The two-step Mini Nutritional Assessment procedure in community resident homes

Department of Nursing Science, University College of Health Sciences, Jönköping University, Jönköping, Sweden.
Journal of Clinical Nursing (Impact Factor: 1.26). 06/2008; 17(9):1211-8. DOI: 10.1111/j.1365-2702.2007.02012.x
Source: PubMed


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: Nutritional assessment in older people to detect malnutrition or risk of malnutrition is essential to avoid adverse nutrition-related outcomes. Poor nutritional status appears to be a major contributing factor for poor prognosis in malnourished individuals. Nowadays, nutritional assessment is considered to be one of the domains which should be evaluated in comprehensive geriatric assessment (CGA). CGA is a comprehensive assessment tool with the capacity of detecting impairments in older people and, at the same time, suggest interventions. Although many assessment tools are proposed, those used in CGA are not widely agreed. After 20 years of clinical practice and research, the Mini Nutritional Assessment (MNA) seems to be the tool most widely accepted by health carers and patients for the assessment of nutritional impairment in CGA.
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