Association between a malnutrition screening tool and mealtime observation checklist items in older people receiving oral intake support: A cross-sectional study of four long-term care facilities

Eri Nishioka; Mayumi Iwata; Noriko Kumai; Yoshinari Matsumoto; Chika Momoki; Yoko Yasui; Daiki Habu

doi:10.1111/opn.12610

Association between a malnutrition screening tool and mealtime observation checklist items in older people receiving oral intake support: A cross-sectional study of four long-term care facilities

Int J Older People Nurs. 2024 May;19(3):e12610. doi: 10.1111/opn.12610.

Authors

Eri Nishioka¹, Mayumi Iwata², Noriko Kumai³, Yoshinari Matsumoto⁴, Chika Momoki⁵, Yoko Yasui⁴, Daiki Habu⁴

Affiliations

¹ Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, Osaka, Japan.
² Division of Home Care Support Services, Specified Nonprofit Corporation Noppo-no-Kai, Nagoya, Japan.
³ Department of Nutrition Management, Medical Corporation Iseikai, Osaka, Japan.
⁴ Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka, Japan.
⁵ Department of Food Science and Human Nutrition, Faculty of Agriculture, Setsunan University - Hirakata Campus, Hirakata, Japan.

PMID: 38618707
DOI: 10.1111/opn.12610

Abstract

Background: Multiple nutritional screening tools are available for older people; however, few screening tools include specific eating behaviours as risk factors that could lead to poor food intake. The 24-item mealtime observation checklist (MOCL), developed by the Japanese Ministry of Health, Labour and Welfare in 2015, comprises signs, symptoms and conditions during mealtime that reflect eating and swallowing functions and oral conditions.

Objectives: To examine factors associated with malnutrition among the MOCL items in older people.

Methods: A cross-sectional study was conducted using data from a retrospective cohort study conducted at four long-term care facilities in Japan. Among the older people residing in the facilities, 198 who received oral intake support were included in the analyses. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA^®-SF), and comparisons were made between 'malnutrition' and 'at-risk or well-nourished'. The association between each MOCL item and malnutrition was assessed using multivariable logistic regression analysis.

Results: Of the 198 participants, 98 (49.5%) were classified as 'malnutrition', 98 (49.5%) as 'at-risk' and 2 (1%) as 'well-nourished' by MNA^®-SF. After adjusting for participant characteristics such as age and sex, significant associations with malnutrition were observed for four items from the 24-item MOCL: 'Has fatigue due to extended mealtime (odds ratio [OR] = 3.20, 95% confidence interval [CI]: 1.36-7.53)', 'Food residues in the oral cavity are conspicuous (OR = 2.77, 95% CI: 1.38-5.52)', 'Has difficulty swallowing food and takes time to swallow (OR = 3.78, 95% CI: 1.45-9.84)' and 'Assisted feeding is required (OR = 3.70, 95% CI: 1.73-7.91)'.

Conclusions: The four signs, symptoms and conditions during mealtime identified in this study may be associated with malnutrition in older people.

Implications for practice: These may indicate the potential eating problems that can lead to malnutrition. By incorporating them into early intervention and prevention measures, health care providers may help prevent malnutrition and improve the nutritional status of older people.

Keywords: dementia; dysphagia; mealtime observation; nursing care; nutritional screening; oral condition; oral intake.

MeSH terms

Aged
Checklist*
Cross-Sectional Studies
Humans
Long-Term Care
Malnutrition* / diagnosis
Meals
Nutrition Assessment
Nutritional Status
Retrospective Studies