Nutritional status according to Mini Nutritional Assessment is related to functional status in geriatric patients — independent of health status

Objectives

The aim of this study was to investigate the relationship between nutritional and functional status in acute geriatric patients including mobility and considering health status.

Design

Cross-sectional study.

Setting

Hospital.

Participants

205 geriatric patients (median age 82.0 (IQR: 80–86) years, 69.3% women).

Measurements

Nutritional status was determined by Mini Nutritional Assessment (MNA) and patients were categorized as well-nourished (≥ 24 points), at risk of malnutrition (17–23.5 points) or as malnourished (< 17 points). Functional status was determined by Barthel Index (BI) and Timed ‘Up and Go’ Test (TUG) and related to MNA categories. Using binary multiple logistic regression the impact of nutritional status on functional status was examined, adjusted for health status.

Results

60.3 % of the patients were at risk of malnutrition and 29.8 % were malnourished. Ability to perform basic activities of daily living (ADL) decreased with declining nutritional status. The proportion of patients unable to perform the TUG increased with worsening of nutritional status (45.0 % vs. 50.4 % vs. 77.0 %, p<0.01). After adjusting for age, gender, number of diagnoses, disease severity and cognitive function, a higher MNA score significantly lowered the risk of being dependent in ADL (OR 0.85, 95 % CI 0.77–0.94) and inability to perform the TUG (OR 0.90, 95 % CI 0.82–0.99).

Conclusion

Nutritional status according to MNA was related to ADL as well as to mobility in acute geriatric patients. This association remained after adjusting for health status.     

Screening for malnutrition among nursing home residents — a comparative analysis of the Mini Nutritional Assessment, the Nutritional Risk Screening, and the Malnutrition Universal Screening Tool

Background

The European Society for Clinical Nutrition and Metabolism (ESPEN) has recommended the Mini Nutritional Assessment (MNA®), the Nutritional Risk Screening 2002 (NRS), and the Malnutrition Universal Screening Tool (MUST) for nutritional screening in various settings and age groups. While in recent years all three tools have been applied to nursing home residents, there is still no consensus on the most appropriate screening tool in this specific setting.

Aim

The present study aims at comparing the MNA, the NRS, and the MUST with regard to applicability, categorization of nutritional status, and predictive value in the nursing home setting.

Method

MNA, NRS, and MUST were performed on 200 residents from two municipal nursing homes in Nuremberg, Germany. Follow-up data on infection, hospitalization, and mortality were collected after six and again after twelve months.

Results

Among 200 residents (mean age 85.5 ±7.8 years) the MNA could be completed in 188 (94.0%) and the NRS and MUST in 198 (99.0%) residents. The prevalence of ‘malnutrition’ according to the MNA was 15.4%. The prevalence of ‘risk of malnutrition’ (NRS) and ‘high risk of malnutrition’ (MUST), respectively, was 8.6% for both tools. The individual categorization of nutritional status showed poor agreement between NRS and MUST on the one hand and MNA on the other. For all tools a significant association between nutritional status and mortality was demonstrated during follow-up as classification in ‘malnourished’, respectively ‘high risk of malnutrition’ or ‘nutritional risk’, was significantly associated with increased hazard ratios. However, the MNA showed the best predictive value for survival among well-nourished residents.

Conclusion

The evaluation of nutritional status in nursing home residents by MNA, NRS, and MUST shows significant differences. This observation may be of clinical relevance as nutritional intervention is usually based on screening results. As the items of the MNA reflect particularities of the nursing home population, this tool currently appears to be the most suitable one in this setting.     

Nutritional and functional status in geriatric day hospital patients–MNA short form versus full MNA

Objectives

The aims of this study were to determine the prevalence of malnutrition in patients of a geriatric day hospital using the Mini Nutritional Assessment short form (MNA-SF) and the full MNA, to compare both tools, and to examine the relationship between nutritional and functional status.

Design

Cross-sectional study.

Setting

Geriatric day hospital.

Participants

190 patients (72.1% female, median 80 years) aged 65 years or older.

Measurements

In consecutively admitted geriatric day hospital patients nutritional status was assessed by MNA-SF and full MNA, and agreement between both tools calculated by Cohen’s kappa. Basic activities of daily living (ADL), instrumental activities of daily living (IADL) and short physical performance battery (SPPB) were determined and related to MNA categories (Chi²-test, Mann-Whitney-U-test).

