The Relationship between Nutritional Status and Physical Function, Admission Frequency, Length of Hospital Stay, and Mortality in Old People Living in Long-Term Care Facilities

養護機構老人營養狀況與身體功能、住院次數、住院天數及死亡之相關性探討

10.1097/JNR.0b013e318254eac9

林欣潔(Sin-Jie Lin)；黃信彰(Shinn-Jang Hwang)；劉介宇(Chieh-Yu Liu)；林惠如(Hung-Ru Lin)

養護機構 ； 營養狀況 ； 住院次數 ； 住院天數 ； 死亡 ； long-term care facility ； nutritional status ； admission frequency ； hospital stay duration ； mortality

The Journal of Nursing Research

20卷2期（2012 / 06 / 01）

110 - 121

英文

背景 養護機構中，老人營養狀況的問題普遍存在，在台灣，長期照護機構老人營養不良比率高達20%。目的 本研究之目的為調查養護機構中老人營養狀況、身體功能、住院次數、住院天數、死亡情形及其相關性。方法 採回溯性研究設計和方便取樣方式收案174位，年齡為67歲－105歲（平均年齡：82.5歲），居住於台北市北投區合法立案之老人養護機構的住民，由病歷中查詢研究所需之基本人口學資料、過去一年的健康檢查抽血報告、體位測量、身體功能、住院次數、住院天數及死亡原因進行資料收集。研究對象自收案日期回溯入住養護機構達一年以上，含回溯入住一年當中已死亡之個案。結果 結果顯示，過去一年中，養護機構老人在身體功能狀況及小腿圍的變化較明顯，且身體功能狀況與小腿圍具有顯著相關。過去一年的住院狀況與管灌飲食有相關，而進食方式與小腿圍、白蛋白值、膽固醇值具有顯著相關。推論營養狀況中，小腿圍、白蛋白值、膽固醇值與過去一年住院狀況有間接相關。本研究中，年紀越大與管灌飲食的個案，越有住院發生的可能性，且管灌飲食的個案住院天數也較長。此外，小腿圍與血色素營養狀況不良個案與死亡有相關性。結論／實務應用 透過研究結果，建議機構需要更加重視養護機構老人營養狀態，以減少住院及死亡之情形發生，進而能減少其他相關的醫療費用，提昇照護品質。

Background: Nutrition is an important issue for elderly residents of long-term care facilities (LTCFs). About 20% of elderly LTCF residents in Taiwan are malnourished. Purpose: This study investigated correlations between nutritional status and physical function, admission frequency, hospital stay duration, and mortality in elderly LTCF residents. Methods: Researchers used a retrospective study design and convenient sampling to enroll 174 subjects aged 67 to 105 years (average, 82.5 years) who were living in legally registered LTCFs in Beitou District, Taipei City, Taiwan. A review of LTCF resident files provided data on subjects’ demographics, physical examination laboratory results for the most recent 1-year period, anthropometry, physical function, admission frequency, hospital stay duration, and causes of admissions. Subjects had lived in their LTCF for more than 1 year before their enrollment date. Subjects who died during and after the study period were also included in analysis. Results: Results showed significant changes over the study year in subjects’ nutritional status, physical function, and calf circumference. Physical function was found significantly correlated with calf circumference, hospitalization status was found correlated with nasal-gastric tube feeding status, and eating pattern was found correlated with calf circumference and levels of both serum albumin and cholesterol. Nutritional status, calf circumference, albumin level, and cholesterol level also correlated significantly with hospitalization status. In this study, the likelihood of hospitalization increased with age and nasal-gastric tube feeding use. Hospital stay duration for subjects receiving nasal-gastric tube feeding was longer than that for those receiving oral feeding. Also, weak nutritional status scores for calf circumference and hemoglobin levels were factors associated with increased mortality risk.Conclusions/Implications for Practice: Findings recommend that greater attention should be paid to the nutritional status of elderly persons living in LTCFs to reduce hospitalization and death risks, cut medical expenses, and improve quality of care.

