LETTERS TO THE EDITOR Psychosocial Factors in Geriatric Care TO the Editor-A key component of geriatric assessment and intervention is a consideration of psychosocial factors as part of a multidimensional diagnostic and treatment plan.’-3 Despite its importance in geriatric care, psychosocial concerns tend to take the back seat to medical problems. This may be due to lack of resources and time constraints in a busy primary care practice. In addition, the biomedical outcomes of psychosocial factors tend to be underestimated, if not glossed over.4 Over the past year, I had the opportunity to work closely with R.F., a 76 year old man diagnosed to have Parkinson‘s Disease. My main interest was in identifying the clinical manifestations of the disease, considering alternative drug treatments, and understanding pathophysiology. I was intrigued that these concerns were not considered by R.F. to be primary areas of interest. The patient was more concerned about his ability to maintain his independent lifestyle and social network. He was frustrated by the apparent inability of his primary care clinicians to adequately address his ”worries” despite their sincere efforts at patient education. It became apparent to me that my conceptualization of health was very different from R.F.’s own definition of what it meant to be “healthy” in the face of a chronic debilitating disease. For professionals working with older adults, it is important to remember that what we consider as the most important, most interesting, or most pressing problems are not necessarily identical with the patient’s concerns. The opportunity to work closely with R.F. serves as a reminder that the patient is the head of the health care team. KLAUS M. YI, BSG Andrus Gerontology Center University of Southern California Los Angeles, CA REFERENCES 1. Yeo G , lngram L, Skumick J et al. Effects of a geriatric clinic on functional
health and well-being of elders. J Gerontol 1987; 42:252-258. 2. Berkman L. The assessment of social networks and social support in the elderly. J Am Geriatr SOC1983; 31:743-749. 3. Margolis H, Fiorelli IS. An applied approach to facilitatinginterdisciplinary teamwork. J Rehabil 1984; 50:13-17. 4. Langer E, Avonn J. Impact of the psychosocial environment of the elderly on behavior and health outcomes. In: Hess B, Markson E. Growing Old in America, 3rd Ed. New Jersey:Transition Books, 1985.
A Short Questionnaire Estimating Risk of Malnutrition TO the Editor:-We read with interest the recent editorial’ by Dr. Morley on the importance of early and clinically relevant evaluation of nutritional status in the elderly. We, along with others, feel that one of the reasons that insufficient attention is paid to nutritional status is the poor specificity of abnormal nutritional parameters, thus decreasing the index of suspicion for malnutrition in favor of other more readily identifiable diagnoses. Furthermore, nutritional status is infrequently realized to be a major component of the multiple factors which may lead to an elderly patient‘s subtle clinical presentation or slow response to appropriate intervention. Thus, we agree with Dr. Morley’s attempt to devise a simple screening test to assess nutritional status in the elderly. At present, no reliable tool exists to screen for malnutrition in the elderly, especially in patients with multiple problems JAGS 40:976-977, 1992 0 1992 by the American Geriatrics Society
hospitalized for extended periods of time. We have developed a questionnaire to screen for risk of altered nutritional status in the elderly, and which is not meant to replace a formal nutritional evaluation. We utilized the dietician’s assessment method as the “gold standard.” This consists of an objective evaluation of: weight characteristics, anthropometrics, serum albumin, and total lymphocyte count as well as diet history, socioeconomic status, physical disability, medical and drug history, and mental status evaluation. The maximum score, indicating high risk, is 30. Our Nutritional Risk Screening Questionnaire (NRSQ) consists of items pertaining to alterations in body weight, appetite, difficulties in eating or having access to food and its preparation, problems with obtaining regular and appropriate meals since being hospitalized, and an evaluation of ongoing medical problems contributing to altered nutritional status. The maximum score is 20. Preliminary data were collected from concurrent assessments (including the dietician’s formal evaluation and the NRSQ) administered to 36 in-patients on geriatric acute care/ rehabilitation services at two university-affiliated teaching hospitals. According to standard criteria, the patients were described by the dietician as having a normal nutritional status or minimal, moderate, or severe malnutrition. There were 11 males and 25 females with a mean age of 81.6 f 7.3 (range: 65-94). Patients with normal nutritional status or who were minimally malnourished (n = 15) had a mean score of 4.9 f 2.8 (range: 1-10) on the NRSQ and a score of 6.5 f 2.6 (range: 4-14) on the dietician’s evaluation. Patients with moderate malnutrition (n = 13) had a score of 7.6 f 2.4 (range: 3-11) on the NRSQ and a score of 13.0 f 2.9 (range: 9-20) on the dietician’s evaluation. Patients with severe malnutrition (n = 8) had a score of 10.4 f 3.6 (range: 6-16) on the NRSQ and a score of 21.3 f 7.5 (range: 17-25) on the dietician’s evaluation. There was a significant correlation between these scores ( r = 0.63). We are encouraged that our simple screening questionnaire, which can be administered in less than 5 minutes to either a reliable patient or a caregiver, correlates with a thorough dietician’s assessment. While our results are preliminary and require further validation, we feel confident that a screening tool such as this will aid in the timely identification of elderly patients at risk for poor nutrition. JULIAN FALUTZ,MD, FRCP(C) UCLA School of Medicine Los Angeles, CA HUANG,MD, FRCP(C) ALLAN McGill University Center for Studies in Aging LISACALLOW, PDT DONNAHADDAD, PDT McGill University Department o€ Dietetics REFERENCES 1. Morley JE. Why do physicians fail to recognize and treat malnutrition in older persons?J Am Geriatr SOC1991; 39:1139-1140.
