两种不同方法在养老院中应用微型营养评估的比较：居民访谈与护理人员评估。
Comparison of two different approaches for the application of the mini nutritional assessment in nursing homes: resident interviews versus assessment by nursing staff.
机构信息
Department of Geriatric Medicine, University of Erlangen-Nuremberg, Germany.
出版信息
J Nutr Health Aging. 2009 Dec;13(10):863-9. doi: 10.1007/s12603-009-0243-2.
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.
AIMS AND OBJECTIVES
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.
METHOD
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.
背景
当 Mini Nutritional Assessment（MNA）被开发出来时，作者并没有特别关注养老院的环境。由于养老院居民存在认知和语言障碍等诸多特殊性，该评估方法的应用仍存在许多不确定性。
目的和目标
本研究的目的是比较 MNA 在养老院中两种不同应用模式的结果：居民访谈与护理人员评估。
方法
对德国纽伦堡市两家市立养老院的 200 名居民进行 MNA 评估。首先，我们小组的两名研究人员对居民进行一对一访谈。接下来，由护理人员根据访谈结果进行 MNA 评估，但护理人员对第一次 MNA 评估的结果并不知情。为了评估两种不同方法的预后特性，在六个月的随访期间收集了筛查居民的死亡率数据。
结果
在 200 名居民（女性 147 名，男性 53 名；女性平均年龄 86.5 +/- 7.4 岁，男性平均年龄 83.0 +/- 8.5 岁）中，有 138 名（69.0%）居民通过一对一访谈可应用 MNA，有 188 名（94.0%）居民可由护理人员进行 MNA 评估。通过访谈，有 15.2%的居民被归类为营养不良，而通过护理人员评估，有 8.7%的居民被归类为营养不良。两种形式的 MNA 短版评估（加权kappa=0.31；95%置信区间：0.14 - 0.47）以及完整 MNA 评估（加权 kappa=0.35；95%置信区间：0.27 - 0.44）的一致性较低。排除认知障碍患者（n=89）后，完整版本的一致性增加（加权 kappa=0.47，95%置信区间 0.25 - 0.68）。在随访期间，有 25 名（12.5%）研究参与者死亡。死亡率与两种方法的死亡率均显著相关，而护理人员进行 MNA 评估的效果更好（护理人员 p<0.001，居民 p<0.05）。
结论
当将居民访谈与护理人员评估进行比较时，养老院居民的 MNA 结果可能存在显著差异。作者建议 MNA 应常规由护理人员进行应用。这种方法的应用率更高，并且可以减少认知和语言障碍的干扰。在未来的研究中，应明确说明养老院居民的 MNA 应用模式，以方便结果的可比性。
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