Screening for Malnutrition in Sheltered Housing

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.

Key Points

• 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.

Executive summary

1. 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.
2. 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.
3. ‘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.
4. 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.
5. 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.
6. 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.
7. 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.