Pembentukan alat peny aringan risiko malpemakanan hospital (MRST -H) untuk mengenalp asti malpemakanan di kalangan pesakit warga tua
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Date
2006
Authors
Harith, Sakinah
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Abstract
Hospitalised elderly patients are at risk of malnutrition due to the presence of chronic
diseases and inadequate food intake. Therefore, a malnutrition risk screening tool -
hospital (MRST -H) was developed to identify malnutrition among elderly patients in
hospital. The study involved four phases. The first phase focused on the validation of
malnutrition risk screening tool which was formerly developed for community use
(MRST-C). The validation study was conducted among 181 elderly patients (83 men,
98 women; mean age: 73.4 ± 6.2 years; range: 65 to 90 years) upon admission to
University Malaya Medical Center (UMMC). The MRST -C was validated using
standard indicators such as Subjective Global Assessment (SGA), Mini Nutritional
Assessment-Short Form (MNA-SF), Body Mass Index (BMI), mid upper arm
circumference (MUAC), calf circumference (CC), albumin, hemoglobin, total
lymphocyte count and cholesterol. Results indicated the MRST -C had low validity and
unsuitable for hospital use due to its low sensitivity (0.0- 19.1)%, specificity (84.8-
88.0)% and positive predictive values (0.0 - 40.0)%. In addition, MNA-SF also
indicated low validity of sensitivity (0.0 - 80.8)%, specificity (77.9 - 90.6)% and
positive predictive values (0.0- 75.0)% respectively. Therefore, in the second phase a
new MRST i.e MRST -H for hospital use was developed using logistic regression
analysis. The MRST -H consisted of five questions to screening the malnutrition which
were 'had muscle wasting as assessed by mid upper arm circumference', 'had muscle
wasting as assessed by calf circumference', 'weight loss during last month or six
months ago', 'dependant on others for economic resources' and 'unable to eat without
assistance'. A favourable result was obtained using MRST-H with better sensitivity,
specificity and positive predictive values of 40.0%, 94.7% and 74.1 %, respectively. In
the third phase, MRST-H was validated among 100 elderly patients (37 men, 63
women; mean age: 73.1 ± 6.0 years; range: 65 to 95 years) upon newly admitted to the
ward in Kuala Lumpur Hospital. MRST -H was validated against SGA, BMI, MUAC
and CC indicators. Results indicated that MRST-H was acceptable with high sensitivity
(88.2- 100)%, specificity (83.1- 98.8)% and positive predictive values (54.8- 93.8)%
respectively. In the fourth phase, MRST-H was tested for reliability by a researcher and
two nurses. This test was performed among 40 elderly patients (1 0 men, 30 women;
mean age: 74.8 ± 6.8 years; range: 66 to 92 years) in UMMC. Results indicated that the
agreement percentage and Kappa index value were excellent and almost similar among
the researcher and nurse B [87.5%, (kappa = 0.89)] and nurse A [81.3%, (kappa =
0.84)]. While, 'intra-class correlation' (ICC) (95% CI) value indicated an excellent
response from the three raters [0.93 (0.88- 0.96) (p<0.0001)]. In summary, MRST-H is
a valid and reliable screening tool and can be used widely by health professionals in
clinical setting to identify hospitalised elderly patients at high risk of malnutrition.
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Keywords
Alat penyaringan , Malpemakanan , Warga tua