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UWL: Screening and Assessment Methods (2009)

Study Design:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

The aim of the study was the assessment of the nutritional status of older people living in the chosen long-term care setting in Poland as well as the determinants having an effect on the nutritional status of the examined subjects.

Inclusion Criteria:

The subjects included older residents (age 65 years and older) of the nursing home for the somatically ill adults in Bialystok.

Exclusion Criteria:
  • None specifically mentioned
  • Nine individuals did not want to participate or were not able to participate due to their serious health status.
Description of Study Protocol:


The subjects included older residents (aged 65 years and older) of the nursing home for the somatically ill adults in Bialystok.


Cross-sectional study.

Statistical Analysis

  • Multivariate regression analysis (standard, stepwise backward and forward) was used to find independent variables influencing nutritional status of the group studied
  • The total score of the Mini Nutritional Assessment (MNA) was used as the dependent variable for multiple regression analysis.
Data Collection Summary:

Timing of Measurements

Subjects received one-time examination. Two nurses, experienced and trained in geriatric assessment and not employed in the nursing home, were interviewers.

Dependent Variables

  • Experiences connected with living in a nursing home
  • Health status with elements of clinical judgment, the occurrence of chronic illnesses and medication
  • The functional evaluation of the respondent with functional ability scales [Katz Index, Instrumental Activities of Daily Living scale (I-ADL), Geriatric Depression Scale (GDS), Abbreviated Mental Test Score (AMTS), Norton scale and mobility scale]
  • Nutritional status and risk assessed with the MNA.

Independent Variables

  • Age
  • Institutionalization in nursing home.

Control Variable

Socio-demographic information.


Description of Actual Data Sample:
  • Initial N: 109 fulfilling the age criteria were eligible
  • Attrition (final N): 100 were examined (29 males, 71 females). Nine individuals did not want to participate or were not able to because of serious health status.
  • Age: Mean, 79.1±7.78 years. Women were significantly older than men (80.4±7.79 years vs. 75.9±6.86 years; P=0.007).
  • Ethnicity: Not mentioned
  • Location: Poland.
Summary of Results:

Standard Multivariate Regression Analysis of Independent Factors Associated with Total MNA Score







Living Alone Before Nursing Home Placement NS
Katz Index Score NS
I-ADL Score NS
GDS Score
Mobility Scale
Norton Scale Score NS
Number of Drugs Taken Every Day
Stroke in the Past NS
Difficulties in Chewing NS
Having Meals in Resident's Room NS

Other Findings

  • 12% of subjects were malnourished (less than 17 points), 61% were at risk of malnutrition (17 to 23.5 points) and 27% were well-nourished (more than 24 points), according to the MNA test
  • Malnutrition affected more subjects who had difficulty with chewing (P<0.001), were ADL-dependent (P<0.001), had limited mobility (P<0.01), had suspected dementia (P<0.01), had history of cerebral stroke (P<0.05) and who lived with other people coming to the nursing home (P<0.05)
  • The risk of malnutrition was observed significantly more often in individuals suspected of depression (P<0.01) and living in urban areas before nursing home placement (P<0.05)
  • Well-nourished status was observed significantly more frequently in men (P<0.05), people with good psycho-physical abilities such as good mobility (P<0.001), without signs of depression (P<0.001) or cognitive impairment (P<0.001), ADL independency (P<0.01), no risk of pressure sores (P<0.05), with good teeth status (P<0.01) and having meals in a dining room and not in the resident's room (P<0.001).
  • The significant determinants of lower scores on the MNA in the regression analysis were:  Suspected depression, I-ADL dependency, limited mobility, female sex and higher number of drugs. 
Author Conclusion:
  1. The study has confirmed that malnutrition remains a common problem among older people living in nursing homes. Based on MNA, one-tenth of the study subjects living in nursing homes seemed to be malnourished and more than half of them seemed to be at risk of malnutrition.
  2. Malnutrition is an increasing hazard especially for older women, for people with emotional disturbances and I-ADL dependent as well as for subjects taking a greater number of drugs
  3. Introducing the periodic assessment of the nutritional status among older residents in nursing homes with simple measures such as the MNA tool could allow for the implementation of appropriate nutritional intervention in specific cases. 
Funding Source:
Other: Prepared within the framework of the KBN 4-01470/2005 research project
Reviewer Comments:
  • Individuals not able to participate due to serious health status
  • Recruitment methods, inclusion criteria and exclusion criteria were not well-described.
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) N/A
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? ???
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? No
  2.2. Were criteria applied equally to all study groups? N/A
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? ???
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? ???
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) ???
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? Yes
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? Yes
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? No
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes