1.Content identification for the development of a nutrition resource kit for malnourished and at-risk elderly: A review
Iman Nabihah Noor Azam ; Aliza Haslinda Hamirudin ; Sakinah Harith ; Mohd Aznan Md Aris ; Karimah Hanim Abd Aziz ; Siti Nur Amirah Sheikh Hishamuddin ;
Malaysian Journal of Nutrition 2021;27(No.3):373-396
Introduction: Elderly population is more likely to suffer from malnutrition, thereby
requiring appropriate nutrition education as part of nutrition intervention to
overcome this issue. This review aims to identify content suitable for developing a
nutrition resource kit that provides nutritional guidance to combat malnutrition
among malnourished and at-risk elderly in health clinics setting, particularly in
Malaysia. Methods: A literature search was conducted up to 15th December 2019
in four databases: PubMed, Scopus, COCHRANE, and ProQuest Health & Medical
Collection. Potential literature on nutrition education, suitable dietary guidelines
and existing educational materials for elderly in the community, in English and
Malay languages, were searched to identify suitable content for the nutrition
resource kit. All relevant documents were included based on inclusion and exclusion
criteria. Data were extracted and analysed according to the PRISMA-ScR guidelines.
Results: A total of 27 documents consisting of articles, printed materials and
guidelines were included for analysis. Suitable content included information related
to malnutrition such as definition, signs and symptoms, cause-consequences, and
nutrition management, which included food plate, serving size, menu suggestion,
examples of recipes, tips to increase energy and protein intakes through food or
drink, texture modification, a guide to using oral nutritional supplements, tips for
maintaining nutrient content in food and drink, tips to encourage to eat, and oral
health. Conclusion: A nutrition resource kit tailored for malnourished and at-risk
elderly would be a beneficial nutrition intervention. There is a need to incorporate
these information in the development of a nutrition resource kit to improve their
dietary intake.
2.Development of nutrition screening guideline content for use by healthcare staffs in older adults in health clinic setting: A scoping review
Siti Nur Amirah Sheikh Hishamuddin ; Aliza Haslinda Hamirudin ; Sakinah Harith ; Mohd Aznan Md Aris ; Karimah Hanim Abd Aziz ; Iman Nabihah Noor Azam ; Nurul Syaireen A Rashid
Malaysian Journal of Nutrition 2022;28(No.1):119-148
Introduction: Malnutrition, specifically undernutrition, in community-dwelling
older adults reduces their well-being and predisposes to diseases. Therefore, timely
malnutrition identification through nutrition screening is needed to identify at risk
and malnourished patients. This study aimed to develop the content of nutrition
screening guideline to facilitate healthcare staffs in health clinics to administer a
validated nutrition screening tool specifically for older adults. Methods: A scoping
review was conducted electronically using SCOPUS, PubMed, ProQuest Health &
Medical Complete, and Cochrane databases. The systematic search was performed
up to 31st December 2021. Search terms were created for identification of eligible
and related articles. Inclusion and exclusion criteria were determined for the
systematic search. The search was limited to English and Malay languages, and
full text articles with no limitation of years. All data were extracted and analysed,
guided by the PRISMA extension for scoping reviews (PRISMA-ScR). Results:
From 728 identified articles, 18 articles were included in the analysis. Identified
information for the guideline content were: introduction, aims and objectives,
definition of malnutrition, prevalence of malnutrition, implementation of nutrition
screening, guidance on administering items in validated tools, and guidance on
anthropometric measurements. Meanwhile, format and flow charts from established
guidelines served as references for the guideline development process. Conclusion:
Appropriate content to develop a nutrition screening guideline has been identified
based on this review. Development of a guideline based on this content can facilitate
healthcare staffs to perform timely nutrition screening in older adults.
3.Barriers and Opportunities of Nutrition Screening in Elderly Patients in Health Clinic Settings in Kuantan, Pahang: A Qualitative Study
Siti Nur Amirah Sheikh Hishamuddin ; Aliza Haslinda Hamirudin ; Sakinah Harith ; Mohd Aznan Md Aris ; Karimah Hanim Abd Aziz ; Nurul Syaireen A Rashid
Malaysian Journal of Medicine and Health Sciences 2021;17(No.4):21-29
Introduction: The elderly population are susceptible to malnutrition due to many factors. Hence, timely malnutrition
identification through nutrition screening needs to be performed routinely in health clinics. However, the
nutrition screening practice in health clinics need to be improvised for malnutrition identification among the elderly
population. This study identifies barriers and opportunities for nutrition screening in elderly patients in health clinic
settings. Method: A qualitative study was conducted among healthcare staff from urban and rural health clinics in
Kuantan, Pahang, Malaysia. In-depth individual interviews were performed, audio-recorded and transcribed verbatim.
Non-participant observations that act as triangulation were conducted among elderly patients (aged ≥60 years)
attending the sampled health clinics. Both data from the interviews and observations were analysed thematically
using NVivo software. Results: Twenty healthcare staff participated in the interviews were medical officers (n=6),
medical assistants (n=8), staff nurses (n=4), and community nurses (n=2) with a mean age of 33.7±6.3 years. Twenty-
one elderly patients were involved in non-participant observations. The four themes that emerged as barriers and
opportunities were: time, patient factors, organisation factors and nutrition screening knowledge. Time constituted
the main barrier, whilst incorporating a validated nutrition screening tool into current health screening practices was
identified as the most practical approach to performing nutrition screening. Staff also highlighted the need for appropriate
guidelines for implementing nutrition screening. Conclusion: This study identified appropriate approaches to
implementing nutrition screening among elderly patients in health clinics. Developing a comprehensive nutrition
screening guideline may facilitate healthcare staff in performing nutrition screening.
4.Development and Feasibility Assessment of a Nutrition Screening Guideline in Older Patients for Use by Healthcare Staff in Health Clinic Setting: An Action Research Study
Siti Nur Amirah Sheikh Hishamuddin ; Aliza Haslinda Hamirudin ; Sakinah Harith ; Mohd Aznan Md Aris ; Karimah Hanim Abd Aziz ; Nurul Syaireen A Rashid
Malaysian Journal of Medicine and Health Sciences 2023;19(No.1):46-56
Introduction: Older persons are more susceptible to malnutrition. However, malnutrition identification through
nutrition screening is not routinely performed in Malaysia’s health clinics due to no specific nutrition screening
guideline and validated tool in this setting. This study aimed to develop a nutrition screening guideline for older patients and assess its feasibility for use by healthcare staff in health clinic setting. Methods: This study was conducted
in three phases. In Phase I, needs assessment was conducted amongst healthcare staff. Development of nutrition
screening guideline in Phase II involved scoping review and validation amongst six experts and twelve healthcare
staff. In Phase III, twenty-two healthcare staff participated in feasibility assessment using in-depth interviews after
completing nutrition screening in older patients. Interview data was analysed thematically using NVivo Software
12.0. Results: A Malay language version of nutrition screening guideline in A4-sized with 31 pages was developed
and validated. Items with a content validity index ≥0.83 from experts review were retained, while <0.83 were revised
accordingly. Validation amongst healthcare staff showed positive responses. The guideline was then assessed for
feasibility, where 110 older patients (mean age= 68.7±6.1 years) were screened by healthcare staff using the newly
developed nutrition screening guideline. Four themes emerged from in-depth interviews: 1) Ease of use; 2) Identification and management of malnutrition; 3) Acceptability; and 4) Implementation of nutrition screening. Conclusion:
The newly developed and validated nutrition screening guideline is well-accepted and feasible for healthcare staff to
screen older patients in health clinic setting for timely malnutrition identification and management.