Results

36.3 % and 44.7% of the patients were at risk of malnutrition, 8.9 % and 5.8 % were malnourished according to MNA-SF and full MNA, respectively. Agreement between both MNA forms was moderate (?=0.531). No significant associations between MNA-SF and ADL, IADL and SPPB, and between full MNA and SPPB were observed. According to full MNA, the proportion of patients with limitations in ADL and IADL significantly increased with declining nutritional status (ADL: 2.1 vs. 8.2 vs. 18.2 %, p=0.044; IADL: 25.5 vs. 47.1 vs. 54.5 %, p=0.005) with a simultaneous decrease of the proportion of patients without limitations. Well-nourished patients reached significantly higher ADL scores than patients at risk of malnutrition (95 (-100) vs. 95 (85- 100), p=0.005) and significantly higher IADL scores than patients at risk or malnourished (8 (6-8) vs. 7 (5-8) vs. 6 (4-8), p=0.004).

Conclusion

The high prevalence of risk of malnutrition and the observed association between functional status and nutritional status according to full MNA call for routine nutritional screening using this tool in geriatric day hospital patients.

     

Screening for malnutrition in nursing home residents: Comparison of different risk markers and their association to functional impairment

Objectives

To identify nursing home residents with malnutrition or at risk of malnutrition by using different markers, determine if the Mini Nutritional Assessment (MNA®) is able to identify all residents at risk according to single risk markers and explore the relation between risk markers and functional impairment.

Design

Cross-sectional study.

Setting

Six German nursing homes.

Participants

286 residents (86±7y, 89% female).

Measurements

Screening for malnutrition or its risk included low BMI (≤22 kg/m²), recent weight loss (WL), low food intake (LI) as single risk markers and MNA (<24 points, p.) as composite marker. Prevalence of single nutritional risk markers in different MNA categories was compared by cross-tables. Mental (cognition, mood) and physical function (mobility) were assessed by interviewing nursing staff and association of impaired status to nutritional risk markers determined by Chi² test.

Results

32.9% of residents had a low BMI, 11.9% WL and 21.3% LI. 60.2% were categorized malnourished (18.2%) or at risk of malnutrition (42.0%) by MNA. 64% presented at least one of these nutritional risk markers. Of those classified malnourished by MNA, 96.2% also showed low BMI, WL or LI. In contrast, eleven residents (9.6%) considered well-nourished by MNA presented single risk markers (9 low BMI, 2 WL). Cognitive impairment, depressive symptoms and immobility was present in 59.0%, 20.8% and 25.5%, respectively. Functional impairment, and in particular severe impairment, was to a higher proportion present in residents at nutritional risk independent of the chosen marker (MNA<24 p., low BMI, WL, LI).

Conclusion

The high prevalence of nutritional risk highlights the importance of regular screening of nursing home residents. The MNA identified nearly all residents with low BMI, WL and LI. The close association between nutritional risk and functional impairment requires increased awareness for nutritional problems especially in functionally impaired residents, to early initiate nutritional measures and thus, prevent further nutritional and functional deterioration.     

Nutritional status and functional capacity of community-dwelling elderly in southern Laos

Objectives

The aim of this study was to assess the nutritional status and functional capacity of 144 community-dwelling elderly in three rural ethnic groups, namely, the Oy, the Brau and the Lao, of southern Laos.

Methods

The Mini nutritional assessment (MNA) questionnaire and Determine Your Nutritional Health checklist were used to assess nutritional status. The Barthel Activities of Daily Living questionnaire and Lawton and Brody’s Instrumental Activities of Daily Living questionnaire were used to assess the functional capacity of the respondents.

Results

The MNA score results indicated that 92.5 % of Oy respondents, 85.4 % of Brau respondents and 60 % of Lao respondents were malnourished. Analysis of variance tests showed that the MNA scores of the Oy and Lao ethnic groups and of the Brau and Lao ethnic groups were significantly different ( both p < 0.01), but that there was no significant difference between the MNA scores of the Oy and Brau ethnic groups (p > 0.05). In terms of functional capacity, 47.2 % of Oy respondents, 43.9 % of Brau respondents and 20 % of Lao respondents had limitations in their activities of daily living, whereas 98.1 % of Oy respondents, 97.6 % of Brau respondents and 86 % of Lao respondents had limitations in their instrumental activities of daily living. Body mass index, reduced appetite, number of meals consumed daily and presence of common diseases predicted nutritional status in all three ethnic groups; the remaining factors differed by ethnicity. This result implies that ethnic differences and other factors, such as location of the village, services, resources within the village and respondents’ lifestyles, can affect nutritional status.

