老人的非刻意體重下降及其危險因素與處置

Unintentional Weight Loss, Its Risk Factors and Management in Older Adults

蘭淑貞(Shu-Jan J Lan) ； 彭又文(Yu-Wen Peng)

《長期照護雜誌》 15卷2期 (2011/08) Pp. 145-156

https://doi.org/10.6317/LTC.201108_15(2).0009

摘要

老人的非刻意體重下降是指老人在過去30天內，在沒有刻意減重的情況下，體重下降超過原有的5%或以上；過去120天內，體重下降超過原有的10%或以上；或在6-12個月內，體重下降超過原有的5%或以上。它會造成免疫力下降、降低生活品質，增加罹病率及死亡率。罹病率包括骨折與憂鬱症。9個D(nine D''''s)和老人體重下降有關：disease（疾病，包括急性與慢性）；depression（憂鬱）；drugs（藥物）；失智症(dementia)；腹瀉(diarrhea)；吞嚥困難(dysphagia)；牙齒(dentition)；味覺異常(dysguesia)；功能異常(dysfunction)。危險因素有癌症、每天吃不到一餐、胃口下降、嚴重營養不良、社交活動降低、近90天內曾住院、進食量減少、便秘、跌倒、吞嚥困難、慢性問題影響情緒、壓力性潰瘍與疼痛、憂鬱、藥物使用、口腔因素、沒錢、失智行為、無法獲得較喜歡的食物等。它的處置必須收集危險因素等資料進行評估，找出確切原因。然而體重下降的真正原因不明佔16-28%。無論是否能鑑定出原因，都要給予營養支持或補充，少量多餐，給予所喜愛的食物，盡可能減少飲食限制，提供高熱量密度食物以達到足夠的熱量以及各種營養素。盡量考慮以口進食，若無法自口進食，則使用管灌餵食，此措施乃期望非刻意體重下降的老人能逐漸恢復到健康體重。

關鍵字

老人 ； 體重下降 ； 危險因素

並列摘要

Unintended (unintentional) weight loss [UWL] or involuntary weight loss (IWL) in the older adults is defined as a weight loss of at least 5% of body weight in the past 30 days, at least 10% of body weight in the past 120 days (4 months) or at least 5% of body weight in 6~12 months. In older adults, UWL or IWL results in decrease of immunity, quality of life and increase of morbidity including depression and mortality. UWL are linked to 9 D's including disease, depression, drugs, dementia, diarrhea, dysphagia, dentition, dysguesia and dysfunction or disorder. The risk factors for UWL or IWL include cancer, less than a meal daily, loss of appetite, severe malnutrition, decrease of social activity, hospitalization in the past 90 days, decrease in food intake, constipation, fall, swallowing difficulty, chronic conditions influencing mood, stress ulcer and pain, depression, use of special drugs, poor oral health, no money, dementia behavior, inability of getting preferable foods. The management of UWL or IWL should collect essential information including risk factors and conduct assessment as well. To identify real cause is crucial. No matter whether the real cause can be identified or not (Of older adults with UWL, 16~28% can not be identified the real cause), nutrition support or supplementation must be given with more frequencies and less amount of foods. Providing preferable foods and reducing food restriction as much as possible. Serving foods of high nutrient density in order to give adequate energy and all nutrients. Oral intake is priority. Tube feeding is used only as oral intake is not feasible. All efforts are expected to restore healthy body weight.

並列關鍵字

older adults ； unintended unintentional weight loss ； risk factors