BioPsychoSocial Assessment Tools for the Elderly - Assessment Summary Sheet

Test: Mini Nutritional Assessment (MNA)

Year: 1989

Domain: Biological

Assessment Tool Category: General Health

Variations/Translations: Variations: Full length version (MNA) and MNA Short Form (MNA-SF). Translations: English, Arabic, Chinese, Chinese simplified, Czech, Danish, Dutch, Farsi, Finnish, French, German, Greek, Hungarian, Italian, Japanese, Latvian, Norwegian, Portuguese, Slovenian, Spanish, Swedish, Turkish and Thai.

Setting: Clinics, Hospitals, Nursing Homes, Home Care.

Method of Delivery: Questionnaire. Self administered or for use in a clinical interview.

Description: The Mini Nutritional Assessment (MNA) is a quick nutritional status assessment for older adults. The goal of this tool is to evaluate older individuals risk for malnutrition in the hopes of early recognition of need for nutritional intervention. This tool is also a rapid test for physicians and other health care providers for identifying older adults who may need more complex nutritional assessment. The MNA includes anthropometric measurements (weight, height, and weight loss), global assessment (the lifestyle of the individual, medication history, and mobility), dietary questionnaire (fluid intake, ability to feed independently, and number of meals), and subjective assessment (personal interpretation of health and nutrition status). These domains make up the 18 questions on the MNA.

Scoring/Interpretation: The sum of 18 questions can provide a maximum score of 30. The person with a score greater than or equal to 24 points is considered well-nourished, a score of 17 – 23.5 is considered at risk for malnutrition, and a score of less than 17 classifies the person as malnourished.

Time to Administer: Approximately 10 minutes.

Availability: Available online

Software: N/A

Website: http://www.mna-elderly.com/default.html

Quantitative/Qualitative: Quantitative

Validity (Quantitative): The MNA was validated in three consecutive studies between 1991 and 1993 on over 600 participants for early detection of malnutrition. Initially in 1991, it was validated in Toulouse, France during a study of over 150 older adults ranging from healthy to the frailest. Again, in 1993 in a population of 347 community dwelling older adults and the MNA-SF was also validated in 1993 in a study with 120 older adults.

The studies used to validate the MNA focused on its effectiveness and accuracy while looking to sensitivity, specificity and predictive values to prove this. Sensitivity was found to be 96%, specificity 98% and the predictive value was 97%.

Reliability (Quantitative):

In a study by Bleda et al. (2002) where two different nurses administered the MNA. The ICC was calculated after a two-way ANOVA 4 there was no difference between the two administrators. In terms of internal consistency using a one-sided confidence interval, the total MNA score during the first assessment was 0.83 with the one sided confidence interval being 0.78 and after the second assessment it was found to be 0.74 with a one sided confidence interval of 0.66. In terms of test-re-test reliability, the ICC for the total MNA score for both the first and second assessment was 0.89 indicating excellent reliability.

References:

Beck, A., Holst, M., & Rasmussen, H. (2008). Efficacy of the Mini Nutritional Assessment to predict the risk of developing malnutrition or adverse health outcomes for old people. The European e-Journal of Clinical Nutrition and Metabolism, 3, 102-107.

Bleda, M., Bolibar, I., Pares, R., & Salva, A. (2002). Reliability of the Mini Nutritional Assessment (MNA) in Institutionalized Elderly People. The Journal of Nutrition, Health & Aging, 6, 134-137.

Nestle Nutrition Institute. (2009). MNA Mini Nutritional Assessment. Retrieved on March 20, 2010 from http://www.mna-elderly.com/default.html

Secher, M., Soto, M., Villars, H., van Kan, A., & Vellas, B. (2007). The Mini Nutritional Assessment (MNA) after 20 years of research and clinical practice. Clinical Gerontology, 17, 293-310.

Vellas, B., Guigoz, Y., Garry, P., Nourhashemi, F., Bennahum, D., Lauque, S., & Albarede, J. (1999). The Mini Nutritional Assessment (MNA) and its use in Grading the Nutritional Status of Elderly Patients. Nutrition, 15, 116-122.

Comments: Appropriate for use with individuals aged 65 and older. These are only a few examples of validity and reliability in the MNA. More than 400 published studies in both clinical and research settings have supported the sensitivity, specificity and reliability of this tool. It is also the most validated and vastly used tool for assessing nutritional status in the elderly.