Comparison of Braden Nutritional Risk Screening to Dietary and Weight Outcomes: Clinical and Research Insights

Friday, 28 July 2017: 3:10 PM

Susan M. Kennerly, PhD1
Tracey L. Yap, PhD2
Melissa K. Batchelor-Murphy, PhD2
Lisa Boss, PhD, MSN, BSN3
Susan D. Horn, PhD4
Ryan Barrett, MS5
Nancy Bergstrom, PhD6
(1)College of Nursing, East Carolina University, Greenville, NC, USA
(2)School of Nursing, Duke University, Durham, NC, USA
(3)Memorial Hermann Northeast Medical Center, Humble, TX, USA
(4)School of Medicine, University of Utah, Salt Lake City, UT, USA
(5)International Severity Information Systems, Inc. and the Institute for Clinical Outcomes Research, Salt Lake City, UT, USA
(6)Center on Aging, University of Texas Health Science Center at Houston, Houston, TX, USA

Purpose: The Braden Scale for Pressure Sore Risk© is a screening tool used to determine overall risk of pressure ulcer (PrU) development and estimate severity of individual resident risk factors, such as nutrition. Nurses often use the Braden nutrition subscale to screen nursing home (NH) residents for nutritional risk, and recommend a complete nutritional assessment as needed. Clinical and research insights gained in comparing initial Braden Nutrition subscale (hereafter nutrition subscale) scores to dietary intake and resident outcomes (e.g., BMI and body weight change) will be highlighted and a researcher-developed nutritional risk evaluation and PrU prevention care planning framework introduced.

Methods:  Secondary data from the TURN study’s investigation of U.S. and Canadian NH residents (n= 690) who scored at moderate or high PrU risk were used to evaluate the nutrition subscale’s utility for identifying nutritional intake risk factors. Associations were studied between the nutrition subscale screening score, dietary intake (mean percent meal intake and by meal type, mean number of protein servings, and type of protein source(s), and percent intake of supplements and snacks), weight outcomes, and new PrU incidence.

Results: The majority (61.9%) of residents who were at moderate risk for PrU development and 59.2% of those at high risk consumed a mean meal intake of <75%. Less than 18% of residents consumed <50% of meals or refused meals. No significant differences were observed in body weight variances by nutrition subscale risk or in mean number protein servings/meal [1.4 (+ SD=0.58) versus 1.3 (+ SD=0.53)] for moderate versus high risk residents. Nutrition subscale estimates approximated subsequent estimated dietary intake.

Conclusion: Nutrition subscale scores can offer insight into meal intake patterns for those at PrU risk. Findings support use of the Braden Scale’s nutrition subscale as a preliminary screening method to identify focused areas for potential intervention. Dietary intake monitoring in conjunction with weight loss or gain as indicators of dietary adequacy helped further document connections between nutrition risk category, intake, and weight sustainability. Clinical and research insights will be discussed in relation to nutritional risk evaluation and care planning framework to aid translation of findings to PrU prevention practice.