老人營養風險指標在長期照護機構的運用

The Use of the Geriatric Nutritional Risk Index in Institutionalized Older Patients

莊富如(Fu-Ju Chuang)

指導教授 ： 胡雪萍 博士

臺北醫學大學/公共衛生暨營養學院/保健營養學研究所/碩士(2012年)

https://doi.org/10.6831/TMU.2012.00077

摘要

國內長期照護機構因營養師欠缺，全國將近8 萬五千床的機構老人，能由專業營養師介入評估的老人照護比例相對低，在專業人員不足且需求性大的狀況下，現階段尋求一個簡易的老人營養篩檢評估工具以輔助營養師作為營養照護順序的指標提升營養照護的效率及品質是迫切需要的。故針對長期照護機構臨床常見之營養評估工具血清白蛋白(Albumine, Alb) 、身體質量指數(body mass index, BMI)、體重下降比例及老人營養風險指標(Geriatric nutritional risk index, GNRI) ，來探討何者較適合用來評估此族群之營養狀況，以利營養師臨床之應用。共募集122 位來自北、中、南三家長期照護機構老人，發現GNRI 與Alb 相較於其他評估法在「正常組」及「營養不良危險組」中與住院天數具有顯著組間差異性並呈現負相關。以ROC curve 分析，GNRI 相較於Alb 及BMI 具有較高之效度。更進一步以GNRI 之四個層級進行比較，結果顯示GNRI 之層級差異與住民之體重、白蛋白及一、三及六個月的住院天數具有顯著差異，表示隨著GNRI 分數之上升，病患有較佳之營養狀況，且住院天數有下降的趨勢。故認為針對長期照護機構老人，GNRI 較能作為臨床營養評估工具，以輔助營養師臨床之應用。

關鍵字

長期照護機構、老人、營養評估、老人營養風險指標

並列摘要

The prevalence of malnutrition is very high in elder in Taiwan. This has been demonstrated in every healthcare setting and particularly in long-term care units. The problem of a limited number of dietitians in a long-term care, nutritional screening tools have become vitally important to identify those elders at nutritional risk from the elders in a large facility. We used albumin (Alb), body mass index (BMI), body weight change and Geriatric Nutritional Risk Index (GNRI) to set up an early assessment tool of nutrition status may help in monitoring elder. One hundred twenty- two elders completed this study who were from three long-term care units. GNRI and Alb has significant difference between “normal” and “at risk” groups and negative correlation with length of hospital day(LHS) than other methods. In validity, GNRI better than Alb and BMI can avoid to loss elders who were at risk. To identified the GNRI deeply, there are significant difference with albumin, body weight, hospital day in four levels. It confirmed as GNRI scores increased, could respond to nutrition status. In conclusion, Geriatric nutritional risk index (GNRI) is a good nutritional screen and predictive method in institutionalized resident elderly.

並列關鍵字

elder, long-term care, nutrition assessment, GNRI

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