1. Russell, C. A., & Elia, M. (2008). Nutrition screening survey in the UK in 2007. Retrieved from http://www.BritishAssociationofParenteralandEnteralNutrition.org.uk/pdfs/nsw/nsw07_eport.pdf
2. Department of Social Affairs, Ministry of the Interior. (2011). Resource distribution statistics for elderly welfare institutions in Taiwan. Retrieved from http://sowf.moi.gov.tw/04/07/07.htm ()
3. Department of Social Affairs, Ministry of the Interior. (2007). 2007 Evaluation indices: Elderly welfare organizations in Taiwan. Retrieved from http://sowf.moi.gov.tw/04/10.htm()
4. Atalay, B. G.,Yagmur, C.,Nursal, T. Z.,Atalay, H.,Noyan, T.(2008).Use of subjective global assessment and clinical outcomes in critically ill geriatric patients receiving nutrition support.Journal of Parenteral and Enteral Nutrition,32(4),454-459.
5. 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,48(3),162-169.
6. Carriere, I.,Dupuy, A. M.,Lacroux, A.,Cristol, J. P.,Delcourt, C.(2008).Biomarkers of inflammation and malnutrition associated with early death in healthy elderly people.Journal of American Geriatrics Society,56(5),840-846.
7. Chan, L. C.(2000)。Taipei City, Taiwan, ROC，National Defense Medical Center。
8. Chen, C. C.,Tang, S. T.,Wang, C.,Huang, G. H.(2009).Trajectory and determinants of nutritional health in older patients during and six-month post-hospitalisation.Journal of Clinical Nursing,18(23),3299-3307.
9. Chen, P. S.(2007)。Tainan City, Taiwan, ROC，Chia Nan University of Pharmacy and Science。
10. Chiu, Y. W.、Lin, W. Y.、Hsieh, P. C.、Li, C. I.、Chiou, C. H.(2005)。A survey to identify effective nutritional assessment indicators in long-term care facilities。Journal of Evidence-Based Nursing，1(2)，112-122。
11. Correia, M. I.,Waitzberg, D. L.(2003).The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis.Clinical nutrition,22(3),235-239.
12. Cress, M. E.,Schechman, K. B.,Mulrow, C. D.,Fiatarone, M. A.,Gerety, M. B.,Buchner, D. M.(1995).Relationship between physical performance and self-perceived physical function.Journal of the American Geriatrics Society,43(2),93-101.
13. Cuervo, M.,Ansorena, D.,García, A.,González Martínez, M. A.,Astiasarán, I.,Martínez, J. A.(2009).Assessment of calf circumference as an indicator of the risk for hyponutrition in the elderly.Nutrición hospitalaria: Organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,24(1),63-67.
14. Cuervo, M.,García, A.,Ansorena, D.,Sánchez-Villegas, A.,Martínez-González, M.,Astiasarán, I.,Martínez, J.(2009).Nutritional assessment interpretation on 22,007 Spanish community-dwelling elders through the Mini Nutritional Assessment Test.Public Health Nutrition,12(1),82-90.
15. Debette, S.,Leone, N.,Courbon, D.,Gariépy, J.,Tzourio, C.,Dartigues, J. F.,Zureik, M.(2008).Calf circumference is inversely associated with carotid plaques.Stroke: Journal of the American Heart Association,39,2958-2965.
16. Drame, M,Dia, P. A.,Jolly, D.,Lang, P. O.,Mahmoudi, R.,Schwebel, G.,Novella, J. L.(2009).Factors predictive of long-term mortality in patients aged 75 years or older hospitalized from the emergency department: The SAFES cohort.Presse Medicale,38(7-8),1068-1075.
17. Fontaine, J.,Raynaud-Simon, A.(2008).Pressure sores in geriatric medicine: The role of nutrition.Presse Médicale,37(7-8),1150-1157.
18. Guigoz, Y.,Lauque, S.,Vellas, B. J.(2002).Identifying the elderly at risk for malnutrition: The mini nutritional assessment.Clinics in Geriatric Medicine,18(4),737-757.
19. Harris, D. G.,Davies, C.,Ward, H.,Haboubi, N. Y.(2008).An observational study of screening for malnutrition in elderly people living if sheltered accommodation.Journal of Human Nutrition and Dietetics,21,3-9.
20. Huang, S. H.、Chen, P. R.、Chang, C. J.、Lai, H. S.、Cheng, C. P.、Liu, H. Y.、Yang, R. S.(2005)。The effects of nutritional status and gastrointestinal complications on the nutrient intake among the inpatients with tube feeding。Formosan Journal of Medicine，9(4)，467-474。
21. Kaur, S.,Miller, M. D.,Halbert, J.,Giles, L. C.,Crotty, M.(2008).Nutritional status of adults participating in ambulatory rehabilitation.Asia Pacific Journal of Clinical Nutrition,17(2),199-207.
22. Keller, H. H.,Ostbye, T.(2003).Nutritional risk and time to death; predictive validity of SCREEN (Seniors in the Community Risk Evaluation for Eating and Nutrition).The Journal of Nutrition, Health & Aging,7(4),274-279.
23. Keller, H. H.,Ostbye, T.,Goy, R.(2004).Nutritional risk predicts quality of life in elderly community-living Canadians.Journals of Gerontology Series A-Biological Sciences & Medical Sciences,59(1),68-74.