Erratum To the Editor-This letter concerns our article which was published in JAGS last year.’ In the article the Mann-Whitney U test was used to assess the effects of type of symptom on the Sickness Impact Profile scores. During further analyses of the data for other purposes,
0002-8614/92/$3.50
health and well-being of elders. J Gerontol 1987; 42:252-258. 2. Berkman L. The assessment of social networks and social support in the elderly. J Am Geriatr SOC1983; 31:743-749. 3. Margolis H, Fiorelli IS. An applied approach to facilitatinginterdisciplinary teamwork. J Rehabil 1984; 50:13-17. 4. Langer E, Avonn J. Impact of the psychosocial environment of the elderly on behavior and health outcomes. In: Hess B, Markson E. Growing Old in America, 3rd Ed. New Jersey:Transition Books, 1985.
A Short Questionnaire Estimating Risk of Malnutrition TO the Editor:-We read with interest the recent editorial’ by Dr. Morley on the importance of early and clinically relevant evaluation of nutritional status in the elderly. We, along with others, feel that one of the reasons that insufficient attention is paid to nutritional status is the poor specificity of abnormal nutritional parameters, thus decreasing the index of suspicion for malnutrition in favor of other more readily identifiable diagnoses. Furthermore, nutritional status is infrequently realized to be a major component of the multiple factors which may lead to an elderly patient‘s subtle clinical presentation or slow response to appropriate intervention. Thus, we agree with Dr. Morley’s attempt to devise a simple screening test to assess nutritional status in the elderly. At present, no reliable tool exists to screen for malnutrition in the elderly, especially in patients with multiple problems JAGS 40:976-977, 1992 0 1992 by the American Geriatrics Society
hospitalized for extended periods of time. We have developed a questionnaire to screen for risk of altered nutritional status in the elderly, and which is not meant to replace a formal nutritional evaluation. We utilized the dietician’s assessment method as the “gold standard.” This consists of an objective evaluation of: weight characteristics, anthropometrics, serum albumin, and total lymphocyte count as well as diet history, socioeconomic status, physical disability, medical and drug history, and mental status evaluation. The maximum score, indicating high risk, is 30. Our Nutritional Risk Screening Questionnaire (NRSQ) consists of items pertaining to alterations in body weight, appetite, difficulties in eating or having access to food and its preparation, problems with obtaining regular and appropriate meals since being hospitalized, and an evaluation of ongoing medical problems contributing to altered nutritional status. The maximum score is 20. Preliminary data were collected from concurrent assessments (including the dietician’s formal evaluation and the NRSQ) administered to 36 in-patients on geriatric acute care/ rehabilitation services at two university-affiliated teaching hospitals. According to standard criteria, the patients were described by the dietician as having a normal nutritional status or minimal, moderate, or severe malnutrition. There were 11 males and 25 females with a mean age of 81.6 f 7.3 (range: 65-94). Patients with normal nutritional status or who were minimally malnourished (n = 15) had a mean score of 4.9 f 2.8 (range: 1-10) on the NRSQ and a score of 6.5 f 2.6 (range: 4-14) on the dietician’s evaluation. Patients with moderate malnutrition (n = 13) had a score of 7.6 f 2.4 (range: 3-11) on the NRSQ and a score of 13.0 f 2.9 (range: 9-20) on the dietician’s evaluation. Patients with severe malnutrition (n = 8) had a score of 10.4 f 3.6 (range: 6-16) on the NRSQ and a score of 21.3 f 7.5 (range: 17-25) on the dietician’s evaluation. There was a significant correlation between these scores ( r = 0.63). We are encouraged that our simple screening questionnaire, which can be administered in less than 5 minutes to either a reliable patient or a caregiver, correlates with a thorough dietician’s assessment. While our results are preliminary and require further validation, we feel confident that a screening tool such as this will aid in the timely identification of elderly patients at risk for poor nutrition. JULIAN FALUTZ,MD, FRCP(C) UCLA School of Medicine Los Angeles, CA HUANG,MD, FRCP(C) ALLAN McGill University Center for Studies in Aging LISACALLOW, PDT DONNAHADDAD, PDT McGill University Department o€ Dietetics REFERENCES 1. Morley JE. Why do physicians fail to recognize and treat malnutrition in older persons?J Am Geriatr SOC1991; 39:1139-1140.
Erratum To the Editor-This letter concerns our article which was published in JAGS last year.’ In the article the Mann-Whitney U test was used to assess the effects of type of symptom on the Sickness Impact Profile scores. During further analyses of the data for other purposes,
0002-8614/92/$3.50