Conclusions

Because predictors of nutritional status varied by ethnicity, there is a need for area-specific interventions aimed at improving the quality of life of the elderly in these areas.     

Nutritional status according to the Mini Nutritional Assessment (MNA®) and frailty in community dwelling older persons: A close relationship

Objective

This study investigates the association between MNA results and frailty status in community-dwelling older adults. In addition the relevance of singular MNA items and subscores in this regard was tested.

Design

Cross-sectional study.

Setting

Community-dwelling older adults were recruited in the region of Nürnberg, Germany.

Participants

206 volunteers aged 75 years or older without cognitive impairment (Mini Mental State Examination >24 points), 66.0% female.

Measurements

Frailty was defined according to Fried et al. as presence of three, pre-frailty as presence of one or two of the following criteria: weight loss, exhaustion, low physical activity, low handgrip strength and slow walking speed. Malnutrition (<17 points) and the risk of malnutrition (17–23.5 points) were determined by MNA®.

Results

15.1% of the participants were at risk of malnutrition, no participant was malnourished. 15.5 % were frail, 39.8% pre-frail and 44.7% non-frail. 46.9% of the frail, 12.2% of the pre-frail and 2.2% of the non-frail participants were at risk of malnutrition (p<0.001). Hence, 90% of those at risk of malnutrition were either pre-frail or frail. For the anthropometric, dietary, subjective and functional, but not for the general MNA subscore, frail participants scored significantly lower than pre-frail (p<0.01), and non-frail participants (p<0.01). Twelve of the 18 MNA items were also significantly associated with frailty (p<0.05).

Conclusions

These results underline the close association between frailty syndrome and nutritional status in older persons. A profound understanding of the interdependency of these two geriatric concepts will represent the basis for successful treatment strategies.     

Dentition status,malnutrition and mortality among older service housing residents

Background

Oral health status and oral health problems can affect eating habits and thus consequently the nutritional status of frail older people.

Objectives

To assess older service house residents’ dentition and its associations with nutritional status and eating habits, and as well as to explore the prognostic value of dentition status for mortality.

Design

A cross-sectional study with a three-year follow-up.

Methods

In 2007, we assessed the nutritional status of all residents in service houses in the two cities of Helsinki and Espoo in Finland (N=2188). Altogether 1475 subjects (67%) participated in the study; dentition status data were available for 1369 of them. Using a personal interview and assessment, trained nurses familiar to the resident collected the subjects’ demographic data, medical history, functional and cognitive status, information on dentition status, oral symptoms, eating habits and diets. We assessed nutritional status with the Mini Nutritional Assessment (MNA), and retrieved information on mortality from central registers on 6 July 2010.

Results

Edentulousness was common; more than half of the residents (52%) had lost all their teeth: 7% (n=94) were totally edentulous without prosthesis (Group 1), 45% (n=614) had removable dentures (Group 2), and 48% (n = 661) of the residents, had some natural teeth left (Group 3). Dentition status was associated with age, gender, education and disability. According to the MNA, 13% were malnourished, 65% were at risk for malnutrition, and 22% were well nourished. Edentulousness without prosthesis was associated with malnutrition, oral symptoms and infrequent use of oral care services. In Group 1, 52% were deceased during follow-up period. The respective figures for Groups 2 and 3 were 48% and 40% (p=0.004). However, in Cox regression analysis adjusted for age, gender, comorbidity and MNA score, dentition status no longer predicted mortality.

Conclusion

Edentulousness is still common among older service housing residents. Edentulousness without prosthesis was associated with poor nutritional status, oral symptoms and infrequent use of dental services. These findings suggest the need for co-operation between nursing staff and oral care services.     

Validation of the revised mini nutritional assessment short-forms in nursing homes in Spain

Objective

To contribute to the validation of the revised BMI-MNA-SF and CC- MNA-SF with regard to association and agreement with the full-MNA, considered as gold standard, in nursing homes in Spain.

Design

Prospective analysis.

Setting

Nursing homes.

Participants

Eight hundred ninety five subjects aged 65 or older meeting inclusion criteria.

