探討門診高齡病人之營養不良、衰弱及跌倒風險的相關性

在門診就醫的高齡病人族群中，常可見多重疾病合併衰弱、營養不良及跌倒風險的病人，但礙於門診醫療服務模式，高齡衰弱的門診病人,較少有機會接受衰弱評估，而營養不良為衰弱形成的促發因素，跌倒是衰弱可能發生的不良結果﹔然而國內外文獻針對門診高齡族群，探討衰弱、營養不良與跌倒風險三者之相關性文獻少，故本研究目的為（1）了解門診高齡病人之衰弱程度﹔（2）評價門診高齡病人之營養不良風險﹔（3）評量門診高齡病人之跌倒風險﹔（4）探討門診高齡病人營養不良、衰弱與跌倒風險之相關性。本研究採橫斷性調查研究設計，於南部某醫學中心之高齡整合門診、老年醫學科門診、一般醫學內科門診進行方便取樣，共收案145位。研究者以(1)自擬個案基本屬性問卷、(2)中文版衰弱評估量表(Edmonton Frail Scale, EFS)、(3)營養不良通用篩檢工具(Malnutrition Universal Screening Tool, MUST)及(4)跌倒風險評估工具(Peninsula Health-Fall Risk Assessment Tool, PH–FRAT)進行問卷調查，並進行三公尺行走測試及手握力測量。採用SPSS for window 20.0版統計套裝軟體進行描述性統計如：平均數、百分比、標準差等，及推論性統計，如：Spearman相關分析及卡方檢定。研究對象以女生居多，佔58.6%，平均年齡為73.43（± 8.27）歲﹔在衰弱程度發現：無衰弱者佔71%，衰弱前期者佔14.5%，衰弱者佔14.5%；營養不良低度風險者有90.3%，中度及高度風險共佔9.7%；輕度跌倒風險者有96.6%，中度及高度跌倒風險有3.4%。分析結果發現衰弱與跌倒風險(r=.21, p＜.01)呈顯著正相關，衰弱與營養不良無顯著相關(r= –.07, p＝.39)，營養不良與跌倒風險亦無顯著相關(r= –.06, p＝.46)。本研究結果顯示有衰弱之門診高齡病人，跌倒風險相對較無衰弱病人高，建議及早針對門診高齡病人進行衰弱及跌倒風險的評估，根據個別的衰弱及跌倒風險介入處置措施，以避免衰弱的惡化及跌倒發生之不良後果，而建議未來研究在營養不良與衰弱及跌倒風險之間的關係，有待再做進步一步的測試

關鍵字

老人；衰弱；營養不良；跌倒風險

並列摘要

Among the elderly group who visited outpatient department for certain medical treatment, it was easy to see the obvious fact that the ones had more comorbidity and also had higher risk of frailty, malnutrition and fall events. However, in outpatient department service modes, we do not have the opportunity to perform detailed assessment in these debilitating elderly groups. In hypothesis of frailty, malnutrition was one of those aggravating factors and both contributed to worse consequences, such as fall events. In Contemporary articles and reviews, in the elderly groups at outpatient clinic services, it had few convincing references to know how much correlation it was among frailty, malnutrition and fall. For the purpose, this study aimed to understand the followings: (1) To know the extent of frailty in elderly in outpatient clinic services (2) To evaluate the extent of malnutrition risk in elderly in outpatient clinic services (3) To evaluate the extent of fall risk in elderly in outpatient clinic services (4) To know how much correlation it was among frailty, malnutrition and fall. In this study, we executed a cross-sectional design and recruited the elderly volunteers in outpatient clinics, including integrated-geriatric, geriatric and general medicine department in the medical center of Southern Taiwan. A total of 145 cases were recruited during the study. All participants had accepted questionnaire analysis, including (1) Key individual clinical characteristics (2) Edmonton Frail Scale in Chinese version (3) Malnutrition Universal Screening Tool (4) Peninsula Health-Fall RiskAssessmentTool. Also, all participants had accepted further 3-meter walking test and grasp muscle power measurement. For the statistical analysis, we had used software with version 14.0 of SPSS for Windows. The statistical data included the average, percentage, Standard Deviation and inferential statistics of Spearman Rank Correlation and Chi-square distribution. Among those participants, it was in average age of 73.43 (± 8.27) years-oid and female predominant, 58.6% included. In subgroups analysis, it was present in 71%, 14.5%, and 14.5% of the nonfrail, prefrail, and frail subjects. Malnutrition risk was present in 90.3% and 9.7% of low risk and mid/high risk groups and fall risk was present in 96.6% and 3.4% of low risk and mid/high risk groups. We analyzed those data in Spearman correlation coefficient and showed positive correlation in frailty and fall (r=.21, p＜.01), but neither correlation in frailty and malnutrition (r= –.07, p＝.39) nor in fall and malnutrition(r= –.06, p＝.46). In conclusion, in the elderly at outpatient clinic, the result showed the more frailty and the higher fall risks. It benefits from earlier risk assessment of frailty and fall in the elderly at outpatient practice, and we could do the individual intervention to avoid worse consequences, like more frailty and falls. However, the undetermined result had been among malnutrition, frailty and falls and need more analysis in future study.