ADA article: use NSI checklist for education, not screening

Nation's Restaurant News, August 4, 1997

CHICAGO -- A 10-point checklist developed seven years ago by the Nutrition Screening Initiative to measure malnutrition risk in the elderly should not be used by dietitians and care-givers as a screening tool for nutritional risk in the elderly, according to an article in the current Journal of the American Dietetic Association.

Instead, the checklist can be very effective as an educational or nutrition awareness tool, said Tufts University researchers who studied the checklist and compared its effectiveness with an earlier vehicle, known as the Nutrition Status Survey.

"Our data suggest that using the NSI checklist as a screening tool may ignore some risk factors that could be eliminated or delayed by intervention," stated the article, written by four researchers from the Human Nutrition Research Center on Aging at Tufts University. "In fact, the checklist may be used more effectively as an awareness and/or educational tool by enabling elderly people and their caretakers to recognize nutritional risk factors and seek early intervention."

The NSI, a joint project of the ADA, the National Council on the Aging and the American Academy of Family Physicians, developed the checklist as an educational tool. The questionnaire asked seniors for information on such items as how many meals they eat per day, how many different medications they take, whether they are able to shop for food, whether they eat alone often and what types of chewing or swallowing problems they might have.

However, the weighted scoring system used with the checklist led people and elderly nutrition groups to use it to screen seniors for nutrition risk.

The Tufts researchers compared the questionnaire with the Nutritional Status Survey, conducted on nearly 600 Boston residents age 60 and older from 1981 to 1984. Taking the answers from the survey and applying them to corresponding questions in the NSI checklist, researchers discovered that only 45.8 percent of the respondents who reported poor health in the original survey would have been identified by the NSI questionnaire.

More significant, the NSI list would have uncovered only 36.2 percent of all subjects who reported low nutrient consumption.

"The individual questions identify specific, targeted problems that may have long-term negative impact, yet they may be missed if the cumulative score were to be used as the sole criterion for screening people," the researchers stated.

However, they added, if the individual risk factors were taken separately and they or their consequences were eliminated, premature death might be avoided in nearly 20 percent of the men and 51 percent of the woman in the original survey.

"Our results do suggest that when the NSI checklist is used as an educational instrument, it could have an important public health impact on the early mortality of community-dwelling elderly subjects," they concluded.