Measurements

Correlation, diagnostic accuracy and agreement between the revised MNA short forms and the MNA full form.

Results

The MNA-SFs correlated strongly with the full MNA version (Pearson’s correlation coefficient r=0.904; p<0.001). High values of sensitivity, specificity and predictive values were obtained for the BMI- MNA-SF and CC-MNA-SF against the full-MNA when the dichotomized categorizations “malnourished-at risk of malnutrition” vs “well nourished” and “malnourished” vs “at risk of malnutrition-well nourished” were considered (Youden’s index at least 0.695 in all cases). Areas under the ROC curves also reached high values (BMI-SF: 0.950 and CC-SF: 0.923 for the first categorization; BMI-SF: 0.979 and CC-SF: 0.978 for the second one) showing both tests excellent accuracy with the full-MNA. The agreement between the MNA-SFs and the full-MNA was quantified as the percentage of correct classifications. The BMI-MNA-SF classified 83.80% correctly and the CC-MNA-SF classified 78.55% correctly. Significant proportions of subjects were underestimated by both MNA-SFs. Just about 6% of overestimations were found in both cases.

Conclusion

The revised BMI-MNA-SF and CC-MNA-SF are rapid, easy and reliable tools capable to identify malnourished individuals and those who are at risk of malnutrition with minimal misclassifications with potential harm in nursing home residents. Due to the special characteristics of elderly staying in these institutions, the CC-MNA-SF is a good option to replace the BMI-MNA-SF when BMI is not available.     

Caregiver-reported swallowing difficulties,malnutrition, and mortality among older people in assisted living facilities

Objective

The aim of this study is to explore the prevalence of swallowing difficulties (SWD) and their associations with nutritional status, eating habits, nutritional care, and mortality among older people in assisted living.

Design

A cross-sectional study with interviews and nutritional assessments at baseline and 3-year follow-up for mortality.

Setting

Assisted living facilities in the Helsinki metropolitan area, Finland.

Participants

All residents (N=1466) in assisted living facilities.

Measurements

Personal interviews yielded information on demographics, medical history, functional status, SWDs and eating habits. Residents’ nutritional status was assessed with the Mini Nutritional Assessment (MNA). Three-year mortality data were retrieved from central registers.

Results

SWDs were common; 11.8% of subjects suffered from them. Those with SWDs were older, more often female, and more frequently had Parkinson’s disease, chronic obstructive pulmonary disease (COPD), and chronic/ recurrent infections than those without SWDs. No differences were present between the groups in prevalence of stroke or dementia, but more severe cognitive decline occurred among those with SWDs. According to the MNA, 30.6% of those with SWDs were malnourished (<17 points), whereas the respective figure for those without SWDs was 11.0% (p <.001). Those with SWDs ate more often fluid or puréed food (27.8% vs. 3.8%, p <.001), ate more often little or quite little of their food portion (32.6% vs. 23.5%, p <.010), and consumed less fluids (< 5 cups/day 51.7% vs. 35.6%, p<.001) than those without SWDs. Of those with SWDs, 55.0% died by the end of follow-up, whereas the respective figure for those without SWDs was 41.5%. In logistic regression analysis using age, sex, comorbidities, and MNA as covariates, SWDs continued to predict mortality (OR=1.49, 95% CI=1.04 ?2.12).

Conclusions

SWDs are common and associated with poor nutrition and risk of death of patients in assisted living facilities. Nurses should be trained to assess SWDs and nutritional problems in order to take optimal care of these residents.     

Poor nutritional status is associated with urinary tract infection among older people living in residential care facilities

Aim

To investigate factors associated with poor nutritional status in older people living in residential care facilities.

Methods

188 residents (136 women, 52 men) with physical and cognitive impairments participated. Mean age was 84.7 y (range 65–100). The Mini Nutritional Assessment (MNA), Barthel ADL Index, Mini Menial State Examination (MMSE), and Geriatric Depression Scale were used to evaluate nutritional status, activities of daily living, cognitive status and depressive symptoms. Medical conditions, clinical characteristics and prescribed drugs were recorded. Univariate and multivariate regressions were used to investigate associations with MNA scores.

