The Mini Nutritional Assessment (MNA) is the Gold Standard
The Mini Nutritional Assessment (MNA) is the most well-validated and widely used nutritional screening tool for the elderly, including those in institutional settings like nursing homes and hospitals. Its specific design for the geriatric population makes it superior to more general screening tools in this context. The MNA has evolved over time from a more extensive 18-item questionnaire into its current preferred format for clinical practice: the 6-item Mini Nutritional Assessment Short-Form (MNA-SF).
Why the MNA-SF is Preferred for Geriatric Screening
Healthcare practitioners in institutional settings favor the MNA-SF for several key reasons:
- Efficiency: The MNA-SF takes less than five minutes to complete, making it ideal for routine quarterly screenings of institutionalized older adults. The rapid assessment minimizes burden on both staff and residents.
- Specificity: The tool includes questions and metrics tailored to the common risk factors for malnutrition in older adults, such as cognitive decline, psychological distress, and impaired mobility. This offers a more comprehensive picture of nutritional risk than tools that focus solely on BMI or weight loss.
- Flexibility: Recognizing the difficulty of measuring height and weight in bedridden or immobile patients, the MNA-SF offers an option to substitute a calf circumference measurement for the BMI calculation. This practical adaptation ensures accuracy even with physical limitations.
- Robust Validation: The MNA, including its short form, has been extensively validated in numerous international studies across different settings, including nursing homes. Its proven reliability gives clinicians confidence in its results.
A comparison of common nutritional screening tools
To understand the MNA's dominance in geriatric care, it is helpful to compare it with other widely used screening tools, such as the Malnutrition Universal Screening Tool (MUST).
| Feature | Mini Nutritional Assessment Short-Form (MNA-SF) | Malnutrition Universal Screening Tool (MUST) |
|---|---|---|
| Target Population | Specifically designed and validated for older adults (>65 years). | Validated for use in adults of all ages, including older people. |
| Number of Items | 6 questions. | 5 steps/items. |
| Questions Covered | Food intake, weight loss, mobility, psychological stress/acute illness, dementia/depression, and BMI (or calf circumference). | BMI, unintentional weight loss, and acute disease effect. |
| Ease of Use | Quick (less than 5 minutes) and incorporates practical substitutions for difficult measurements like BMI. | Also considered easy to use by trained caregivers. |
| Sensitivity in Geriatrics | Higher sensitivity for detecting malnutrition risk in older populations, particularly those with complex needs like dementia. | Lower sensitivity compared to MNA-SF in geriatric day hospital settings. |
| Predictive Validity | Better predictor of outcomes like length of stay and readmission rates in older inpatients compared to MUST. | Predicts mortality but may underestimate risk in frail older patients. |
The Malnutrition Universal Screening Tool (MUST)
Developed by the British Association for Parenteral and Enteral Nutrition (BAPEN), the MUST is a popular tool, but it is not specifically tailored for older adults. While it is easy to use, studies show it can miss more at-risk older patients than the MNA-SF. Its reliance on standard BMI cut-off points can be problematic for older adults, who may have normal or high BMIs but still suffer from poor nutrition due to sarcopenia (age-related muscle loss). For institutionalized geriatrics with complex health issues, the MNA's inclusion of questions on cognitive status, stress, and mobility provides a more nuanced risk assessment.
Actionable steps following MNA-SF screening
Nutritional screening is not an endpoint but rather the beginning of an action-oriented process. A positive MNA-SF result signals the need for a comprehensive nutritional assessment by a registered dietitian or nutritional support team. This assessment aims to identify the underlying causes of malnutrition, such as poor appetite, dysphagia (swallowing difficulties), or inadequate support at mealtimes. Based on this detailed evaluation, a care plan can be developed, which may include:
- Dietary modifications, such as food fortification or high-energy, high-protein supplements.
- Assistance with feeding and meal preparation.
- Addressing underlying health issues that affect nutritional intake.
- Regular monitoring and follow-up to track progress.
Conclusion
For institutionalized geriatrics, the Mini Nutritional Assessment (MNA), particularly its Short Form (MNA-SF), stands out as the most appropriate and widely used screening tool. Its geriatric-specific design, speed, and validation across multiple care settings make it superior to more general tools like the MUST for this population. By effectively identifying older adults at risk of malnutrition, the MNA-SF enables timely intervention, preventing further health deterioration and improving outcomes. Healthcare professionals should integrate the MNA-SF into routine care protocols to ensure proper nutritional care for this vulnerable population. For more information on nutritional screening and the MNA, visit the official MNA® website, which offers user guides, forms, and validation studies: MNA-elderly.com.
