COPD is the fourth leading cause of death in the United States and is projected to be the third leading cause of death for both men and women by 2020. The Burden of Obstructive Lung Disease (BOLD) initiative estimates that 10.7 million people in the US have COPD and the costs for COPD are estimated at $832 billion over the next 20 years. In the person with chronic obstructive pulmonary disease (COPD), nutritional disorders are associated with higher morbidity, lower exercise tolerance, increased dyspnea, and lower health-related quality of life. COPD is also a systematic disease with manifestations extending beyond airflow obstruction to include nutritional changes, skeletal muscle disfunction, and cardiovascular effects. Weight loss and protein-calorie malnutrition are prominaent aspects of chronic pulmonary failure and progressive weight loss is observed in one third to one half of patients with COPD. It is unique among leading causes of death in western society given that prevalence, associated morbidity and mortality continue to rise. In the elderly population, the prevalence of malnutrition is common with up to 12% of mobile elderly, 20% of medical outpatients, 85% of nursing home residents, and 50% of hospitalized elders being malnourished. A valid and reliable tool to identify malnutrition that has been used in various elderly populations is the Nestle MNA Mini-Nutritional Assessment. The MNA is available at no cost, can be completed in 5 minutes, and has an interactive version that can be completed online. This tool can assist in the identification of malnourished patients before severe changes occur in weight or serum protein levels. The purpose of this capstone project was the implementation of an evidence-based practice guideline for the recognition of malnutrition in elderly patients with COPD using the Nestle Mini-Nutritional Assessment (MNA) tool in an outpatients setting. The objective for this project was to improve healthcare delivery for the elderly population with COPD utlizing the MNA tool in the implementation of an evidence-based guideline. The project was guided by the Johns Hopkins Nursing Evidence-Based Practice Model and paralleled the goals of the Institute of Medicine. A total of 36 patients with a COPD diagnosis, ages 65 to 90 years, participated in the project with 56% demonstrating either malnutrition or a risk for malnutrition by the MNA. The interactive version of the MNA was utilized, allowing the printed report to be scanned into the patient chart. Data was gathered by the Advanced Practice Nurse. Patients who were deemed malnourished or at-risk for malnutrition were referred to a registered dietician for further evaluation. The MNA will be a part of routine COPD care for this population of patients. This project has allowed for transformational change in this area of pulmonary care for elderly patients with COPD.
