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.
Six German nursing homes.
286 residents (86±7y, 89% female).
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.
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).
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.
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Cowan DT, Roberts JD, Fitzpatrick JM, While AE, Baldwin J. Nutritional status of older people in long term care settings: current status and future directions. Int.J Nurs Stud. 2004;41(3):225–237.
Meijers JM, Halfens RJ, van Bokhorst-de van der Schueren MA, Dassen T, Schols JM. Malnutrition in Dutch health care: prevalence, prevention, treatment, and quality indicators. Nutrition. 2009;25(5):512–519.
Salva A, Coll-Planas L, Bruce S, et al. Nutritional assessment of residents in long-term care facilities (LTCFs): recommendations of the task force on nutrition and ageing of the IAGG European region and the IANA. J Nutr Health Aging. 2009;13(6):475–483.
Morley JE. Assessment of malnutrition in older persons: a focus on the Mini Nutritional Assessment. J Nutr Health Aging. 2011;15(2):87–90.
Volkert D, Saeglitz C, Gueldenzoph H, Sieber CC, Stehle P. Undiagnosed malnutrition and nutrition-related problems in geriatric patients. J Nutr Health Aging. 2010; 14(5):387–392.
Raynaud-Simon A, Revel-Delhom C, Hebuteme X. Clinical practice guidelines from the French Health High Authority: nutritional support strategy in protein-energy malnutrition in the elderly. Clin Nutr. 2011;30(3):312–319.
Volkert D. [Nutritional guidelines and standards in geriatrics]. Z Gerontol Geriatr. 2011;44(2):91–96, 99.
Volkert D, Berner YN, Berry E, et al. ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clin Nutr. 2006;25(2):330–360.
Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2009 (2):CD003288.
Chan M, Lim YP, Ernest A. Tan TL. Nutritional assessment in an Asian nursing home and its association with mortality. J Nutr Health Aging. 2010;14(l):23–28.
Donini LM, De Felice MR, Savina C, et al. Predicting the outcome of long-term care by clinical and functional indices: the role of nutritional status. J Nutr Health Aging. 2011;15(7):586–592.
Meijers JM, Halfens RJ, Wilson L, Schols JM. Estimating the costs associated with malnutrition in Dutch nursing homes. Clin Nutr. 2011;31(l):65–68.
Rolland Y, Aquino JP, Andrieu S, et al. Identification of the main domains for quality of care and clinical research in nursing homes. J Nutr Health Aging. 2011;15(5):410–424.
Kondmp J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–421.
Meijers JM, van Bokhorst-de van der Schueren MA, Schols JM, Soeters PB, Halfens RJ. Defining malnutrition: mission or mission impossible? Nutrition. 2010;26(4):432–440.
White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement, of the academy of nutrition and dietetics/american society for parenteral and enteral nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad.Nutr Diet. 2012; 112(5):730–738.
Neelemaat F, Bosnians JE, Thijs A, Seidell JC, van Bokhorst-de van der Schueren MA. Oral nutritional support in malnourished elderly decreases functional limitations with no extra costs. Clin Nutr. 2012;31(2):183–190.
Sieber CC. Nutritional screening tools—How does the MNA compare? Proceedings of the session held in Chicago May 2–3, 2006 (15 Years of Mini Nutritional Assessment). J Nutr Health Aging. 2006;10(6):488–492.
Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature-What does it tell us? J Nutr. Health Aging. 2006; 10(6):466–485.
lnzitari M, Doets E, Bartali B, et al. Nutrition in the age-related disablement process. J Nutr Health Aging. 2011;15(8):599–604.
Ljungqvist O, van Gossum A, Sanz ML, de Man F. The European fight against malnutrition. Clin Nutr. 2010;29(2):149–150.
Valentini L, Schindler K, Schlaffer R, et al. The first nutritionDay in nursing homes: participation may improve malnutrition awareness. Clin Nutr. 2009;28(2):109–116.
Arvanitakis M, Coppens P, Doughan L, van Gossum A. Nutrition in care homes and home care: recommendations — a summary based on the report approved by the Council of Europe. Clin Nutr. 2009;28(5):492–496.
Arvanitakis M, Beck A, Coppens P, et al. Nutrition in care homes and home care: how to implement adequate strategies (report of the Brussels Forum (22–23 November 2007)). Clin Nutr. 2008;27(4):481–488.
Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status J Nutr Health Aging. 2009;13(9):782–788.
Kaiser MJ, Bauer JM, Uter W, et al. Prospective validation of the modified mini nutritional assessment short-forms in the community, nursing home, and rehabilitation setting. J Am Gerialr Soc. 2011;59(11):2124–2128.
