Nutritional assessment and self-efficacy evaluation in determining risk in an elderly cohort study
Wish, Karen Whitney
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The Nutrition Screening Initiative (NSI), a screening protocol for elderly individuals, was validated against recognized anthropometric, biochemical, and physical indicators of malnutrition in a study conducted in two rural communities. This follow-up study assessed the participants to determine if there were differences in the nutritional risk factors a year later. A second purpose was to assess differences in dietary intake data obtained by 24-hour recall and food frequency questionnaire, and differences in identification of nutritional risk, intake < 67% of the Recommended Dietary Allowances (RDA). A third purpose was to correlate nutrition health belief data and self-efficacy data, and to assess the relationship between these instruments and nutritional risk factors. Sixty-six participants (74% return rate) participated in the follow-up assessment, 46 females and 20 males (mean age 74.6 years, range 61 to 89 years). There were no significant differences in the objective measures of nutritional status one year later. The mean NSI Determine Checklist score for assessing nutritional risk was 5.4 in the current study and 5.0 in the past study (p = 0.5095). The lack of change may be due to the short time between assessments. There were significant differences between the two dietary analysis instruments. Differences were evident in mean nutrient intakes, the number of nutrients identified as < 67% of the RDAs, and factors related to nutritional risk. Nutrients of concern identified in this study were vitamins E, D, Bg, thiamin, and calcium. The nutrition health belief instrument barrier scores were poorly correlated to self-efficacy scores (r = -0.09), and the benefit and barrier components of the nutrition instrument ( r = - 0.25). Self-efficacy scores were highly correlated to benefit categories (r = 0.79). Since barriers interfere more with dietary intervention success, the self-efficacy instrument might not provide adequate information for dietary behavior change programs. Relationships between the Determine Checklist nutrition risk scores and risks due to dietary deficiency or barriers to behavior change were not established. Using one instrument for nutritional risk screening will identify some individuals, but others with unaddressed risks may not be identified.