Abstract
Background: Malnutrition is common in the elderly, especially among those who are hospitalized. Elderly in-patients often have depressed appetite, reduced food intake and nutritional imbalance. These
conditions increase disease risks and even mortality.
Objective: The study was aimed to (a) assess the nutritional status of hospitalized elderly patients, and (b) to validate the predictive ability of two modified versions of the Mini Nutritional Assessment (MNA) in elderly hospitalized patients.
Methods: The study employed purposive sampling and recruited 109 consecutive elderly (?65y) new patients who were hospitalized during March 2009 in an area hospital in rural Central-Western Taiwan. At approximately 24 hours after their arrival subjects were interviewed for assessing their nutritional statuses with three versions of the MNA, the original, the modified Taiwan version 1 (T-1) and Taiwan version 2 (T-2).
T-1 was the same as the original version in all aspects except the anthropometric questions (Questions F, Q & R) where population specific BMI, mid-arm circumference (MAC) and calf-circumference (CC) cut-points replaced the original cut-points whereas T-2 omitted the BMI question and redistributed its scores to MAC and CC questions and adopted incremental cut-points and scoring. All versions maintained the same total scores and rating system. Results were statistically analyzed with SPSS 12.0 Software Package. Friedman Test and Wilcoxon Signed-rank Test were used to determine the significance of differences among the results graded with the three versions. Multivariate linear regression analysis was applied to determine the variables associated with the nutritional status. The study protocol was approved by the hospital IRB and all patients or their legal guardians signed an informed written concent.
Results: Among the 109 patients, only 91 had complete data and those were used for further analyses.
The original MNA scale rated 43 (47.3%) patients malnourished, 36 (39.6%) at risk of malnutrition and only 12 (13.2%) normal; T-1 rated 38 (41.8%), 23 (25.3%) and 30 (33.0%), respectively; and T-2 rated 49 (53.8%), 29 (31.9%) and 13 (14.3%) normal. Analyses with Friedman Test and Wilcoxon Signed-rank Test indicated that result rated with the T-1 version was different from that rated with the original and the T-2 versions whereas no difference was detected between results rated with the original and T-2 versions.
Conclusion: Results indicate that malnutrition is prevalent among elderly hospitalized patients and also suggest that for frail elderly hospitalized patients, T-2 which has increased MAC and CC weightings to replace BMI weighting in the scale may better reflect the nutritional risk status. Routine assessment and timely intervention is the key to improving the nutritional status of frail elderly. T-2 is a tool particularly suitable for assessing the nutritional status of these frail patients.
