跨領域團隊合作照護計畫對於肌少症前期之老年人的成效探討：前驅研究

The Effect of an Intervention Program and Multidisciplinary Care on Pre-Sarcopenia in the Elderly: A Preliminary Study

陳怡伶(Yi-Lin Chen)；楊琇淳(Siou-Chun Yang)；周世逢(Shih-Feng Chou)；林文豪(Wen-Hao Lin)；陳芳婷(Fang-Tung Chen)；田慧勳(Hui-Hsun Tien)

肌少症 ； 老年人 ； 營養 ； 運動訓練 ； 跨領域團隊合作照護 ； Sarcopenia ； Older adult ； Nutrition ； Exercise training ； Interprofessional practice

醫學與健康期刊

10卷1期（2021 / 03 / 01）

35 - 46

繁體中文

目的：隨著老化的發生和肌肉質量的流失所造成的肌少症影響老年族群的失能狀況。本研究目的透過跨領域團隊合作，針對肌少症前期之老年人設計結合營養衛教和運動訓練的課程，以期達到預防及延緩肌少症的發生。方法：採單一組別前後測驗，納入65歲以上肌少症前期之老年人參與由跨領域團隊所設計的課程，每周1堂2小時共12堂，課程內容包含營養攝取、肌少症衛教與運動訓練。統計分析以魏克森符號等級檢定法比較課程前後之步行速度、肌握力、30秒坐到站檢測、肌肉量、迷你營養評估量表及自編問卷。結果：21位老年人參與12周課程並進入統計分析。自編問卷顯示在介入後100%皆願意且有信心每週運動3至5次、每日均衡飲食及使用彈力帶運動；而在步行速度（p＜0.01）和迷你營養評估量表總分（p＜0.01）達顯著提升；肌握力、30秒坐到站和肌肉量雖未達顯著，介入後之得分均較前測進步。結論：本研究發現12周的介入課程可顯著提升肌少症前期之老年人的步行速度及降低營養不良的風險。

Objectives. Sarcopenia is an age-related loss of skeletal muscle mass with progressive decline in muscle strength leading to dysfunction and poor quality of life. Therefore, it is important to prevent or delay its development and progression. The aims of this study was to develop a program combining nutrition and exercise training for older adults with pre-sarcopenia to postpone the progression of disability and improve the physical function. Methods. This study was a one-group pretest-posttest design. We enrolled subjects older than 65 years old with pre-sarcopenia to participate in this program which included nutrition counseling, exercise training and health education offered by an multidisciplinary team one session per week two hours per session for twelve weeks. Outcome was assessed by comparing pre- and post-intervention walking speed, grip strength, the 30-Second Chair Stand Test, muscle mass, Mini Nutritional Assessment and self-administered questionnaire. Results were analyzed by Wilcoxon Signed-Rank test. Results. The self-administered questionnaire showed all the subjects were willing and confident that they could perform the exercises 3-5 times per week, keep balance diet and able to use elastic bands. We found significant improvement in walking speed (p＜0.01) and Mini Nutritional Assessment scores (p＜0.01). Grip strength, the 30-Second Chair Stand Test and muscle mass were improved, but not significantly. Conclusion. This 12-weeks program involving nutrition and exercise training can improve walking speed and decrease risk of malnutrition in older adults with pre-sarcopenia.

