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The two-step Mini Nutritional Assessment Procedure in Community Resident Homes
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Department of Nursing Science, University College of Health Sciences, Jönköping University, Jönköping, Sweden.
2008 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 9, 1211-1218 p.Article in journal (Refereed) Published
Abstract [en]

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.

Background: There is a need in clinical practice to assess nutritional status in older people and to identify those who could benefit from early intervention.

Methods: 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.

Results: 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.

Conclusions: 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.

Relevance to clinical practice: 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.

Place, publisher, year, edition, pages
2008. Vol. 17, no 9, 1211-1218 p.
Keyword [en]
interrater reliability, nurses, nursing, nutritional status, resident homes, staff education
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-14016DOI: 10.1111/j.1365-2702.2007.02012.xOAI: oai:DiVA.org:liu-14016DiVA: diva2:22468
Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2017-12-13
In thesis
1. Nutritional Intervention in Elderly People Admitted to Resident Homes
Open this publication in new window or tab >>Nutritional Intervention in Elderly People Admitted to Resident Homes
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim was to investigate the effects of an intervention, based on education given to staff and implementation of an individualized nutritional programme given to the residents, to compare assessments on admission with a previous study, and to perform diagnostic test and inter-rater reliability of the Mini Nutritional Assessment (MNA). A further aim was to identify and describe factors with regard to appetite among the residents.

Upon admission, and after a four month intervention period, residents were classified as being either protein energy malnourished (PEM), or not, based on anthropometry and biochemical measurements. On both occasions, the Activity Index and the Mini Mental State Examination were used. In order to identify individuals in need of nutritional care, the MNA was performed. Information about medical data was obtained. A total of 127 residents were consecutively admitted to eight resident homes in a municipality in Sweden. Three resident homes constituted the experimental unit (n = 68) and five the control unit (n = 59). Fifteen residents were interviewed using a qualitative method, to investigate what affects their appetite.

On admission 32 % of the residents were classified as PEM, which was similar to in the previous study. A higher frequency of residents in the present study had severe medical diseases and cognitive impairment, compared with the previous study, indicating changed admission criteria in the present study.

Between the experimental and the control groups, no differences were seen in any specific anthropometric or biochemical variable. Within the groups, statistically significant differences were seen, as the number of PEM residents in the experimental group decreased, and motor activity and overall cognitive function improved. In the control group, motor activity deteriorated. This indicates that the intervention improved nutritional status and functional capacity in the residents.

Diagnostic sensitivity was 73 % regarding MNA versus PEM, and 89 % regarding MNA short form (MNA-SF) versus MNA, which indicates a rather high degree of sensitivity in both tests. Inter-rater reliability of MNA, carried out by simultaneous assessments by registered nurses and researcher showed a moderate agreement of 62 % (kappa 0.41).

The interview study showed that the willingness to eat was what affected the residents´ appetite. The willingness to eat contains internal factors, dependent on mood and personal values, as well as external factors, dependent on wholesomeness, food, eating environment and meal fellowship. When planning and realizing residents´ nutritional care, factors affecting the residents´ appetite have to be taken into consideration.

In conclusion, the results show that it is important to implement and develop strategies for individual nutritional care, in order to prevent and treat malnutrition in elderly people, which is in line with recommendations given by the European Society of Parenteral and Enteral Nutrition (ESPEN) and with the Swedish goal of nursing actions.

Place, publisher, year, edition, pages
Institutionen för medicin och vård, 2006
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 951
Keyword
Elderly people, resident homes, comparison, nutritional intervention, education, individualised care, inter-rater reliability, appetite, qualitative method
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-7470 (URN)91-85497-87-8 (ISBN)
Public defence
2006-06-09, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2009-08-23

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Wikby, KerstinEk, Anna-ChristinaChristensson, Lennart

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