台灣高齡者人口學及食物可獲性影響因素與飲食行為的相關

Association of Dietary Behaviors with Demographic Factors and Food Accessibility among Taiwanese Older Adults

蔡宗達(Tsung-Ta, Tsai) ； 廖麗娜(Li-Na Liao) ； 李佳霙(Chia-Ing Li) ； 李采娟(Tsai-Chung Li) ； 王英偉(Ying-Wei Wang) ； 黃惠煐(Hui-Ying Huang) ； 林正介(Cheng-Chieh Lin)

《台灣老年醫學暨老年學雜誌》 12卷4期 (2017/11) Pp. 257-273

https://doi.org/10.29461/TGG.201711_12(4).0004

摘要

背景與目的：台灣老年人營養不良的盛行率正在增加。營養不良會造成身體功能下降、肌肉量減少、骨量下降、貧血、認知功能退化等。營養素的攝取不足，會直接增加老年人死亡的風險。此外，高齡者之身體機能的限制會增加營養不良的風險，例如取得、製作食物。因此本研究目的為探討台灣高齡者人口學及食物可獲性影響因素與飲食行為之間的相關性。方法：本研究使用台灣國民營養健康狀況變遷調查NAHSIT 2005-2008年資料庫，研究對象為65歲以上老人族群，以問券搜集高齡者人口學變項包括：性別、年齡、教育程度、婚姻狀況、城鄉；食物可獲性的影響因素包括：經濟能力、膳食製備能力、社會資源支持、生理及心理知能…等。於問卷中，使用二項整體性飲食行為當作依變項，分別進行羅吉斯迴歸分析，分別是（1）會依據均衡飲食原則（每天都吃到六大類食物）來選擇食物、（2）一天吃的食物種類有十五種以上（不包括零食、糖果、飲料）。結果：參與該次營養調查的高齡者共1,028人，平均年齡約73歲，在平常的飲食行為中，高達七成二的高齡者“很少會依據均衡飲食原則來選擇食物”，同時高達八成七的高齡者“一天吃的食物種類很少有十五種以上”。其中，女性(76.6%、91.0%)比率顯著高於男性(68.0%、84.1%)。以多變項羅吉斯迴歸分析發現，低教育程度、低個人月收入、居住在鄉村區、PCS生理健康構面及MCS心理健康構面分數愈低，其“很少會依均衡飲食原則選擇食物”的風險較高。此外，年齡愈大、低教育程度、居住在鄉村區，其“一天吃的食物種類很少有十五種以上”的風險較高。進一步檢查城鄉與各個影響因素的交互作用，結果發現居住於鄉村區的高齡者，其本身的教育程度對於個人飲食行為的影響非常顯著。結論與建議：由以上結果可預見年齡愈大、教育程度愈低、個人月收入較低、居住在鄉村區、單身/獨居者等擁有較高營養不良風險的飲食行為，較需作為營養不良篩檢及介入的族群。居住於鄉村區的高齡者，其本身的教育程度對於個人飲食行為的影響非常顯著，建議可從營養教育著手，以提升高齡者健康飲食行為。[衛生福利部國民健康署委託辦理，惟報告內容不代表衛生福利部國民健康署意見]

關鍵字

高齡者 ； 食物可獲性 ； 飲食行為

並列摘要

Background and Objective: Aging is a process of gradual malnutrition. The prevalence of malnutrition among the elderly in Taiwan, approximately 1.7% for males and 2.4% for females, is increasing and likely to result in anemia, cognitive decline, and decrease in physical function, muscle mass, and bone mass. Insufficient nutrient intake directly increases the risk of death among the elderly. In addition, elderly people are at an increased risk of malnutrition because of their health conditions and physical functions. For example, difficulties in obtaining, cooking, and eating food can lead to malnutrition for the elderly in the long run. Therefore, the purpose of this study is to explore the association of dietary behaviors with demographic factors and food accessibility among elderly people in Taiwan. Methods: In this study, the NAHSIT (Nutrition and Health Survey in Taiwan) data during the period of 2005-2008 were used to investigate the changes in nutritional status of the elderly population (people aged 65 years and over) in Taiwan. A questionnaire was used to collect demographic variables of the elderly subjects, including gender, age, educational level, marital status, and house location (urban or rural area), and factors affecting the level of food availability, notably financial ability, dietary preparation capability, accessibility to social resources or support, and physiological and psychological competence. In the questionnaire for nutrition survey, only two questions are related to dietary behaviors: (1) Do you select food based on the principle of balanced diet (so as to ensure daily intake of the six major types of food)? and (2) Do you have over 15 kinds of food every day (excluding snack, confectionery and beverage)?. The two dietary behaviors are accordingly used as the dependent variables for logistic regression analysis. Results: A total of 1028 elderly people participated in this survey, with an average age of 73 years. In terms of normal dietary behaviors, as high as 72% of the elderly subjects ＂seldom select food based on the principle of balanced diet,＂ and 87% ＂rarely have more than 15 kinds of food a day＂ with the percentage of women (76.6%, 91.0%) significantly higher than that of men (68.0%, 84.1%). Logistic regression analysis showed that subjects with a lower level of education, lower monthly income, and living in rural areas tended to have poorer physical fitness and mental health as indicated by lower PCS (physical component score) and MCS (mental component score) respectively and were more likely to ＂seldom select food based on the principle of balanced diet.＂ Moreover, subjects who were older, less educated, and living in rural areas appeared to be at a higher risk of having less than 15 kinds of food a day. Further examination on the interaction between house location and other influencing factors found the level of education in the elderly subjects living in rural areas exerting a highly significant influence on their dietary behaviors; most of the less educated, rural area-dwelling elderly subjects ＂seldom select food based on the principle of balanced diet＂ and rarely have more than 15 kinds of food every day). There was, however, no obvious correlation between level of education and dietary behavior among the elderly subjects living in metropolitan areas. Conclusions and Recommendations: As indicated by the study results, elderly people with a lower level of education, lower monthly income, dwelling in rural areas, and living alone are more likely to practice dietary behaviors placing them at a higher risk of malnutrition and are therefore in greater need for screening and intervention. For elderly rural area dwellers whose level of education plays a crucial role in affecting dietary behaviors, nutrition education programs are recommended as a starter for promoting nutrition knowledge and practice of healthy dietary behaviors.

並列關鍵字

elderly ； food availability ； diet behavior