Results

The mean MNA score was 20.5 ±3.7 (range 5.5–27) and the median was 21 (interquartile range (IQR) 18.8–23.0). Fifteen per cent of participants were classified as malnourished and 66% at risk of malnutrition. Lower MNA scores were independently associated with urinary-tract infection (UTI) during the preceding year (β = ? 0.21, P = 0.006), lower MMSE scores (β = 0.16, P = 0.030), and dependent in feeding (β = ? 0.14, P = 0.040).

Conclusion

The majority of participants were at risk of or suffering from malnutrition. Urinary tract infection during the preceding year was independently associated with poor nutritional status. Dependence in feeding was also associated with poor nutritional status as were low MMSE scores for women. Prospective observations and randomized controlled trials are necessary to gain an understanding of a causal association between malnutrition and UTI.     

Factors associated with deterioration of mini nutritional assessment-short form status of nursing home residents during a 2-year period

Objective

A number of other studies have been conducted to verify the Mini Nutritional Assessment (MNA) or the MNA short form (MNA-SF) as a nutritional assessment/screening tool in various clinical settings or communities. However, there are few longitudinal studies using these tools to analyze which factors affect the incidence of deteriorating nutritional status. We tried to identify the factors associated with deterioration of MNA-SF status of nursing home residents during a 2-year period.

Methods

Participants were 392 people with a mean age of 84.3 in 12 nursing homes in Japan. The factors associated with deterioration in MNA-SF categories during the study period compared to stable/improved MNA-SF categories were identified.

Results

At baseline, 19.9% of the participants were malnourished and 60.2% were at risk of malnutrition, according to the MNA-SF classification. After 2 years, 66.3% participants maintained and 6.1% participants improved their nutritional status according to the MNA-SF classification, while 27.6% showed deterioration in MNA-SF status. Stepwise logistic-regression procedure indicated that basic ADL impairment and hospitalization during the follow-up period were associated with declining MNA-SF status.

Conclusions

Poor basic ADL status and hospitalization during the follow-up period were associated with malnutrition and risk of malnutrition as assessed by MNA-SF of nursing homes residents during a 2-year period.     

Use of the Mini Nutritional assessment to detect frailty in hospitalised older people

Objectives

The aims of this study were to: (1) determine the prevalence of undemutrition and frailty in hospitalised elderly patients and (2) evaluate the efficacy of both the Mini-Nutritional Assessment (MNA) screening tool and the MNA short form (MNA-SF) in identifying frailty.

Setting and Participants

A convenient sample of 100 consecutive patients (75.0 % female) admitted to the Geriatric Evaluation and Management Unit (GEMU) at The Queen Elizabeth Hospital in South Australia.

Measurements

Frailty status was determined using Fried??s frailty criteria and nutritional status by the MNA and MNA-SF. Optimal cut-off scores to predict frailty were determined by Youden??s Index, Receiver Operator Curves (ROC) and area under curve (AUC).

Results

Undernutrition was common. Using the MNA, 40.0% of patients were malnourished and 44.0% were at risk of malnutrition. By Fried??s classification, 66.0 % were frail, 30.0 % were pre-frail and 4.0 % robust. The MNA had a specificity of 0.912 and a sensitivity of 0.516 in predicting frailty using the recommended cut-off for malnourishment (< 17). The optimal MNA cut-off for frailty screening was <17.5 with a specificity of 0.912 and sensitivity of 0.591. The MNA-SF predicted frailty with specificity and sensitivity values of 0.794 and 0.636 respectively, using the standard cut-off of < 8. The optimal MNA-SF cut-off score for frailty was < 9, with specificity and sensitivity values of 0.765 and 0.803 respectively and was better than the optimum MNA cut-off in predicting frailty (Youden Index 0.568 vs. 0.503).

Conclusion

The quickly and easily administered MNA-SF appears to be a good tool for predicting both under-nutrition and frailty in elderly hospitalised people. Further studies would show whether the MNA-SF could also detect frailty in other populations of older people.     

Nutritional status of community-dwelling elderly with newly diagnosed Alzheimer’s disease: Prevalence of malnutrition and the relation of various factors to nutritional status

Objetives

To determine the prevalence of malnutrition and its relation to various factors in community-dwelling elderly with newly diagnosed Alzheimer’s disease (AD).

Design

Retrospective crosssectional study.

Setting

Memory clinic in a rural part of the Netherlands.

