title: Comparison of two different approaches for the application of the mini nutritional assessment in nursing homes: resident interviews versus assessment by nursing staff.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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 to 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.
authors.affiliation: Department of Geriatric Medicine, University of Erlangen-Nuremberg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Kaiser
authors.forename: K
authors.initials: K
authors.lastname: Winning
authors.forename: W
authors.initials: W
authors.lastname: Uter
authors.forename: S
authors.initials: S
authors.lastname: Lesser
authors.forename: P
authors.initials: P
authors.lastname: Stehle
authors.forename: C C
authors.initials: CC
authors.lastname: Sieber
authors.forename: J M
authors.initials: JM
authors.lastname: Bauer
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D005858:Germany; D006707:Homes for the Aged; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000401:mortality; D009730:Nursing Assessment / Q000379:methods*; D009735:Nursing Homes; D015596:Nutrition Assessment; D009752:Nutritional Status; D010043:Outcome and Process Assessment, Health Care; D011378:Prognathism