Abstract :
Background: When the Mini Nutritional Assessment (MNA©) was developed, the authors did not
specifically focus on the nursing home setting. Due to a number of particularities of nursing home residents, such
as cognitive and linguistic disabilities, a number of uncertainties with regard to its application await clarification.
Aims and objectives: The aim of this study was to compare the results of two different modes of MNA
application in nursing homes: resident interviews versus assessment by nursing staff. Method: The MNA was
applied to 200 residents of two municipal nursing homes in Nuremberg, Germany. First one-on-one interviews of
the residents were conducted by two researchers from our group. Next, the MNA was applied by the attending
nursing staff who was blinded to the results of the first MNA. To evaluate the prognostic properties of the two
different approaches, data on mortality of the screened residents were collected during a six-month follow-up
period. Results: Among 200 residents (f 147 m 53, f 86.5±7.4 y. m 83.0±8.5 y.), the MNA could be applied to
138 residents (69.0%) by one-on-one interviews and to 188 residents (94.0%) by the nursing staff. 15.2% of the
residents were categorised as malnourished by the interviews and 8.7% by the nursing staff’s assessment. The
agreement of the two forms was low for the MNA short form (weighted kappa = 0.31; 95% CI: 0.14 - 0.47) as
well as for the full MNA (weighted kappa = 0.35; 95% CI: 0.27 - 0.44). After exclusion of residents with
cognitive impairment (n=89), agreement for the full version increased (weighted kappa = 0.47, 95% CI 0.25 -
0.68). 25 (12.5%) study participants deceased during the follow-up period. Mortality was significantly associated
with the mortality for both approaches, while the MNA application by the nursing staff proved to be superior
(nursing staff p<0.001, residents p<0.05). Conclusions: The results of the MNA in nursing home residents may
differ substantially when resident interviews are compared to assessment by nursing staff. The authors
recommend that the MNA should be routinely applied by the nursing staff. The application rate is higher and
interference with cognitive as well as linguistic deficits is lower. In future studies, the mode of MNA application
in nursing home residents should be clearly stated to facilitate comparability of results
Keywords :
Nutrional screening , Mini Nutritional Assessment , Malnutrition , nursing home.