24. Kikafunda, J. K.,Lukwago, F. B.(2005).Nutritional status and functional ability of the elderly aged 60 to 90 years in the Mpigi District of central Uganda.Nutrition,21(1),59-66.
25. Kvamme, J. -M.,Gronli, O.,Florholmen, J.,Jacobsen, B. K.(2011).Risk of malnutrition is associated with mental health symptoms in community living elderly men and women: the Tromso study.BMC Psychiatry,11(112),1-8.
26. Lai, M. J.(2007)。Taichung City, Taiwan, ROC，Asia University。
27. Metheny, N. A.(2006).Preventing respiratory complications of tube feedings: Evidence-based practice.American Journal of Critical Care,15(4),360-369.
28. Metheny, N. A.,Stewart, B. J.,McClave, S. A.(2011).Relationship between feeding tube site and respiratory outcomes.Journal of Parenteral and Enteral Nutrition,35(3),346-355.
29. Minosso, J. S. M.,Amendola, F.,Alvarenga, M. R. M.,Oliverira, M. A. C.(2010).Validation of the Barthel index in elderly patients attended in outpatient clinics, in Brazil.ActaPaul Enferm,23(2),218-223.
30. Omran, M. L.,Morley, J. E.(2000).Assessment of protein energy malnutrition in older persons, part I: History, examination, body composition, and screening tools.Nutrition,16(1),50-63.
31. Ostir, G. V.,Markides, K. S.,Black, S. A.,Goodwin, J. S.(1998).Lower body functioning as a predictor of subsequent disability among older Mexican Americans.The Journal of gerontology. Series A, Biological sciences and medical sciences,53(6),M491-M495.
32. Portero-Mclellan, K. C.,Staudt, C.,Silva, F. R.,Delbue Bernardi, J. L.,Baston Frenhani, P.,Leandro Mehri, V. A.(2010).The use of calf circumference measurement as an anthropometric tool to monitor nutritional status in elderly inpatients.Journal of Nutrition, Health & Aging,14(4),266-270.
33. Seiler, W. O.(2001).Clinical pictures of malnutrition in III elderly subjects.Nutrition,17(6),496-498.
34. Shyu, Y. I.、Hsiung, P. C.、Dai, Y. T.、Chen, Y. C.、Huang, J. M.(1993)。Characteristics of Residents in long-term care facilities。The Journal of Nursing Research，1(1)，7-15。
35. Singh, I.,Bhaldraithe, S. D.,Bondin, D,Goorah, N.(2010).Nutrition in the elderly: Abasic standard of care and dignity for older people.British Journal of Hospital Medicine,71(1),1-3.
36. Sorensen, J.,Kondrup, J.,Prokopowicz, J.,Schiesser, M.,Krähenbühl, L.,Meier, R.,EuroOOPS Study(2008).EuroOOPS: An international, multicentre study to implement nutritional risk screening and evaluate clinical outcome.Clinical Nutrition,27(3),340-349.
37. Stechmiller, J. K.(2003).Early nutritional screening of older adults: Review of nutritional support.Journal of Infusion Nursing,26(3),170-177.
38. Stratton, R. J.,Elia, M.(2006).Deprivation linked to malnutrition risk and mortality in hospital.The British Journal of Nutrition,96(5),870-876.
39. Su, S. F.(2005)。Kaohsiung City, Taiwan, ROC.，Kaohsiung Medical University。
40. Suominen, M. H.,Sandelin, E.,Soini, H.,Pitkala, K. H.(2009).How well do nurses recognize malnutrition in elderly patients?.European Journal of Clinical Nutrition,63(2),292-296.
41. Taiwan Association of Long-Term Care Professionals(2003)。Survey of the distribution of institutional care supply and demand for disable elderly in the year 2002 in Taiwan。The Journal of Long Term Care，7(6)，181-181。
42. Ulijaszek, S. J.,Kerr, D. A.(1999).Anthropometric measurement error and the assessment of nutritional status.British Journal of Nutrition,82(3),165-177.
43. Verbrugge, L. M.,Jette, A. M.(1994).The disablement process.Social Science and Medicine,38(1),1-14.
44. Visvanathan, R.,Penhall, R.,Chapman, I.(2004).Nutritional screening of older people in a sub-acute care facility in Australia and its relation to discharge outcomes.Age and Ageing,33(3),260-265.
45. Volkert, D.,Pauly, L.,Stehle, P.,Sieber, C. C.(2011).Prevalence of malnutrition in orally and tube-fed elderly nursing home residents in Germany and its relation to health complaints and dietary intake.Gastroenterology Research and Practice,2011(247315),1-9.
46. Wang, S. C.(ed.)(2000).Gerontological nursing.Taipei City, Taiwan, ROC:Farseeing.
47. Wijnhoven, H. A. H.,Bokhorst-de van der Schueren, M. A. E.,Wijnhoven, H. A. H.,Bokhorst-de van der Schueren, M. A. E.,Visser, M.(2010).Low mid-upper arm circumference, calfcircumference, and body mass index and mortality in older persons.The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences,65(10),1107-1114.
48. Yang, S. H.(2004)。Taipei City, Taiwan, ROC.，Nursing and Health Science, National Taipei University。

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