Mini Nutritional Assessment (MNA) for Older Adults
Malnutrition can happen to anyone, but older adults are particularly at risk.
Because malnutrition has been associated with diminished cognitive capacity and declining functional ability, it’s important to identify malnutrition in older people as early as possible.
There are many screening tools that healthcare professionals can use to assess malnutrition risk.
One such tool that has been validated for identifying malnutrition in older adults is the Mini Nutritional Assessment (MNA).
This article explains the components of the MNA and how you can use it to identify malnutrition or the risk of malnutrition in older adults.
What is the mini nutritional assessment?
The MNA is a screening and assessment tool validated for use in older adults aged 65 and above who are malnourished or at risk of malnutrition (1).
The tool determines whether a person may be well-nourished, at risk of malnutrition, or malnourished.
However, the MNA is not a diagnostic tool for malnutrition — it is only a screening tool.
To make a malnutrition diagnosis, a dietitian must complete a comprehensive nutrition assessment, which includes a nutrition-focused physical exam.
The MNA was developed in 1989 by two researchers and was initially validated in a group of more than 150 healthy, frail, and acutely ill older adults in France between 1990 and 1991 (2).
Since that time, the MNA has been the most widely used tool for nutritional screening and assessment in older people (3, 4, 5).
Components of the assessment
Originally consisting of 18 self-reported questions, the current MNA now consists of six questions that take less than five minutes to complete.
The questions include criteria specific to aging such as functionality, depression, and dementia.
They are as followed (6):
Ask the person:
- “Have you eaten less than normal over the past three months?”
- If so, “is this because of lack of appetite, chewing or swallowing difficulties?
- If yes, “have you eaten much less than before or only a little less?”
- For a re-assessment, rephrase the question: “Has the amount of food you have eaten changed since your last assessment?”
Ask the person or review their medical history:
- “Have you lost any weight without trying over the last three months?”
- “Has your waistband gotten looser?”
- “How much weight do you think you have lost? More or less than 7 lbs (about 3 kg)?”
Ask the person, review their medical record or gather information from other caregivers:
- “Are you presently able to get out of bed or chair?”
- “Are you able to get out of the house or go outdoors on your own?”
Ask the person, review their medical record and use professional judgment:
- “Have you suffered a bereavement recently?”
- “Have you recently moved your home?”
- “Are you, or have you been sick recently?”
Review their medical records, use professional judgment or ask nursing staff or their caregiver to provide information about the severity of the person’s neuropsychological problems.
If BMI is not available, replace question F1 with F2.
After you have filled in the appropriate numbers, total them for the final screening score.
Recommendations for interventions
Depending on the MNA screening score, there are recommended interventions.
12-14 points: Normal nutritional status
Rescreen:
- After acute event or illness
- Every three months for people in long-term care
8-11 points: At risk of malnutrition
The recommendations are different depending on whether there is weight loss.
No weight loss:
- Monitor weight closely
- Rescreen every three months
Weight loss:
- Diet enrichment
- Oral nutrition supplementation (400 cal/day)
- Monitor weight closely
- Further in-depth nutrition assessment and nutrition-focused physical exam
0-7 points: Malnourished
Treat:
- Oral nutritional supplementation (400-600 cal/day)
- Diet enrichment
- Monitor weight closely
- Further in-depth nutrition assessment
The bottom line
The MNA is a validated screening tool for identifying malnutrition and malnutrition risk in older adults aged 65 years and older.
The tool consists of six questions related to food intake, weight loss, mobility, acute event or illness as well as neuropsychological problems.
Based on the screening score, there are recommendations for interventions to help treat or prevent malnutrition.