1. 李雅萍, YP,蔡兆勳, JS,陳慶餘, CY(2016)。肌少症簡介。長期照護雜誌，20，105-114。
   連結：
2. 張瀞文, CW,唐慧媛, HY,許哲豪, JH(2017)。老年肌少症（Sarcopenia）之診斷與檢測。文化體育學刊，87-97。
   連結：
3. 歐陽鍾美, CM(2016)。老人肌少症之營養防治與照護。長期照護雜誌，20，137-147。
   連結：
4. 簡盟月, MY,何靖雯, CW(2016)。運動訓練對肌少症的治療成效。長期照護雜誌，20，125-136。
   連結：
5. Bales, CW,Ritchie, CS(2002).Sarcopenia, weight loss, and nutritional frailty in the elderly.Annu Rev Nutr,22,309-323.
6. Bauer, J,Biolo, G,Cederholm, T(2013).Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group.J Am Med Dir Assoc,14,542-559.
7. Beckwée, D,Delaere, A,Aelbrecht, S(2019).Exercise interventions for the prevention and treatment of sarcopenia. A systematic umbrella review.J Nutr Health Aging,23,494-502.
8. Burton, LA,Sumukadas, D(2010).Optimal management of sarcopenia.Clin Interv Aging,5,217-228.
9. Cermak, NM,Res, PT,de Groot, LC,Saris, WH,Van Loon, LJ(2012).Protein supplementation augments the adaptive response of skeletal muscle to resistance-type exercise training: a meta-analysis.Am J Clin Nutr,96,1454-1464.
10. Chen, LK,Liu, LK,Woo, J(2014).Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia.J Am Med Dir Assoc,15,95-101.
11. Damanti, S,Azzolino, D,Roncaglione, C,Arosio, B,Rossi, P,Cesari, M(2019).Efficacy of nutritional interventions as standalone or synergistic treatments with exercise for the management of sarcopenia.Nutrients,11,E1991.
12. Fielding, RA,Vellas, B,Evans, WJ(2011).Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia.J Am Med Dir Assoc,12,249-256.
13. Gazzotti, C,Albert, A,Pepinster, A,Petermans, J(2000).Clinical usefulness of the mini nutritional assessment (MNA) scale in geriatric medicine.J Nutr Health Aging,4,176-181.
14. Hanach, NI,McCullough, F,Avery, A(2019).The impact of dairy protein intake on muscle mass, muscle strength, and physical performance in middle-aged to older adults with or without existing sarcopenia: A systematic review and meta-analysis.Adv Nutr,10,59-69.
15. Hughes, VA,Roubenoff, R,Wood, M,Frontera, WR,Evans, WJ,Fiatarone Singh, M(2004).Anthropometric assessment of 10-y changes in body composition in the elderly.Am J Clin Nutr,80,475-482.
16. Janssen, I,Heymsfield, SB,Ross, R(2002).Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability.J Am Geriatr Soc,50,889-896.
17. Jones, CJ,Rikli, RE,Beam, WC(1999).A 30-s chair-stand test as a measure of lower body strength in community-residing older adults.Res Q Exerc Sport,70,113-119.
18. Kanamori, S,Takamiya, T,Inoue, S(2015).Group exercise for adults and elderly: determinants of participation in group exercise and its associations with health outcome.J Phys Fitness Sports Med,4,315-320.
19. Lang, PO,Michel, JP,Zekry, D(2009).Frailty syndrome: A transitional state in a dynamic process.Gerontology,55,539-549.
20. Lesinski, M,Hortobágyi, T,Muehlbauer, T,Gollhofer, A,Granacher, U(2015).Effects of balance training on balance performance in healthy older adults: a systematic review and meta-analysis.Sports Med,45,1721-1738.
21. Liao, CD,Chen, HC,Huang, SW,Liou, TH(2019).The role of muscle mass gain following protein supplementation plus exercise therapy in older adults with sarcopenia and frailty risks: A systematic review and meta-regression analysis of randomized trials.Nutrients,11,E1713.
22. Liao, WC,Wang, CH,Yu, SY,Chen, LY,Wang, CY(2014).Grip strength measurement in older adults in Taiwan: a comparison of three testing positions.Australas J Ageing,33,278-282.
