title: Assessment and treatment of malnutrition in Dutch geriatric practice: consensus through a modified Delphi study.
abstract: OBJECTIVE
  scientific evidence regarding the optimal management of malnutrition in geriatric patients is scarce. Our aim was to develop a consensus statement for geriatric hospital practice concerning six elements: (i) definition of malnutrition, (ii) screening and assessment, (iii) treatment and monitoring, (iv) roles and responsibilities of involved health care professionals, (v) communication and coordination of care between hospital and community health care professionals, (vi) quality indicators for malnutrition management.
  
  
  METHODS
  a modified Delphi study.
  
  
  METHODS
  eleven geriatricians with special interest in malnutrition participated. In four rounds the experts rated the relevance of 204 statements, which were based on a literature review, on a five-point Likert scale. From the responses, means and 95% CIs were calculated. Consensus was defined as a lower 95% confidence limit ≥4.0.
  
  
  RESULTS
  the panel reached consensus that malnutrition should be considered a geriatric syndrome. The nutritional status should be assessed using the Mini Nutritional Assessment combined with comprehensive geriatric assessment. Nutritional interventions should be combined with interventions targeting underlying factors. Specific goals for nutritional therapy and ways to achieve them were agreed upon. According to the experts, malnutrition is best managed by a multidisciplinary team for whom roles and responsibilities were specified. At discharge written information about the nutritional problem, treatment plan and goals should be provided to the patient, caregiver and community health care professionals.
  
  
  CONCLUSIONS
  this study shows that a qualitative study based on a modified Delphi technique can result in national consensus on essential ingredients for a practical malnutrition guideline for geriatric patients.
authors.affiliation: Geriatric Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands. dieneke.van.asselt@znb.nl
authors.forename: Dieneke Z B
authors.initials: DZ
authors.lastname: van Asselt
authors.forename: Marian A E
authors.initials: MA
authors.lastname: van Bokhorst-de van der Schueren
authors.forename: Tischa J M
authors.initials: TJ
authors.lastname: van der Cammen
authors.forename: Luc G M
authors.initials: LG
authors.lastname: Disselhorst
authors.forename: Andre
authors.initials: A
authors.lastname: Janse
authors.forename: Sabine
authors.initials: S
authors.lastname: Lonterman-Monasch
authors.forename: Huub A A M
authors.initials: HA
authors.lastname: Maas
authors.forename: Miruna E
authors.initials: ME
authors.lastname: Popescu
authors.forename: Carla J M
authors.initials: CJ
authors.lastname: Schölzel-Dorenbos
authors.forename: Walter M W H
authors.initials: WM
authors.lastname: Sipers
authors.forename: Carel M M
authors.initials: CM
authors.lastname: Veldhoven
authors.forename: Hugo H
authors.initials: HH
authors.lastname: Wijnen
authors.forename: Marcel G M
authors.initials: MG
authors.lastname: Olde Rikkert
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D003697:Delphi Technique; D019317:Evidence-Based Medicine / Q000592:standards; D015577:Geriatric Assessment / Q000379:methods*; D005853:Geriatrics / Q000592:standards*; D006761:Hospitals / Q000592:standards; D006801:Humans; D033183:Interdisciplinary Communication; D044342:Malnutrition / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D009426:Netherlands; D015596:Nutrition Assessment; D009752:Nutritional Status; D010348:Patient Care Team / Q000592:standards; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care / Q000592:standards; D009626:Terminology as Topic; D016896:Treatment Outcome