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.     

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.     

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.     

Validation of the modified mini nutritional assessment short-forms in different populations of older people in Poland

Objective

To assess the usefulness in different populations of elderly people in Poland of both modified versions of Mini Nutritional Assessment Short-Forms (MNA-SFs) with a three-category scoring classification: one using BMI (MNA-SF-BMI) and another using calf circumference (MNA-SF-CC).

Setting and Participants

A group of 932 community-dwelling subjects from the urban environment, 812 subjects from the rural environment and 859 subjects from an institutional environment (nursing homes).

Measurements

Agreement between both MNA-SFs and the MNA full form. Results: MNA-SF-BMI correctly classified 84.12%, 82.51% and 81.84% of subjects from urban, rural and institutional environment, respectively. For MNA-SF-CC those values were 82.4%, 71.8% and 76.6%, respectively. The sensitivity and specificity of MNA-SF-BMI and MNA-SF-CC against full MNA in screening for “at risk/malnutrition” and “malnutrition” were generally very high, except for relatively lower sensitivity (74.1%) when screening for “malnutrition” with MNA-SF-CC in nursing homes.

Conclusion

Both MNA-SFs can be recommended as screening tools in assessing the nutritional state of the community-dwelling and institutionalised elderly in Poland. The full version of the MNA confirmed the results of MNA-SFs in this group. The “classic” MNA-SF using BMI was found to perform better than the MNA-SF-CC. The MNA-SF-CC should be used only when measuring BMI is not possible. While using MNASF-CC in nursing homes, a higher MNA-SF-CC cut-point of eleven should be rather used in this population to screen for “at risk/malnutrition”.     

Agreement between different versions of MNA

Abstract

Malnutrition occurs frequently in the elderly with important clinical and functional consequences. Moreover, the treatment of malnutrition in the elderly may be effective if clinical and nutritional interventions are performed in the early stages. Therefore the early identification of the risk of malnutrition using validated and handy tools plays a pivotal role in terms of clinical outcome. Mini Nutritional Assessment (MNA) was validated for this purpose since many years but it is still ongoing the debate over whether the use of different items in certain clinical conditions can be effective without affecting the validity of the nutritional status evaluation. The aim of this study was to assess the agreement between different versions of MNA in the evaluation of nutritional risk in elderly subjects.

Methods

522 subjects, 345 women and 177 men, were recruited from nursing homes or were free living in three different regions in Italy. All subjects underwent a multidimensional geriatric evaluation, addressed especially to nutritional status. We compared three different versions of MNA: the “original” version; a “proportional” MNA (MNA-P) in which the total MNA score was replaced by the ratio between the maximum score that each subject could obtain without including the body mass index (BMI) and the total original MNA score; and a third version in which calf circumference (CC) and mid-upper arm circumference (MAC) were used instead of BMI.

Results

According to the original MNA, a high prevalence of malnutrition was found out in both genders (26% of women and 16.3% of men); both the versions of MNA, in which BMI was not considered, showed a good predictive value compared to original MNA. In particular, the MNA-P. showed an overall efficiency equal to 89,1% with specificity and positive predictive value respectively equal to 97.5% and 95.2%. MNA-CC-MAC showed even better results in terms of overall efficiency (91.4%), sensitivity (81.1%), specificity (97.1%), positive and negative predictive values (94.2% and 94.4%, respectively).

Conclusion

The different versions of MNA gave similar results in the classifications of subjects and in comparison with nutritional and biochemical parameters. Moreover MNA versions that did not considered BMI seem to be more effective in singling out subjects with risk factors related to malnutrition (disability, reduced strength and calf circumference, anaemia).     

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.     

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.     

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.     

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.     

Malnutrition in Turkish nursing homes: A correlate of short term mortality

Objective

Elderly nursing home residents are under high risk of malnutrition. Early interventions to prevent malnutrition may play a critical role in malnutrition-mortality correlation. This study aimed to obtain insight into the prevalence of malnutrition in nursing homes in the capital city of Turkey and the role of malnutrition in predicting the risk for short-term mortality.

Design

This study was conducted in seven different residential care facilities in Ankara.

Measurements

Nutritional status was evaluated by Mini Nutritional Assessment-Short Form.

Results

The mean age of the 534 participants was 79.46±7.22 years. Nutritional assessment revealed that 15.9% of all older adults suffered from malnutrition and another 53.6% were at risk of malnutrition. The mortality rate for all subjects was 118 (22.1%) over 18 months, which was significantly higher in participants with malnutrition.

Conclusions

We noted a high prevalence of malnutrition and a strong correlation of increased mortality with malnutrition in nursing home residents. Given the negative impact of malnutrition on mortality and morbidity, an emphasis should be placed on an effective nutritional policy in nursing homes.     

Nutritional screening strategy in nonagenarians: The value of the MNA-SF (Mini Nutritional Assessment short form) in NutriAction

Objectives

To identify older subjects at risk of malnutrition using the most appropriate tool available for the specific setting and to evaluate the Mini Nutritional Assessment short form (MNA-SF) in a sample of nonagenarians.

Design

Questionnaire based national screening week for the risk and prevalence of malnutrition in older people (NutriAction).

Setting

Older people in the community (CD) and in nursing homes (NH).