23. Liu, CJ,Chang, WP,Araujo de Carvalho, I,Savage, KEL,Radford, LW,Amuthavalli Thiyagarajan, J(2017).Effects of physical exercise in older adults with reduced physical capacity: meta-analysis of resistance exercise and multimodal exercise.Int J Rehabil Res,40,303-314.
24. Liu, CJ,Latham, NK(2009).Progressive resistance strength training for improving physical function in older adults.Cochrane Database Systematic Rev,8,CD002759.
25. Mehra, S,Dadema, T,Kröse, BJ(2016).Attitudes of older adults in a group-based exercise program toward a blended intervention; A focus-group study.Front Psychol,7,1827.
26. Naseeb, MA,Volpe, SL(2017).Protein and exercise in the prevention of sarcopenia and aging.Nutr Res,40,1-20.
27. Rosenberg, IH(1997).Sarcopenia: origins and clinical relevance.J Nutr,127,990S-991S.
28. Seo, JA,Cho, H,Eun, CR(2012).Association between visceral obesity and sarcopenia and vitamin D deficiency in older Koreans: the Ansan Geriatric Study.J Am Geriatr Soc,60,700-706.
29. Sipilä, S,Suominen, H(1995).Effects of strength and endurance training on thigh and leg muscle mass and composition in elderly women.J Appl Physiol,78,334-340.
30. Ter Borg, S,de Groot, LC,Mijnarends, DM(2016).Differences in nutrient intake and biochemical nutrient status between sarcopenic and nonsarcopenic older adults-results from the Maastricht Sarcopenia Study.J Am Med Dir Assoc,17,393-401.
31. Van Abbema, R,De Greef, M,Crajé, C,Krijnen, W,Hobbelen, H,Van Der Schans, C(2015).What type, or combination of exercise can improve preferred gait speed in older adults? A metaanalysis.BMC Geriatr,15,72.
32. Vellas, B,Villars, H,Abellan, G(2006).Overview of the MNA®-Its history and challenges.J Nutr Health Aging,10,456-463.
33. Vlietstra, L,Hendrickx, W,Waters, DL(2018).Exercise interventions in healthy older adults with sarcopenia: A systematic review and meta‐analysis.Australas J Ageing,37,169-183.
34. Yang, Y,Breen, L,Burd, NA(2012).Resistance exercise enhances myofibrillar protein synthesis with graded intakes of whey protein in older men.Br J Nutr,108,1780-1788.
35. Yoshimura, Y,Wakabayashi, H,Yamada, M,Kim, H,Harada, A,Arai, H(2017).Interventions for treating sarcopenia: a systematic review and meta-analysis of randomized controlled studies.J Am Med Dir Assoc,18,553.e1-553.e16.
36. 中華民國內政部統計處。[行政公告]107年第15周內政統計通報。https://www.moi.gov.tw/stat/news_detail.aspx?sn=13742。引用12/10/2019。Department of Statistics, Ministry of the Interior (R.O.C). Abridged life in Republic of China Area. Available at: https://www.moi.gov.tw/stat/news_detail.aspx?sn=13742.Accessed December 10, 2019. [In Chinese]
37. 吳易謙, IC,熊昭, C,陳慶餘, CY,吳名祥, MS,許志成, CC(2014)。台灣社區老人肌少症流行病學初探。台灣醫學，18，290-302。
38. 吳蔓君, MC(2015)。肌少症簡介。家庭醫學與基層醫療，30，103-107。
39. 李明芬, MF,吳承誌, CC,李仁鳳, JF(2018)。預防肌少症：飲食蛋白質及維生素D的重要性。臺灣營養學會雜誌，42，33-38。
40. 柯俊宏, CH,吳幸娟, SJ,李宜樺, YH(2017)。補充富含支鏈胺基酸營養品對於社區中老年肌少症之成效。臺灣老年醫學暨老年學雜誌，12，29-41。
41. 陳弘哲, HJ,許慧雅, HY,周明岳, MY,杜明勳, MS(2014)。老人營養評估與篩檢。家庭醫學與基層醫療，29，65-74。
42. 陳慧君, HC,黃素華, SH,鄭金寶, CP,楊榮森, RS(2015)。老年衰弱症的營養處置。台灣醫學，19，534-541。
43. 鄭丁靚, TC,黃安君, AC,彭莉甯, LN(2016)。國際肌少症研究診斷標準彙整。台灣老年醫學暨老年學雜誌，11，213-224。

1. 鄭芮期,歐鳳仙,蒲典聖,張鳳儀,王詩筠(2023)。離島偏鄉銀髮族預防及延緩失能狀態之探討：以澎湖縣白沙鄉講美社區為例。運動與遊憩研究，17(4)，66-75。
2. (2024)。如何延緩日間照顧中心長輩身體之功能性表現退化。醫學與健康期刊，13(3)，125-136。