台北市某區域醫院居家醫療個案之營養狀況調查

Nutritional Status among Taipei City Residents Receiving Home Care Service from the Municipal Hospital System

林宜芬(Yi-Fen Lin) ； 許瑩瑩(Ying-Ying Hsu) ； 陳珮蓉(Pey-Rong Chen) ； 李光申(Kuang-Sheng Lee) ； 翁林仲(Lin-Chung Woung) ； 黃勝堅(Sheng-Jean Huang)

《台灣老年醫學暨老年學會雜誌》 13卷4期 (2018/11) Pp. 224-235

https://doi.org/10.29461/TGGa.201811_13(4).0002

摘要

目的：本研究目的為探討居家個案的營養現況，了解營養照護對於居家個案之重要性，以作為未來居家營養照護之參考。方法：本研究設計採橫斷性研究，納入符合居家整合醫療試辦計畫的個案共60名，年齡20〜90歲間。由營養師以迷你營養評估（Mini nutritional assessment, MNA）量表及營養照護紀錄表單做評估，並以24小時飲食回憶法評估每日熱量及蛋白質攝取量。結果：個案平均年齡75.8±11.7歲，營養不良者有23人（38.3%）、具營養不良風險者有32人（53.3%）、無營養不良者有5人（8.3%）。依營養不良程度分組，各組間行動能力、管灌飲食使用與否、進食能力、平時食物準備來源對象的比例有顯著差異。經迴歸分析，使用管灌飲食與否為主要影響營養不良風險的因素，管灌飲食者的營養不良風險約為完全經口飲食者4.0倍（95%信賴區間：1.0－15.8）。結論：居家灌食個案營養不良風險顯著較高，營養對於居家長期照顧個案是重要環節之一，營養師應在醫療團隊間提供居家長期照顧個案的營養監控與照護。

關鍵字

居家整合醫療 ； 營養不良 ； 居家營養師 ； 居家灌食

並列摘要

Objectives: This study aimed to obtain insights about improving the quality of home-based nutrition care by exploring the current nutritional status of the subjects, Taipei City residents receiving home care services from a member in the municipal hospital system. Methods: The study adopted a cross sectional design and enrolled 60 subjects aged between 20 to 90 years old and meeting the inclusion criteria of the Pilot Program for Home-based Integrated Medical Care. The nutritional status of each subject was determined by the Mini Nutritional Assessment (MNA) and nutrition care record. Daily calories and protein intakes were assessed using the 24-hour dietary recall. Results: The average age of the subjects was 75.8±11.7 years. Twenty-three subjects were malnutrition cases (38.3%), 32 subjects were at risk of malnutrition (53.3%), and 5 subjects (8.3%) were normal. Variables related to malnutrition were mobility, tube feeding, swallowing ability, eating ability, and food preparations and sources. Further regression analysis showed that the odds ratio (OR) of malnutrition between the tube-feeding group and the oral-feeding group was 4.0 [95% confidence interval (CI), 1.0-15.8]. Conclusions: Patients requiring tube feeding at home were at higher risk of malnutrition, indicating the need of additional attention for potential nutritional problems. Nutrition is one of the major links in home-based long-term care. Dietitian should work closely with the medical teams to monitor and manage on a regular basis the nutritional status of home care service recipients.

並列關鍵字

home care ； malnutrition ； dietitian ； tube feeding