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題名：「依需介入」可有效改善護理機構老人營養狀況及身體活動功能
作者：李麗琴
作者(外文)：LEE Li-Chin
校院名稱：亞洲大學
系所名稱：健康產業管理學系健康管理組
指導教授：蔡仲弘
學位類別：博士
出版日期：2013
主題關鍵詞：介入成效；營養不良；護理機構老人；營養評估；營養介入；營養狀況；身體活動功能；Effectiveness；Malnutrition；Nursing home elderly；Nutritional assessment；Nutritional intervention；Nutritional status；Physical functional status
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背景：營養是維持身體健康的重要因素，但老人營養不足相當普遍又常不被察覺。定期評估可以早期發現營養不良者，且有利及時介入，以有效改善老人的營養狀況。
目的：本研究目的在探討「依需介入」模式對改善機構老人的營養及身體活動功能的成效。
方法：本研究以隨機對照試驗探討「依需介入」模式的成效。選擇護理之家≥65歲，意識清楚，BMI ≤25 kg/m2之住民為對象，並依據性別及有無接受復健治療隨機分配為介入組及對照組。定期每4週進行營養評估，介入組個案若被評定為MNA ≤24分且BMI ≤24 kg/m2者則及時地接受大豆蛋白營養代餐(50 g約供應9.5 g蛋白質，250大卡)。介入時間為24週。於基準點、12及24週各測定個案的營養狀況 (身體體位及血液生化指標值)及身體活動功能(手握力及巴氏量表分數)。以獨立樣本t檢定比較兩組在營養介入後之成效，並以成對樣本t檢定分析各組在營養介入的前後其組內差異，並以概似估計方程式 (Generalized estimating equation, GEE)分析營養介入後在不同測量階段對老人營養與身體活動功能的介入成效。
結果: 「依需介入」顯著的改善體重、BMI、臂中圍、小腿圍、血清白蛋白、血清總膽固醇、手握力及日常活動功能(都p<0.05)。介入後第4週體重、BMI、臂中圍及小腿圍呈現顯著改善並維持至第24週；第12週開始血清白蛋白、血清總膽固醇及手握力顯現介入成效且維持至第24週；第24週時日常活動功能才呈現顯著成效；介入措施對血球比容、血色素及總淋巴球則無顯著改變(p>0.05)。
結論：「依需介入」是改善護理機構老人營養狀況的有效策略。以個案營養需求為主之研究設計及補充以大豆蛋白營養代餐可以明顯改善機構老人的營養指標及身體活動功能。「依需介入」可以做為未來増進機構老人健康及身體活動功能的基礎模式。此模式應適用於一般社區老人的健康促進，更有效運用老人照護資源。
Background: Nutrition is an important element in geriatric health. Protein-energy malnutrition is common in institutionalized elderly. Routine screening is key for early identification of the elderly at risk of malnutrition.
Objective: This study examined the effectiveness of a “need-based nutritional intervention” strategy for improving the nutritional and physical functional status of nursing home elderly.
Methods: We conducted a prospective randomized, controlled interventional trial with 92 non-bed-ridden elderly (≥65 y, BMI ≤25 kg/m2) recruited from a nursing home in central Taiwan. Subjects were randomly assigned to either the control or the intervention group by gender. Each subject in the intervention group would receive a 50 g/day soy protein-based nutritional supplement containing 9.5 g protein, 250 kcal energy and all essential micro-nutrients if his/her MNA (Mini Nutritional Assessment) score was ≤24 and BMI ≤24 kg/m2. The supplementation would be suspended if either condition was not met. All subjects were measured for nutritional status with the MNA at baseline and every 4 weeks during the study period, and for serum biochemical indicators and physical functional status (Barthel’s index and handgrip strength) at 0, 12 and 24 weeks. Intervention effects were analyzed with the Generalized Estimating Equations (GEE).
Results: The "need-based nutritional intervention" significantly improved weight, BMI, mid-arm and calf circumferences, serum albumin and cholesterol concentrations, handgrip strength and Barthel’s index according to GEE (all p<0.05) adjusted for sociodemographic, and health- and nutrition-related variables. However, the intervention did not improve hemoglobin, hemotocrit or total lymphocyte count.
Conclusions: Results clearly indicate that the "need-based nutritional intervention" is an effective and practical strategy for improving the nutritional and physical functional status of the nursing home elderly. The possible application of the strategy in the general population deserves further investigation.
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