利用貝氏量表評估台灣長期照護之男性老年居民的營養不良風險

Abstract

目的：營養不良是老年中常見的健康問題。在台灣，老年人必須在巴氏量表（BI）達到90分以上，才有資格申請入護理機構；但是，不需要有營養評估。本研究的目的是當老年人要求轉診護理機構時，是否可以以BI去評估營養狀況。方法：這是一個多中心的橫斷式研究。在2010年11月至2011年5月之間對台灣三個療養院的居民進行評估。其中包括251位年齡在70歲以上的個案。我們收集了個案的背景資料、BI評分、迷你營養評估以及調查牙齒健康和吞嚥能力的問卷。結果：平均年齡和BI評分分別為82.9（SD5.6）和88.8（SD21.7）。在研究樣本中，確定有營養不良風險的個案為123名（49.0％）。在預測營養不良的風險上，BI有高度的準確性（ROC曲線為79.1％）。較低的BI分數與較高的營養不良風險相關。所有BI項目中，爬樓梯項目與營養狀況之間的相關性最強（Cohen：0.90），其次是活動能力和輪椅到床的移動（ES：0.76）。結論：我們強調早期預防老年營養不良是相當重要。本研究顯示，BI可以協助初步評估營養狀況。  Objective: Malnutrition is a common health concern among the older population. In Taiwan, older adults are required to score 90 or higher on the Barthel Index (BI) to qualify for admission to public long-term care institutions; however, they are not ob-ligated to undergo nutritional assessments. This study demonstrated the utility of the BI in determining nutritional status when older adults are referred to public long-term institutions. Methods: In this multicentre cross-sectional study, 251 residents aged 70 years or older at three nursing homes in Taiwan were evaluated between November 2010 and May 2011. Information on participants’ health history was collected, in-cluding BI scores, Mini Nutritional Assessment results, and previous responses to a questionnaire on dental health and swallowing capacity. Results: The mean age and BI score were 82.9 (SD 5.6) and 88.8 (SD 21.7), respectively. Among the study sample, 123 (49.0%) participants were identified as having a risk of malnutrition. The BI had high accuracy (area under the receiver operating characteristic curve, 79.1%) when used to predict the risk of malnutrition. Lower BI scores were associated with a higher risk of malnutrition. Of all BI items, the stair-climbing item had the highest correlation with nutritional status (Cohen’s standardised effect size [ES]: 0.90), followed by mobility and chair–bed transfers (both ESs: 0.76). Conclusion: We emphasise that preventing worsening malnutrition in older long-term care residents is crucial. The present study revealed that the BI can help with the primary assessment of nutritional status in older adult men, although it cannot be a decisive tool by itself for nutritional status assessment.