Appendix 114-C Assessment Instruments for Non-Medicaid Home and Community Based Services: Nutrition Screening Initiative – DETERMINE (NSI-D) | HCBS-5300-MANUAL

The Nutrition Screening Initiative (NSI) Checklist is a scored checklist aimed at developing the nutritional awareness of older adults living in the community. The checklist was developed to be either self-administered by the older adult or used by professionals to rate the potential or actual nutrition risk status. The Checklist has been psychometrically tested and found to have acceptable levels of reliability and validity. The checklist does not provide a clinical diagnosis but does provide an effective initial screen of nutrition risk. Often, people who score high on the checklist have multiple problems, which can be addressed once identified.

The Nutrition Screening Initiative is a project of the American Academy of Family Physicians, The Academy of Nutrition and Dietetics and the National Council on the Aging. Following is a summary of the instrument.

The Nutrition Screening Initiative is a national collaborative effort committed to the identification and treatment of nutritional problems in older persons. Analysis was used to derive item weights that would predict poor nutrient intakes and low perceived health status. Sensitivity and specificity values were reviewed to define low, moderate, and high nutritional risk scores. This resulted in a revised checklist containing 10 yes/no items. Scores of 6 or more points define persons at high nutritional risk, and in a study by Posner, et. al. identified between 36% and 46% of older persons who may be at increased nutritional risk owing to inadequate intakes of essential nutrients or to fair or poor perceived health.

DETERMINE was designed by the American Academy of Family Physicians, the National Council on the Aging and others as part of the Nutrition Screening Initiative. This tool can be used by professionals working with elders to assess their risk for poor nutritional status or malnutrition. The DETERMINE questionnaire can also be used to measure an individual’s change in level of nutritional risk over time. If DETERMINE scores taken prior to beginning a new nutrition program are compared with scores later in the program, a decrease in the resulting score would indicate a corresponding decrease in the elder’s nutritional risk. In this way, the effectiveness of the program for the individual can be evaluated.

The “DETERMINE” in the name of the assessment is a mnemonic associated with the various factors associated with nutritional risk:

D – disease
E – eating poorly
T – tooth loss/mouth pain
E – economic hardship
R – reduced social contact
M – multiple medications
I – involuntary weight loss
N – needs assistance in self-care
E – elderly

It is important to review responses to each question in addition to the total score to identify appropriate interventions based on those areas of risk.