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系統識別號 U0026-1502201522523000
論文名稱(中文) 老年病人住院期間營養不良風險提高 之相關因素研究
論文名稱(英文) Factors for Increasing Risk of Malnutrition in Older Adults during Hospitalization
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 103
學期 1
出版年 104
研究生(中文) 邱予妡
研究生(英文) Yu-Hsin Chiu
學號 TC6011060
學位類別 碩士
語文別 中文
論文頁數 86頁
口試委員 指導教授-盧豐華
共同指導教授-郭素娥
口試委員-張家銘
中文關鍵字 住院  老年病人  營養不良風險  MUST營養不良篩檢工具 
英文關鍵字 Hospitalization  the elderly patients  the risk of malnutrition  Malnutrition Universal Screening Tool. 
學科別分類
中文摘要 住院老人營養攝取不足或失衡問題,在國內外皆相當普遍。過去30年在美國和英國進行的研究發現,約有20-50%住院患者,因醫療過程和接受手術而有營養風險提高跡象。加上老人有生理老化問題,也會造成對熱量需求下降及食物攝取減少,因而增加營養不良的風險。病人於住院期發生的營養不良風險提高現象,大部分並未受到應有的重視。目前各醫院雖有營養篩檢評估,但對營養不良風險提高之敏感度仍有不足,可能的原因在於醫院人力不足以及成本問題;另目前大部分研究的研究對象,都只偏重在外科手術或癌症病人,但住院病人是以非手術及非癌症的內科老年患者佔多數,且有許多具中高度營養不良風險,更需要被重視並提早預防,因此本研究的目的在於探討造成內科非癌症住院老年病人營養風險提高的相關因素。
本研究為利用病歷回溯之個案對照研究,使用2012年在臺灣南部某醫學中心內科病房住院,且曾接受過兩次以上營養不良通用篩檢工具(Malnutrition Universal Screening Tool, MUST)篩檢之65歲以上住院老年病人為研究族群,經挑選無風險提高與風險提高兩組各100位。風險提高組之定義為第2次篩檢分數減第1次篩檢分數等於或大於2分者;無風險提高組則為兩次篩檢分數皆為0分者,兩組間是以年齡、性別、及病房別進行配對。最後使用SPSS 17.0版統計套裝軟體進行描述性及分析性統計分析。
研究結果發現,在社會人口學變項中住院天數超過16天以上(OR:1.7, 95%CI: 1.1-2.5)、生活型態-機構住民(OR:1.7, 95%CI: 1.0-30.3)為住院期間營養不良風險提高之顯著預測因子,在主訴變項中食慾不振(OR: 75.3, 95% CI: 14.9-380.8)、喘(OR: 7.5, 95% CI: 1.6-34.5)、及腹瀉(OR: 42.0, 95% CI: 8.6-205.7)為營養不良風險提高之顯著預測因子。在疾病變項中消化道出血(OR: 6.4, 95% CI: 2.6-16.0)、敗血症(OR: 6.1, 95% CI: 1.7-21.8)、鬱血性心衰竭(OR: 5.2, 95% CI: 1.2-23.0)、貧血(OR: 4.9, 95% CI: 2.0-11.6)、氣喘(OR: 6.9, 95% CI: 1.3-36.8)為營養不良風險提高之顯著預測因子。在過去病史變項中憂鬱症(OR: 9.6, 95%CI: 2.3-38.9) 為營養不良風險提高之顯著預測因子,在生理健康變項中進食量吃介於全部與1/2量(OR: 6.9, 95% CI: 2.6-18.2)、咀嚼困難(OR: 6.7, 95% CI: 2.4-19.1)、吞嚥困難(OR: 6.1, 95% CI: 2.0-18.5)、腹脹(OR: 7.3, 95% CI: 2.2-23.9)為營養不良風險提高之顯著預測因子。在影響營養代謝或食慾之相關藥物變項中,使用之藥物總數(OR: 2.4, 95% CI: 1.5-3.5),使用輕瀉劑Bisacodyl (OR: 41.0, 95% CI: 5.2-323.1)、使用糖尿病藥物Metformin (OR: 2.2, 95% CI: 1.5-9.4)為營養不良風險提高之顯著預測因子。
本研究結果發現照護住院病人過程所收集的各類病史資料之營養不良風險提高預測因素,希望藉此可提高醫護人員在評估住院病人營養狀況時的敏銳度及準確性,達到減少住院期間營養不良風險提高的問題。
英文摘要 Summary
This is a case control study by using chart audit to collect data, to investigate factors for increasing risk of malnutrition in older adults during hospitalization. Those over 65 years old patients admitted to wards of the Department of Internal Medicine in a medical center in southern Taiwan in 2012 and received more than two screenings by using Malnutrition Universal Screening were enrolled. Our study found malnutrition risk during hospitalization from patient’s charts, hoping to improve the sensitivity and accuracy of the medical staffs in assessing patients’ nutritional status, to reduce malnutrition in hospitalization .
論文目次 一、緒論 1
第一節 研究背景 1
第二節 研究重要性 2
第三節 研究目的 3
二、文獻回顧 4
第一節 營養對老人之重要性與影響 4
第二節 導致老人營養不良之原因 8
第三節 住院老年病人之營養不良風險提高因素 13
第四節 營養不良篩檢與評估之區別 20
第五節 常用營養篩檢方法介紹 22
第六節 常用營養評估工具介紹 25
第七節 研究問題 28
三、研究方法 29
第一節 研究架構與設計 29
第二節 研究對象與地點 29
第三節 研究工具 30
第四節 研究進行步驟 38
第五節 資料處理與分析 42
四、結果 43
第一節 研究對象社會人口學變項之分析 43
第二節 研究對象之臨床特徵分析 43
第三節 研究對象生理健康因素分析 51
第四節 研究對象使用影響營養素相關之藥物分析 54
第五節 研究對象心理因素分析 55
第六節 住院期間營養不良風險提高相關預測因子 之邏輯斯複迴歸分析 56
五、討論 61
第一節 社會人口學因素 61
第二節 疾病因素 62
第三節 生理健康因素 66
第四節 藥物因素 69
第五節 心理因素 71
第六節 結論 71
六、研究限制 72
七、參考文獻 73
附錄一 老年病人住院期間營養不良風險提高之相關因素病歷蒐集表 81
附錄二、國立成功大學人體試驗委員會(IRB)同意書 86
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