly, a nutritional risk assessment scale was developed and validated. 126 patients (mean age 82.0 +/- 6.7, range 65-96 years) admitted from home to a geriatric hospital were enrolled in the study. After informed consent was obtained, they underwent a comprehensive geriatric assessment of physical, emotional, and cognitive functions, overall functional capacity, and social situation. The nutritional status was assessed by the nutritional risk assessment scale. This scale consists of items relating to gastrointestinal disorders, chronic diseases with pain, immobility, alterations in body weight, appetite, difficulties in eating, cognitive or emotional problems, medication, smoking and drinking habits, and social situation. The maximum score which indicates a high risk is 12. The scores from the nutritional risk assessment scale were compared with a physician's clinical judgement (patients being graded as "obese', "well-nourished', "undernourished') as the "gold standard' and with body mass index, other anthropometric findings, and serum albumin and prealbumin levels. The nutritional risk assessment scale was reliable (inter- and intrarater) and showed construct and concurrent validity. There was a significant correlation with clinical judgement (p < 0.01) and other parameters of nutritional status (p < 0.05). The scores of undernourished patients (n = 37; 5.35 +/- 1.60, range 3-8) were significantly different (p < 0.05) from those who were classified as well nourished (n = 63; 2.66 +/- 1.59, range 0-7) or obese (n = 26; 2.73 +/- 1.76, range 0-7). When implemented as part of a comprehensive geriatric assessment, this questionnaire can be completed within 5-10 min. The nutritional risk assessment scale is simple and reliable and helps in the identification of elderly patients at risk of poor nutrition.