醫院型家庭責任醫師制度長者居家營養評估

Nutritional Assessment for the Elderly Receiving Home-care Services in Hospital-based Accountable Family Physicians System

杜秀容(Hsiu-Jung Tu) ； 蕭勝煌(Sheng-Huang Hsiao) ； 黃勝堅(Sheng-Jean Huang) ； 郭冠良(Kuan-Liang Kuo) ； 趙珊(Shan Chao)

《北市醫學雜誌》 13卷1期 (2016/03) Pp. 80-88

https://doi.org/10.6200/TCMJ.2016.13.1.08

摘要

目的：臺灣已邁入高齡化社會，社區提供居家長者完善的醫療保健更顯重要。本研究經由醫院型家庭責任醫師制度針對居家長者進行營養訪視，探討其營養評估結果與照護原則建議。方法：本研究為橫斷性研究，採取立意取樣調查方法，對象為「醫院型家庭責任醫師制度試辦計畫」之個案，由營養師隨同醫療團隊進行長者居家訪視。本研究經臺北市立聯合醫院人體試驗委員會許可，經由個案同意簽署參與同意書。研究採結構式訪談問卷，包括：社會人口學與營養相關資料。社會人口學資料包含：性別、年齡、婚姻狀況、教育程度、居住狀況、身分別、行動能力、生活能力等；營養相關資料包含：體位測量、食慾變化、餐次、咀嚼進食能力等。收集其相關資料進行分析，統計分析為描述性統計與卡方檢定。結果：101 位研究參與者其身體質量指數(BMI) 過輕佔9.9%、正常35.6% 及過重或肥胖54.5%，比較三組結果於性別、婚姻狀況、教育程度、居住狀況、社經狀況、行動能力及生活能力等均無顯著差異。飲食攝取狀況分析依上述BMI 三組比較各組間之差異，惟外觀正常或偏胖者有較高之BMI 數值（≥24 Kg/m^2），其餘各組間均無顯著差異。本研究除結構式問卷收集外，並以專業營養師實際觀察訪視分析，了解居家訪視個案真正需求面，發現長者有咀嚼困難、吞嚥困難、食物及營養相關知識不足及製備食物或餐點的能力不足等多面向之飲食問題，可做為未來進一步營養介入之相關策略。結論：本研究藉由醫院型家庭責任醫師制專業醫療團隊進行家庭訪視，營養師提供居家長者慢性病飲食諮詢，發現長者有咀嚼困難、吞嚥困難、食物及營養相關知識不足及製備食物或餐點的能力不足等飲食問題，可做為未來營養介入之策略。且執行送餐服務等針對獨居長者確實有其實質助益，期望未來對於居家長者有更合宜的飲食建議與相關介入。讓長者得以在社區健康老化，使其落實政府『在地老化、在地安養』長期照護的宗旨。

關鍵字

營養 ； 居家訪視 ； 團隊照護

並列摘要

Objectives: This study examined the outcome of nutrition assessment and intervention care conducted under family physician system for home-care elderly. Methods: Purposive sampling survey was adopted in this study and conducted by dietitians who joined the home visits with the medical team. Dietitians collected basic data for nutritional assessment. Descriptive statistics and chi-square test were used for statistical analysis. Results: According to the body mass index (BMI) of the 101 participants, 9.9% were underweight, 35.6% were normal and 54.5% were overweight. There was no significant difference between three groups in gender, marital status, education level, living conditions, socio-economic status, ability to act and the ability to live and so on, except dietary intake between the normal and overweight subjects who had a higher value of BMI (＞ 24 Kg / m^2). Conclusion: Although no variables were associated with dietary intake, dietitians may provide nutrition assessment and appropriate dietary recommendations for the elderly during home visits along with other members of the medical team under family physician system.

並列關鍵字

nutrition ； home-care ； medical team