榮民護理之家住民之營養狀況及日常生活功能評估

Assessment of nutritional status and activities of daily living of VA nursing home residents

賴明珍(Lai Men Jane)

指導教授 ： 蔡仲弘

亞洲大學/健康學院/長期照護研究所/碩士(2008年)

摘要

本研究為了解榮民護理之家老年榮民的營養狀況並分析食慾、憂鬱、日常生活功能及健康狀況與營養狀況的關聯性。以立意取樣訪談某榮民護理之家160名男性住民，並以其例行年度健檢資料進行分析。住民平均體重56.8 ± 9.0公斤，BMI 21.5 ± 3.4 kg/m2。依簡易營養評估(Mini Nutritional Assessment, MNA) 23人(14.4%)營養不良，103人(64.4%)有營養不良風險；依憂鬱量表(Geriatric Depression Scale, GDS)受測者136人中，97人(71.3%)有憂鬱傾向；依ADL, 73人(45.6%)完全依賴，57人(35.6%)中重度依賴，30人(18.8%)輕度依賴；依食慾量表(Council on Nutrition Appetite Questionnaire, CNAQ), 86人(53.8%)食慾不好。五成三住民(84人)很少或沒有規律運動習慣；20.0%罹患一種慢性病，49.4%二種或以上；130人(81.2.%)使用一種以上處方藥物；72人(45.0%)最近六個月曾住院；血清白蛋白平圴為3.6 ± 0.6 g/dL, 35.6%過低(<3.5 mg/dL)。MNA評估結果顯示10-20%營養不良、55-65%具營養風險、只有21-26%營養良好。依相關分析，台灣修訂二版之判別功能良好比原量表或修訂一更好。台灣修訂二版不須運用任何介入性指標也不須BMI，使用將更為簡易，它可以取代原量表，是為一大改進。榮民護理之家住民日常生活功能依賴程度愈高者，營養風險愈高；自評食慾不好者，營養風險也愈高。小腿圍為營養狀況最主要的預測因子。本研究結果顯示榮民護理之家住民高達80%營養不良或具風險。具族群體位指標特性的修訂一及去除BMI題的修訂二、均比原量表功能更好。MNA修訂二在臨床上能使醫護同仁及照顧人員更方便準確的判別營養不良或具風險的護理之家老人。定期評估與及時的介入將可有效提升榮民的生活品質及節省醫療照護開支。

關鍵字

榮民 ； 護理之家 ； 營養評估

並列摘要

Background: Veterans account for approximately one-third of the elderly population in Taiwan. Most of these veterans came to Taiwan with the central government in late 1940s and have served in the armed forces since then. Their lives are different from most civilian citizens and they have special health problems.
Objective: The study was to gain an understanding of the nutritional status of the veterans and to identify the factors important in determining their nutritional status.
Methods: Using purposive sampling, the study recruited 160 of the 350 male veterans in a nursing home managed by a VA hospital in central Taiwan as study subjects. Only those who were cognitively functional and without acute disease/infection were allowed to participate. Each subject was interviewed with a structured questionnaire for personal data, health status and answers to the MNA (Mini Nutritional Assessment), GDS (Geriatric depression scale), CNAQ (Council on Nutrition Appetite Questionnaire) and ADL (Activities of Daily Living), and was measured for anthropometric parameters. Subjects bio-barkers were obtained from their routine measurements carried out at the institution. Their nutritional statuses were graded with three versions of the MNA: the original, MNA-TI which adopted population-specific anthropometric cut-points, and MNA-TII which further had the BMI question in the scale removed and its scores reassigned. All subjects signed a written consent and the IRB of the Hospital approved the study protocol.
Results: The average age was 81 years. The original MNA graded 14.4% malnourished, 64.4% at risk and 21.3% normal; the MNA-TI graded 10.6, 63.8 and 25.6%; and the MNA-TII graded 19.4, 54.4 and 26.3%, respectively. Analysis of these results with Frieman test and Wilcoxon multiple-rank test showed significantly differences among the results of all three versions. However, when malnourished and at risk proportions were combined, only the original MNA was different from the two revised versions. Results also showed that 71.3% of veterans had the tendency to have depression, over 80% had moderate to dependency in ADL, and 54% had poor appetite. The MNA scores of all three versions were highly correlated with hemoglobin, serum albumin, ADL scores, CNAQ scores, MAC, CC, BMI, hospital length of stay, and number of emergency visits, but not with number of chronic diseases and number of prescribed drugs. With the exception of BMI, all parameters showed the strongest correlations with the scores of MNA-TII than of the original scale or MNA-TI. Regression analysis showed that only MAC, CC and albumin were parameters significantly associated with the MNA scores.
Conclusion: Results of this study suggest that a relatively high proportion of veteran residents are at risk of malnutrition and high proportions of these residents also have impaired ADL, psychological problems and poor appetite. The MNA, especially MNA-TII can grade the nutritional status of the veterans effectively. Calf circumference is the leading factors associated with the nutritional status. These results suggest that the MNA can be used for routine screening for individuals with emerging nutritional problems and routine exercise is important for maintaining good nutrition and health.
Keywords: Veterans, nutritional status, Nutritional assessment, calf circumference, elderly.

並列關鍵字

Veterans ； nursing home ； MNA

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