Printable Versions of Materials needed to create station:
Guide for Preceptors:
NOTE: the information posted just below is identical to that in the printable version of the preceptor guide above.
Choosing a Nutrition Screening Tool:
“You are a Primary Care Physician in a Small Community”
This task is intended to help students incorporate the idea that different screening tools may be a better fit in some circumstances than others. We encourage the students to identify the DETERMINE checklist as a good option for community-dwelling older populations because it includes items such as sufficient money to buy food, use of medications, alcohol use, etc. It can be completed as a paper-and-pencil tool in individual or public health settings. In our center, we often use the Mini-Nutritional Assessment (MNA) in circumstances of acute illness or institutionalization where someone else will complete the screening, BMI is available, and/or cognitive or mobility problems are common.
The task is for students to make this distinction by selecting the DETERMINE checklist for a county fair community nutrition screening project, and selecting the MNA for evaluation of an older hospitalized inpatient.
If time is limited, this step can be eliminated & the preceptor can simply point out the differences between the two instruments as they are used in the two case vignettes that follow.
Nutritional Screening using the DETERMINE checklist:
Case A
Case B
Students should read this vignette, complete the DETERMINE checklist, and interpret the score. The case is straightforward and provides all the facts that are needed for the checklist. She scores at high nutritional risk. This task will familiarize the student with this screening tool and also highlight that eating alone, medication use, alcohol use, finances, oral health, functional status (other factors besides simply medical diagnoses, which are often the main focus of students at this stage) are important influences on older adults’ nutritional health.
Nutritional Screening using the Mini-Nutritional Assessment (MNA):
Case A
Case B
Students should read this vignette, complete MNA Screening items A through F, and interpret the score. The case is straightforward and provides all the facts that are needed, except that you may wish to provide a standard BMI Index Table for students to convert height/weight into BMI quickly without a calculator. Although this particular case vignette does not require it, the students can see that further assessment items are also provided on the same MNA tool for other patients who might score in the at-risk range. Point out that this next step requires some anthropometric measurements.
If time allows, this case also provides an opportunity to point out that although poor oral intake & weight loss are part of advancing dementia, that some individuals earlier in their course will have disinhibited eating behaviors and weight gain. It is also an option to point out that BMIs in the standard “overweight” BMI range are actually associated with lower mortality in this clinical context.
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