Interobserver Agreement on Mna Nutritional Scale of Hospitalized Elderly Patients

It is generally admitted that the prevalence of undernutrition at home is not high. However, as showed by a number of studies carried out in Europe and USA (1), it can reach half of the patients when admitted in hospital. Moreover, in a geriatric population, undernutrition is not only linked to a morbidity and mortality increase (2) but also to a bad quality of life (3). The frequence of proteino-energetic undernutrition is difficult to evaluate because often underestimated, especially in the elderly hospitalized population (4). On the other side, there is not much of unanimity concerning the tools for such an evaluation (1). As a matter of fact, in spite of numerous instruments for undernutrition detection, none of them has shown sufficient characteristics to be used in disease detection (5). As a consequence, due to the lack of internationally recognized evaluation scale, like for the Mini Mental State which evaluates the cognitive functions (6) and for the Geriatric Depression Scale which evaluates the depression (7), Guigoz, Vellas and Garry (8) have developped and validated an evaluation scale for the nutritional state of the elderly entitled "Mini Nutritional Assessment" (MNA), completing in that way one of the aspects of gerontologic assessment. According to these authors, the MNA conception has to found upon the following criteria : good reproducibility, clear definition of "good" and "bad" nutritional state, consistency with requirements of clinical practice, minimization of error risk in data recording, good acceptability by patients, and finally cheapness and rapidity. As described in a literature review by Reuben (5), the efficiency of such a tool depends on its reliability when used by different observers. The aim of the present study is to measure the interobserver agreement of MNA nutritional scale for hospitalized elderly patients. Such an assessment does not seem to have so far been carried out, but it is of major importance if MNA is wanted to be included in systematic examination of elderly people when admitted in hospital.