Development and validation of a simple instrument for the recognition of undernutrition in older persons

Undernutrition is a large health care problem. The estimated prevalence of undernutrition in the general older population in primary care is between 10 and 80%, depending on the criteria applied to define undernutrition. Its prevalence in the Netherlands has been estimated to be 20-30%. Undernutrition is not limited to patient groups, but also occurs in older persons without any other disease. Only 50% of undernourished persons are properly recognized. Secondary prevention of undernutrition, i.e. the early recognition of undernutrition in older persons is impossible due to the lack of an easy, cheap and simple instrument. Specific development and application of such an instrument for the general older population in primary care, is expected to improve recognition and early treatment of undernutrition. Early recognition makes it possible to start early treatment and to prevent the adverse future health events of undernutrition, such as functional decline, loss of independence, increased morbidity and mortality, and related health care costs. This study aims to develop an instrument based on simple anthropometric measurements and weight related and nutrition related anamnestic questions, for the proper recognition of undernutrition in older persons and for application in all primary care settings. To focus on clinical relevance, the instrument will be developed based on the prediction of future adverse health outcomes. The study will use previously collected, prospective data from a national representative sample of 3107 older men and women (the Longitudinal Aging Study Amsterdam). The instrument will be developed for the total study sample and, if necessary, for specific subgroups based on sex, age or underlying disease (including cognitive impairment). Backwards logistic regression analyses (for the health outcomes received health care and self reported disability) or Cox proportional hazards analyses (for the health outcome mortality) will be used to develop the instrument. The final instrument(s) will be validated using data from external (inter)national cohort studies of older persons and will be offered to the national programmes “Eten en drinken” , “Wie beter eet wordt sneller beter”, the “Undernutrition Network” of the Dutch Dietetic Association and to the Dutch College of General Practioners NHG for implementation in transmural treatment standards.