Screening for Malnutrition in Sheltered Housing. Group on Nutrition and Sheltered Housing (GNASH), led by BAPEN
The report was launched Tuesday 12th May 2009, at the House of Commons at a Reception hosted by Paul Burstow MP.
- Nutritional problems are common among tenants of sheltered housing in England.
- The ‘Malnutrition Universal Screening Tool’ (‘MUST’) identified 14% of tenants as ‘malnourished’ (medium + high risk) and 24% as obese.
- At any one time, malnutrition is estimated to affect as many if not more people in sheltered housing than in hospital.
- Nutritional screening can be used to identify those at risk of malnutrition so that appropriate action can be taken.
- More tenants and scheme managers of sheltered housing preferred to use ‘MUST’ rather than a questionnaire to detect malnutrition risk.
- There is a need to raise awareness of the problem of malnutrition in sheltered housing and to provide education and training to identify and manage those at risk.
- The ‘Malnutrition Universal Screening Tool’ (‘MUST’) was used to identify malnutrition risk in tenants of sheltered housing in the northern and southern parts of England. The overall age of the 335 tenants studied was 79.3 ± 8.6 (sd) years, with women being significantly older than men (80.6 ± 8.3 years versus 76.7 ± 8.6 years). Three quarters of the tenants had at least one medical condition.
- Malnutrition’ (‘MUST’ medium + high risk) was found to be present in 14% of the tenants (9% high risk and 5% moderate risk). A body mass index (BMI) of less than 20 kg /m2 was present in 62% of those with ‘malnutrition’ and 9% in the population as a whole. A BMI of over 30 kg /m2 was present in 24% of the tenants.
- ‘Malnutrition’ tended to be more common in older tenants, in women who were older than men, and in those who had lived in sheltered housing for longer, but the differences were not significant.
- Attempts to use a questionnaire to predict malnutrition risk and to correlate with ’MUST’ met with limited success. The most useful indicators were current appetite, change in appetite, weight loss, and general appearance (assessed by the scheme manager). The last two indicators were more influential in predicting the ‘MUST’ classification than the first two.
- Use of self-reported height or weight, instead of measurements of weight and height to establish BMI category, misclassified only a small proportion of subjects. With the original ‘MUST’ as reference (using measured weight and height), the following sensitivities and specificities were established: for self reported height and measured weight, 96% and 96% respectively; for self reported weight and measured height, 93% and 96%; and for self reported height and weight, 95% and 91%. The results were better than those obtained using the questionnaire.
- When scheme managers were asked to indicate their preference for using a questionnaire without measurements of weight and height, or ‘MUST’ which involved measurements of weight and height, two thirds preferred to use ‘MUST’. Most tenants had no preference but amongst those that did, most also preferred ‘MUST’. Scheme managers found the application of ‘MUST’ to all tenants as easy or very easy.
- Nutritional screening is an easy procedure that should be used to identify both malnutrition and obesity in sheltered housing. More objective measurements and criteria, such as those incorporated in ‘MUST’, are preferable to less reproducible, subjective criteria. Identification of malnutrition or risk of malnutrition needs to be linked to an appropriate action plan. A good practice guide for addressing malnutrition in sheltered housing is now available.