以「簡易營養評估台灣版」評量護理之家及日間照護失智老人之營養狀況及分析其預測因子

Usefulness of the Mini Nutritional Assessment-Taiwan version in grading the nutritional status of nursing home and day-care elderly with dementia

徐美娜(Mei-Na shiu)

指導教授 ： 蔡仲弘

亞洲大學/健康學院/長期照護研究所在職專班/碩士(2010年)

摘要

目的--本研究目的為在於以簡易營養評估台灣修訂版本評估居住於日間照護或於護理之家失智老人的營養狀況，及分析其營養風險的相關因素。
方法--本研究採立意取樣的方式，以中部某區域醫院附設護理之家60位失智住民及某區域級精神科醫院附設日間留院60位失智病人為研究對象。排除意識不清、嚴重語言或理解障礙者。研究方法以簡易營養評估台灣兩修訂版(Mini Nutritional Assessment, MNA-TI & MNA-TII)及體位測量與生化指標等評估個案的各種功能。以 SPSS12.0中文版統計軟體進行資料分析。以 Wilcoxon Signed-Rank test進行事後檢定，比較兩版本評估結果之差異性，史比爾曼相關(Spearman Correlation)分析兩種版本 MNA總分與各項健康指標之相關性，以多元複回歸分析營養不良之預測因子。
結果--護理之家原量表評定36人(60%)為營養不良，23人(38.3%)具營養風險，1人(1.7%)營養良好；台灣修訂一版23人(38.3%)為營養不良，36人(60%)具營養風險，1人(1.7%)營養良好。而修訂二則分別為35人(58.3%)、24人(40%)及1人(1.7%)。日間留院原量表評定3人(5%)為營養不良，30人(50%)具營養風險，27人(45%)營養良好；台灣修訂一版1人(1.7%)為營養不良，24人(40%)具營養風險，35人(58.3%)營養良好。而修訂二則分別為1人(1.7%)、23人(38.3%)及36人(60%)。相關分析顯示與 MNA總分最具相關之指標為MNA總分與個案之血紅素、血清白蛋白、膽固醇(p<0.05)。住院天數、急診次數、慢性疾病數之變項與MNA之總分呈現負相關，且達顯著意義(p<0.05)。線性複回歸分析顯示慢性疾病數、血清白蛋白為最能預測營養狀況之因子。
結論--本研究顯示簡易營養評估台灣修訂版可有效的判別護理之家或日間留院失智老人的營養風險。體重減輕、臂中圍、小腿圍、慢性疾病數及血清白蛋白為營養狀況的主要預測因子。此量表的使用有助於提昇照護品質及增進失智老人的健康。
關鍵詞：簡易營養評估量表，失智老人，營養評估，營養狀況，營養風險。

關鍵字

簡易營養評估量表，失智老人，營養評估，營養狀況，營養風險。 ； HASH(0xbcdb860) ； HASH(0xbcdb8d8)

並列摘要

Objective: The objective of this study was to assess the nutritional status of residents with dementia from a long-term care institutions or a day-care center in Central Taiwan and to identify the risk factors associated with poor nutrition in these patients.
Methods: With a convenience sampling design, the study recruited 60 eldelry persons with dementia from a long-term institution and another 60 patients with dementia from a local day-care center to serve as subjects. Subjects must be 65 years or older, medically confirmed having dementia, have been a resident of the institution or an attendant of the center for 30 days or more, be able to communicate verbally and without acute infection or hospitalization. A structured questionnaire elcited personal data, disease history and answers to questions in the Mini Nutritional Assessment (MNA). Subjects were also measured for weight, height, mid-arm circumference and calf circumference. Biochemical data were obtained from routine measurements maintained by the institutions. An institutional review board approved the study protocol. Writen consents were obtained from their legal guardians. Nutritional status of each subject was evaluated with two Taiwanese-specific versions of the MNA (TI and TII). Results were analyzed with SPSS 12.0 Statistical Software. Statistical significance was evaluated at alpha=0.05.
Results: Both versions of the MNA can grade the nutritional status of these dementiated patients effectively and produced very comparable results. All but one of the instutionalized patients were either malnourished or at risk of malnutrition whereas approximately 40% of day-care center attendants were either malnourished or at risk of malnutrition. Regresion analyses suggest that recent weight loss, anthropometric status and serum albumin were the major variables associated with the nutritional status of these patients. The nutritional status of the dementiated patients is related to the severity of the disease.
Conclusion: Results of this study suggest that the nutritional status of patients with dementia in the long-term care is very poor. Routine monitoring and timely intervention are important steps to reduce the development of nutritional deficiency in dementiated patients.

Keywords: Mini Nutritional Assessment (MNA); Nutritional assessment; Dementia; Nutritional status; Validation.

並列關鍵字

Mini Nutritional Assessment(MNA) ； Nutritional assessment ； Dementia ； Nutritional status ； Validation. ； AND

參考文獻

Tsai, A. C., Ku, P. Y., & Tsai, J. D. (2008). Population-specific anthropometric cutoff standards improve the functionality of the Mini Nutritional Assessment without BMI in institutionalized elderly in Taiwan. The Journal of Nutrition, Health and Aging (in the press).

Tsai, A. C., Ho, C. S., & Chang, M. C. (2007). Population-specific anthropometric cut-points improve the functionality of the Mini Nutritional Assessment (MNA) in elderly Taiwanese. Asia Pacific Journal of Clinical Nutrition, 16, 656-662.

戰臨茜、高森永、金惠民、李美璇 (2002)。北台灣社區與機構中老人的營養狀況及其預測因子。中華民國營養學會雜誌，27 (3)，147-158。

謝瀛華、鄭惠信，洪清霖(1998)。老人營養與日常生活功能、智力及憂鬱之相關探討。中華民國營養學會雜誌，27(1)，49-56。

Bonnefoy, M., Jauffret, M., Kostka, T., & Jusot, J. F. (2002). Usefulness of calf circumference measurement in assessing the nutritional state of hospitalized elderly people. Gerontology, 483 (3), 162-169.