McDowell MA, Fryar CD, Hirsch R, Ogden CL. Anthropometric reference data for children and adults: U.S. population, 1999–2002. Advance data. Jul 7 2005 (361):1–5.
Al Snih S, Ottenbacher KJ, Markides KS, Kuo YF, Eschbach K, Goodwin JS. The effect of obesity on disability vs mortality in older Americans. Archives of internal medicine. Apr 2 23 2007;167(8):774–780.
Gaskill D, Black LJ, Isenring EA, Hassall S, Sanders F, Bauer JD. Malnutrition prevalence and nutrition issues in residential aged care facilities. Australas J Ageing. 2008;27(4):189–194.
Bartholomeyczik S, Reuther S, Luft L, et al. [Prevalence of malnutrition, interventions and quality indicators in German nursing homes — first results of a nationwide pilot study]. Gesundheitswesen. 2010;72(12):868–874.
Bourdel-Marchasson I. How to improve nutritional support in geriatric institutions. J Am Med Dir. Assoc. 2010;11(1):13–20.
Volkert D, Pauly L, Stehle P, Sieber CC. Prevalence of malnutrition in orally and tube-fed elderly nursing home residents in Germany and its relation to health complaints and dietary intake. Gastroenterol Res. Pract. 2011;2011:247315.
Alves de Rezende CH, Coelho LM, Oliveira LM, Penha SN. Dependence of the geriatric depression scores on age, nutritional status, and haematologic variables in elderly institutionalized patients. J Nutr Health Aging. 2009;13(7):617–621.
Grieger JA, Nowson CA, Ackland LM. Nutritional and functional status indicators in residents of a long-term care facility. J Nutr Elder. 2009;28(1):47–60.
Smoliner C, Norman K, Wagner KH, Hartig W, Lochs H, Pirlich M. Malnutrition and depression in the institutionalised elderly. Br.J Nutr. 2009;102(11):1663–1667.
Vellas B, Lauque S, Gillette-Guyormet S, et al. Impact of nutritional status on the evolution of Alzheimer’s disease and on response to acetylcholinesterase inhibitor treatment. J Nutr Health Aging. 2005;9(2):75–80.
Landi F, Liperoti R, Fusco D, et al. Prevalence and risk factors of sarcopenia among nursing home older residents. J Gerontol A Biol.Sci.Med Sci. 2012;67(1):48–55.
Bauer JM, Sieber CC. Sarcopenia and frailty; a clinician’s controversial point of view. Exp.Gerontol. 2008;43(7):674–678.
Volkert D. The role of nutrition in the prevention of sarcopenia. Wien.Med Wochenschr. 2011;161(17–18):409–415.
Kaiser R, Winning K, Uter W, et al. Functionality and mortality in obese nursing home residents: an example of ‘risk factor paradox’? J Am Med Dir.Assoc. 2010;11(6);428–435.
Nieuwenhuizen WF, Weenen H, Rigby P, Hetherington MM. Older adults and patients in need of nutritional support: review of current treatment options and factors influencing nutritional intake. Clin Nutr. 2010;29(2):160–169.
Bartali B, Frongillo EA, Bandinelli S, et al. Low nutrient intake is an essential component of frailty in older persons. J.Gerontol.A Biol.Sci.Med Sci. 2006;61(6):589–593.
Wirth R, Smoliner C, Sieber CC, Volkert D. Cognitive function is associated with body composition and nutritional risk of geriatric patients. J Nutr Health Aging. 2011;15(8):706–710.
Gillette GS, Abellan vK, Alix E, et al. IANA (International Academy on Nutrition and Aging) Expert Group: weight loss and Alzheimers disease. J Nutr Health Aging. 2007;11(l);38–48.
Donini LM, Saviia C, Cannella C. Nutritional interventions in the anorexia of aging. J Nutr Health Aging. 2010; 14(6):494–496.
Silver HJ. Oral strategies to supplement older adults’ dietary intakes: comparing the evidence. Nutr Rev. 2009;67(1):21–31.
Hebuterne X, Bermon S, Schneider SM. Ageing and muscle: the effects of malnutrition, re-nutrition, and physical exercise. Cuir.Opin.Clin Nutr Metab Care. 2001;4(4):295–300.
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Stange, I., Poeschl, K., Stehle, P. et al. Screening for malnutrition in nursing home residents: Comparison of different risk markers and their association to functional impairment. J Nutr Health Aging 17, 357–363 (2013). https://doi.org/10.1007/s12603-013-0021-z
- nursing home
- nutritional risk