The two-step Mini Nutritional Assessment procedure in community resident homes
ABSTRACT AIMS AND OBJECTIVITIES: The aims were to test internal consistency and interrater reliability of Mini Nutritional Assessment during implementation of Mini Nutritional Assessment in community residential homes and to test sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment-short form vs. Mini Nutritional Assessment.
There is a need in clinical practice to assess nutritional status in older people and to identify those who could benefit from early intervention.
The two-step Mini Nutritional Assessment procedure (Mini Nutritional Assessment-short form and Mini Nutritional Assessment) was used in 127 older people admitted to eight residential homes. In three of those homes (A, B and C), registered nurses simultaneously performed the assessment procedure, after receiving education and training. The intention was to offer the registered nurses a tool for independent practice use.
Internal consistency was 0.68 (Cronbach's alpha) (n = 127). In residential home A, B and C, the registered nurses carried out Mini Nutritional Assessment in 45 residents out of 68. The agreement level between the author's and the registered nurses' assessments was 62% (kappa 0.41). In residential home A, B and C, the agreement level was 89%, 89% and 44%, respectively. Sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment-short form vs. Mini Nutritional Assessment were 89%, 82% and 92%, respectively.
The two-step Mini Nutritional Assessment procedure seems to be a useful tool to identify residents in need of nutritional interventions, despite the registered nurses not carrying out Mini Nutritional Assessment in all residents and the low agreement in residential home C. It indicates that to implement and use Mini Nutritional Assessment in nursing care demands the creating necessary staff resources, such as adequate staffing, sufficient education and continual supervision.
Because of the high sensitivity of Mini Nutritional Assessment-short form and Mini Nutritional Assessment, Mini Nutritional Assessment-short form alone might be sufficient for practice use, as its simplicity might increase its usefulness.
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ABSTRACT: Falls are common in older people and may lead to functional decline, disability, and death. Many risk factors have been identified, but studies evaluating effects of nutritional status are limited. To determine whether nutritional status is a predictor of falls in older people living in the community, we analyzed data collected through the Survey of Health and Living Status of the Elderly in Taiwan (SHLSET). SHLSET include a series of interview surveys conducted by the government on a random sample of people living in community dwellings in the nation. We included participants who received nutritional status assessment using the Mini Nutritional Assessment Taiwan Version 2 (MNA-T2) in the 1999 survey when they were 53 years or older and followed up on the cumulative incidence of falls in the one-year period before the interview in the 2003 survey. At the beginning of follow-up, the 4440 participants had a mean age of 69.5 (standard deviation = 9.1) years, and 467 participants were "not well-nourished," which was defined as having an MNA-T2 score of 23 or less. In the one-year study period, 659 participants reported having at least one fall. After adjusting for other risk factors, we found the associated odds ratio for falls was 1.73 (95% confidence interval, 1.23, 2.42) for "not well-nourished," 1.57 (1.30, 1.90) for female gender, 1.03 (1.02, 1.04) for one-year older, 1.55 (1.22, 1.98) for history of falls, 1.34 (1.05, 1.72) for hospital stay during the past 12 months, 1.66 (1.07, 2.58) for difficulties in activities of daily living, and 1.53 (1.23, 1.91) for difficulties in instrumental activities of daily living. Nutritional status is an independent predictor of falls in older people living in the community. Further studies are warranted to identify nutritional interventions that can help prevent falls in the elderly.PLoS ONE 03/2014; 9(3):e91044. DOI:10.1371/journal.pone.0091044 · 3.53 Impact Factor
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ABSTRACT: The aim of the study was to describe and compare registered (RNs’) and enrolled nurses’ (ENs’) assessments of postoperative pain, risk for malnutrition and pressure ulcers in patients with hip fracture. Furthermore, the aim was to describe and compare their perceptions of using assessment tools. Thirty-four (34) RNs and forty-three (43) ENs, working on orthopaedic wards in Sweden, took part in the study. The assessments were carried out on 82 patients with hip fracture. The assessment tools included the numerical rating scale (NRS), short-form nutritional assessment tool (MNA-SF), modified Norton scale (MNS) and pressure ulcer card. Many patients were assessed to be in postoperative pain and at possible risk for malnutrition. Around 50% were assessed as being at risk for pressure ulcer formation (PU). There is a difference between RNs and ENs assessments of patients’ postoperative pain, risk for malnutrition and PU. ENs assessed to a greater degree that patients were in intense pain currently. RNs assessed to a greater degree that patients had been in intense pain in the past 24 h. Single items on the tools showed differences. However, there was no statistically difference for MNA-SF screening score and MNS total score. ENs found it easier to assess postoperative pain with the NRS compared to RNs.International Journal of Orthopaedic and Trauma Nursing 02/2010; 14(1):30-39. DOI:10.1016/j.joon.2009.05.005
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ABSTRACT: Optimal functioning of the immune system is crucial to human health, and nutrition is one of the major exogenous factors modulating different aspects of immune function. Currently, no single marker is available to predict the effect of a dietary intervention on different aspects of immune function. To provide further guidance on the assessment and interpretation of the modulation of immune functions due to nutrition in the general population, International Life Sciences Institute Europe commissioned a group of experts from academia, government and the food industry to prepare a guidance document. A draft of this paper was refined at a workshop involving additional experts. First, the expert group defined criteria to evaluate the usefulness of immune function markers. Over seventy-five markers were scored within the context of three distinct immune system functions: defence against pathogens; avoidance or mitigation of allergy; control of low-grade (metabolic) inflammation. The most useful markers were subsequently classified depending on whether they by themselves signify clinical relevance and/or involvement of immune function. Next, five theoretical scenarios were drafted describing potential changes in the values of markers compared with a relevant reference range. Finally, all elements were combined, providing a framework to aid the design and interpretation of studies assessing the effects of nutrition on immune function. This stepwise approach offers a clear rationale for selecting markers for future trials and provides a framework for the interpretation of outcomes. A similar stepwise approach may also be useful to rationalise the selection and interpretation of markers for other physiological processes critical to the maintenance of health and well-being.The British journal of nutrition 08/2013; 110(S2). DOI:10.1017/S0007114513001505 · 3.34 Impact Factor