Participants

312 Community-dwelling AD patients, aged 65 years or older, were included.

Measurements

At the time the diagnosis AD was made, socio-demographic characteristics and data on nutritional status (Mini Nutritional Assessment (MNA)), cognitive function (Mini Mental State Examination (MMSE), Cambridge Cognitive Examination (Camcog)), functional status (Interview for Deterioration in Daily Living Activities in Dementia (IDDD), Barthel Index (BI)) and behaviour (Revised Memory and Behaviour Problems Checklist (RMBPC)) were assessed. Characteristics of well-nourished patients (MNA score >23.5) were compared to characteristics of patients at risk of malnutrition (MNA score 17–23.5). Linear regression analysis was performed to assess the effect of various factors on nutritional status.

Results

The prevalence of malnutrition was 0% and 14.1% was at risk of malnutrition. AD patients at risk of malnutrition were more impaired in basic and complex daily functioning than well-nourished AD patients (median IDDD score 41.5 [25th–75th percentile 38.8–48.0] versus median IDDD score 40.0 [25th–75th percentile 37.0–43.0], p = 0.028). The degree of impairment in basic and complex daily functioning (IDDD) was independently related to nutritional status (MNA) (p = 0.001, B = ?0.062).

Conclusion

One in seven community-dwelling elderly with newly diagnosed AD is at risk of malnutrition. The degree of impairment in daily functioning is independently related to nutritional status. Therefore, assessment of the nutritional status should be included in the comprehensive assessment of AD patients. The relation between daily functioning, nutritional status and AD warrants further investigation.     

Different components of nutritional status in older inpatients with cognitive impairment

Objectives

To evaluate different components of nutritional status in older patients with cognitive deficit, particularly in those with mild cognitive impairment (MCI).

Design

Cross-sectional study.

Setting and participants

560 elderly subjects aged ?? 65 years consecutively admitted to an acute Geriatric Unit of Apulia region of southern Italy.

Measurements

A standardized comprehensive geriatric assessment was used to evaluate medical, cognitive, affective and social aspects. Nutritional status was assessed using the mini nutritional assessment (MNA). The cognitive function was categorized into three levels ?? MCI, dementia or normal cognition (NoCI) ?? according to the neuropsychological test score.

Results

Subjects with cognitive decline had significantly lower frequency of well-nourished (MCI=10%, dementia=8%, NoCI=22%, p<0.05) and higher frequency of malnourished (MCI=47%, dementia=62%, NoCI=19%, p<0.001) than patients with normal cognition. Similarly, MNA total score, MNA-3 and MNA-4 subscores were significantly lower in patients with MCI and dementia than patients with normal cognition (p<0.001).

Conclusions

These results suggest that cognitive decline may be associated with malnutrition in this sample of hospitalized older patients. Dietary habits (MNA-3) and subjective assessment of self-perceived quality of health and nutrition (MNA-4) are particularly poor also in patients with MCI and could be. very important variables to be considered in the multidimensional evaluation of subjects with cognitive impairment.     

Institutional factors associated with the nutritional status of residents from 10 german nursing homes (ernstes study)

Objectives

In nursing homes malnutrition among residents is widespread. Because residents place part of their personal freedom of choice into institutional hands, institution-specific factors may influence nutritional status of residents.

Design

Multi-centre cross-sectional study.

Setting

10 nation-wide German nursing homes.

Participants

714 exclusively orally fed residents (aged 65 years and older, not in final weeks of life).

Measurements

Participants’ characteristics (e. g. gender, age, level of care, dementia diagnosis), body mass index (BMI), mini nutritional assessment (MNA), energy intake (3-day dietary record, BLS II.3), and selected institution-specific factors (size of institution, daily rate for food supply, number of residents per care staff member). Metric data are given as median (P25, P75).

Results

11 % of residents (81 % female, 85 (81, 91) years) had a BMI <20 kg/m² (n=658). According to MNA, 10 % of the residents were malnourished (n=650). Capacity of institutions was 116 (56, 139) beds, care staff ratio was 4.1 (3.5, 4.2) residents per care person (mean over all care levels), and daily food budget was 4.45 (4.10, 4.71) Euro/d. Low daily food budget was associated with a higher risk for a BMI <20 kg/m² (OR 3.30 [95 %CI 1.70–6.42]). Higher food budget also decreased malnutrition risk (OR 0.66 [0.46–0.95]) according to MNA. Residents’ mean energy intake was 6.1 (5.2, 7.1; n=565) MJ/day in women and 7.1 (6.2, 8.2; n=132) MJ/day in men. Intake was higher with small facility size, higher food budget, and lower care staff ratio (P <0.05).