Participants

General practices (n=70) and Nursing Homes (n=70).

Measurements

Questionnaire based on items from validated screening instruments: the MNA-SF, the Short Nutritional Assessment Questionnaire (SNAQ) and additional clinically relevant parameters (mobility, independence, social isolation and co-morbidities).

Results

In total 5,334 people were screened of which 16% were aged over 90 years. In this age group, 66% of the screened individuals were at risk of malnutrition (MNA ≤ 11), and women were affected significantly more than men (p<0.001). Actual malnutrition was present in 22% (BMI <20), 20% (SNAQ) and 25% (clinical evaluation). The MNA appeared to be very sensitive but had a low specificity as well in the nonagenarians (98% and 44%) as in the younger old (97% and 52%). The SNAQ was not a sensitive tool for detecting malnutrition in this study population (25%). Although clinical impression had a low sensitivity (60–61%) it has a good specificity (86% in 90+ and 91% below 90yr).

Conclusion

The overall risk of and the prevalence of malnutrition is common in older people. The prevalence is higher in women, in nursing homes and in older age groups. The MNA-SF followed by a clinical subjective evaluation seems to be the preferred strategy for detecting malnutrition in nonagenarians.     

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.     

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.     

Comparison of two different approaches for the application of the mini nutritional assessment in nursing homes: Resident interviews versus assessment by nursing staff

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 t 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.     

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.     

Malnutrition in community-dwelling adults with dementia (Nutrialz Trial)

Objectives

The objective of this study is to assess the nutritional status, measured by the MNA, in community-dwelling elderly individuals with dementia and to identify clinical risk factors for nutritional risk or malnutrition.

Design

Cross-sectional analysis of a cluster randomized clinical trial (Nutrialz).

Setting

Community-dwelling individuals attending dementia clinics.

Participants

940 individuals.

Measurements

The clinical scales assessed were Mini Nutritional Assessment (MNA), Eating Behaviour Scale (EBS), Charlson comorbidity index, Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE), Basic Activities of Daily Living (BADL) score, Instrumental Activities of Daily Living (IADL) score, Neuropsychiatric Inventory Questionnaire (NPI-Q), Cornell depression scale and Zarit Caregiver Burden Interview.

Results

5.2% of participants were classified as being malnourished, 42.6% as being at risk of malnutrition and 52.2% as well nourished. Malnutrition by type of dementia was more frequent in Lewy bodies dementia (18.2%) than in the other types. Worse nutritional status is significantly related to more advanced age and worse cognitive, functional and behavioural profile, as well as increased burden for caregivers. Presence of behavioural symptoms is significantly related to worse nutritional level for all NPI-Q symptoms but depression, exaltation, lack of inhibition and irritability. The items more strongly related to malnutrition are appetite/feeding and hallucinations. Dependence in any basic or instrumental ADL is significantly related to higher risk of malnutrition. Dependence on feeding is a strongly related risk factor, while food preparation is only a moderate one. A logistic regression model to predict at risk/malnutrition kept as significant risk factors EBS (Odds Ratio (OR) 0.84, 95%CI 0.78 to 0.91), Cornell (OR 1.12, 95%CI 1.09 to 1.16), the number of dependent BADL (OR 1.29, 95%CI 1.17 to 1.42), age (OR 1.04, 95%CI 1.02–1.06), MMSE (OR 0.95, 95%CI 0.92 to 0.98) and Charlson (OR 1.18, 95%CI 1.05 to 1.34). A similar model built for prediction of malnutrition retained as significant covariables only EBS, Cornell and the number of dependent BADL.

Conclusion

These results will allow a better understanding of the clinical stage previous to malnutrition. An adequate diagnosis and treatment of identified modifiable factors like functional impairment, eating behaviours and depression could delay or avoid malnutrition.     

Altered Eating Attitudes in Nursing Home Residents and Its Relationship with their Cognitive and Nutritional Status

Background

although eating disorders are usually linked to young adolescents, these mental disorders can also appear in the elderly, especially in those living in nursing homes, which might be associated or not with the cognitive decline; however, there are few data regarding elderly subjects.

Objectives

the objective of the present work was to evaluate the presence of abnormal eating attitudes in nursing home residents and its relation with several cognitive, nutritional and psychological factors that could be influencing their nutritional state.

Design and Setting

a observational experimental study was carried out at several nursing homes of Murcia, Spain.

Subjects

139 nursing home residents.

Methods

EAT-26 test was used to screen classic eating disorders (anorexia and bulimia). Blandford’s scale was employed to determine aversive eating attitudes. Moreover, subjective appetite sensations, body image perception, nutritional (MNA and diet composition) and biochemical data were also evaluated.

Results

33% of the subjects had malnutrition. No subject showed symptoms of anorexia or bulimia; however, subjects with cognitive decline frequently showed aversive feeding behaviours (21.6%). Albumin values were significantly lower in subjects with cognitive impairment.

Conclusions

our data showed a clear relation between cognitive impairment and altered eating attitudes, which was reflected by both biochemical (albumin) and nutritional parameters, while no classic eating disorder was observed in residents with normal cognitive-status. These data confirm the need to strengthen our efforts towards maintaining the nutritional status of the subjects with cognitive impairment.

     

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.