Conclusion

The institutional environment affects the nutritional status of nursing home residents as an independent risk factor. The results suggest promotion of small facilities and the provision of more care staff and more financial resources for food in the structural design of residential homes.     

“It could probably help someone else but not me”: A feasibility study of a snack programme offered to meals on wheels clients

Objectives

Community-based services, such as Meals on Wheels (MOW), allow older adults to remain in their homes for as long as possible. Many MOW recipients experience decreased appetite that limits intake at mealtimes. This pilot study aimed to determine the feasibility of providing high protein high energy snacks to improve nutrient intakes of MOW clients in a regional centre of New South Wales, Australia.

Participants

A convenience sample of 12 MOW clients.

Intervention

Participants received snacks five times a week, in addition to their usual MOW order, for four weeks.

Measurements

Nutritional status was assessed using the Mini Nutritional Assessment tool. Pre-post changes in dietary intake were assessed using a diet history and food frequency questionnaire. Qualitative interviews conducted in clients’ homes were digitally recorded, transcribed verbatim, and themes identified.

Results

Post-intervention, there was a trend for an increased energy (mean = +415kJ (SD=1477)/day) and protein (+7.2 (±14.06) g/day) intake. MNA scores significantly increased (P= 0.036) and proportion of respondents categorised as ‘malnourished’ or ‘at risk of malnutrition’ decreased from 17% to 8%, and 67% to 25%, respectively (P <0.05). Mean body weight increased from 67.1 (±14.3) to 67.8 (±14.8) (P= 0.008), while Body Mass Index (BMI) increased by a mean of 0.78 (±1.16) kg/m2 (P = 0.039). Only half of participants indicated interest in continuing with the program. Reasons included the role of snacks serving as a reminder to eat, as well as their perceived nutritional value. Identified barriers included perceived lack of need for additional food, ability to self-provide such items, and a perceived adequate health status.

Conclusion

Provision of an additional daily mid-meal snack may be a useful addition to existing MOW services, for improved energy and protein intakes. However, not all MOW clients at risk of malnutrition perceived the snacks to be beneficial to them.     

Malnutrition screening and early nutrition intervention in hospitalised patients in acute aged care: A randomised controlled trial

Objectives

High rates of malnutrition have been reported in the older hospitalized patient population. This is recognised to impact on patient outcomes and health costs. This study aimed to assess the impact of nutrition screening and intervention on these parameters.

Design

Randomised controlled prospective study.

Setting

The study was performed in the acute geriatric medicine wards of the Prince of Wales Hospital, Sydney Australia.

Participants

All patients admitted to these wards under a geriatrician with an expected length of stay of at least 72 hours were considered for the study.

Intervention

Patients were screened on admission for malnutrition using the Mini Nutritional Assessment (MNA) tool and randomly assigned to control or intervention groups. Intervention patients were immediately commenced on a malnutrition care plan (MCP). Control patients were only commenced on a MCP if referred by clinical staff.

Measurements

Length of stay (LOS), weight change and frequency of readmission to hospital were compared between the groups.

Results

143 patients were screened. 119 were identified as malnourished (MN) or at risk of malnutrition (AR). Overall LOS was not different between the two groups (control v. intervention: 13.4 ± 1.3 days v. 12.5 ± 1.2 days, p=0.64). However there was a significant decrease in LOS in the MN (control v. intervention: 19.5 ± 3days v. 10.6 ± 1.6 days, p=0.013) and a trend to reduced readmissions. There was no difference in weight change over admission between the groups. Without screening, clinical staff identified only a small proportion of malnourished patients (35% of MN and 20% of AR).

Conclusions

Malnutrition in the older hospital population is common. Malnutrition screening on hospital admission facilitated targeted nutrition intervention, however length of stay and representations were only reduced in older malnourished patients with an MNA score less than 17.     

The mediating effects of depressive symptoms on nutritional status of older adults in long-term care facilities

Objective

To test whether depressive symptoms mediate the effects of activities of daily living (ADLs) on nutritional status of older adults living in long-term care (LTC) facilities in Taiwan.

Design

A cross-sectional study.

Setting

Seventy-three community-based LTC facilities in northern Taiwan.

Participants

This study sampled 306 adults ranging in age from 65 to 97 years who were free of acute infection or disease and who were able to communicate.

Measurements

Nutritional status was assessed by the Mini-Nutritional Assessment (MNA) scale and depressive symptoms were assessed by the short form of the Geriatric Depressive Scale (GDSSF).

Results

MNA scores revealed that 65% of the subjects were at risk for malnutrition (17 to 23.5 points). In addition, depressive symptoms partially mediated the relationship between ADLs and nutritional status, with 10.7% of the effect of depressive symptoms on nutritional status going through the mediator.

Conclusion

Interventions to reduce depressive symptoms among institutionalized older adults should focus on improving nutritional status rather than promoting ADLs, which are believed to be difficult to change.     

Factors associated with poor nutritional status among community dwelling Lebanese elderly subjects living in rural areas: Results of the AMEL study

Objectives

This study aimed to assess the nutritional status, measured by MNA, and its association with socio-demographic indicators and health related characteristics of a representative sample of community dwelling elderly subjects.

Design

Cross-sectional study.

Setting

Community dwelling elderly individuals living in rural communities in Lebanon.

Participants

1200 elderly individuals aged 65 years or more.

Measurements

Socio-demographic indicators and health related characteristics were recorded during a standardized interview. Nutritional status was assessed through Mini Nutritional Assessment (MNA). The 5-item GDS score and the WHO-5-A score were used to assess mood, whereas Mini Mental Status (MMS) was applied to evaluate cognitive status.

Results

The prevalence of malnutrition and risk of malnutrition was 8.0% respective 29.1% of the study sample. Malnutrition was significantly more frequent in elderly subjects aged more than 85 years, in females, widowed and illiterate people. Moreover, participants who reported lower financial status were more often malnourished or at risk of malnutrition. Regarding health status, poor nutritional status was more common among those reporting more than three chronic diseases, taking more than three drugs daily, suffering from chronic pain and those who had worse oral health status. Also, depressive disorders and cognitive dysfunction were significantly related to malnutrition. After multivariate analysis following variables remained independently associated to malnutrition: living in the governorate of Nabatieh (ORa 2.30, 95% CI 1.35–3.93), reporting higher income (ORa 0.77, 95% CI 0.61–0.97), higher number of comorbidities (ORa 1.22, 95% CI 1.12–1.32), chronic pain (ORa 1.72, 95% CI 1.24–2.39), and depressive disorders (ORa 1.66, 95% CI 1.47–1.88). On the other hand, better cognitive functioning was strongly associated with decreased nutritional risk (ORa 0.27, 95%CI 0.17–0.43).

Conclusion

Our results highlighted the close relationship between health status and malnutrition. The identification of potential predictive factors may allow better prevention and management of malnutrition in elderly people.     

The diagnostic accuracy of the revised mini nutritional assessment short form for older people living in the community and in nursing homes

Objective

The aim of this study was to determine the diagnostic accuracy of the CC-SF, which was developed to use calf circumference (CC) instead of BMI in the MNA-SF, for elderly people living in the community and in nursing homes. It also aimed separately to determine the correlation of CC-SF and BMI-SF with the full MNA.

Study Design and Methods

The study included 640 elderly people living in their community and 243 elderly people living in nursing homes. Accuracy was assessed by determining the sensitivity and selectivity of the nutritional assessments. The correlations between the MNA-SFs and the full MNA were analyzed.

Results

The correlation between MNA-SFs and full MNAs was strong, significant and almost identical both in the community and in nursing homes (r=0.86–0.88; p<0.001). The observed agreement between the BMI-SF and the full MNA was 82.2% in the community and 77.8% in the nursing homes. There was a substantial agreement by kappa values in the comparison of community and nursing homes (the Kappa value of the BMI-SF was 0.63 in the community and 0.62 in the nursing homes, and the kappa value of the CC-SF was 0.62 in the community and 0.63 in the nursing homes). When compared to the full MNA the MNA-SFs tended to underestimate nutritional status. Both MNA-SFs had similarly high sensitivity and selectivity, both in the community and nursing homes. (when dichotomized as “malnourished-at risk of malnutrition” versus “well nourished” and “malnourished” versus “at risk of malnutrition-well nourished”) (over 80%).

Conclusion

In cases where BMI cannot be determined, the CC-SF is a good substitute for the BMI-SF.