臺灣博碩士論文加值系統

本研究目的為評估嘉義地區居家與長期照護機構老人營養狀況，並比較兩者之差異。以嘉義地區年滿六十五歲或以上之老人為研究對象，共收案231人(居家84人、長期照護機構147人)，評估方式為體位測量、迷你營養評估表(mini nutritional assessment; MNA)及三日飲食記錄，飲食紀錄以食物成分軟體分析，熱量、巨量及微量營養素需求量參考國人膳食營養素參考攝取量(dietary reference intakes; DRIs)。研究結果顯示，居家全體老人及其男性老人之身高、體重及小腿圍均顯著高於長期照護機構全體老人及其男性老人(p<0.05)；居家女性老人亦以小腿圍顯著高於長期照護機構女性老人。長期照護機構全體老人與其男性及女性老人體重過輕比率高於居家全體老人與其男性及女性老人；居家全體老人及其女性老人肥胖比率則高於長期照護機構全體老人及其女性老人。MNA評估值顯示長期照護機構全體老人與其男性及女性老人營養不良比率顯著高於居家全體老人與其男性及女性老人。居家與長期照護機構老人之醣類、維生素E、維生素B6、鈣及鎂攝取量均低於DRIs建議量，長期照護機構老人除上述營養素不足外，在熱量、維生素B2、磷及鐵攝取量也顯示攝取不足。居家全體老人維生素E及維生素B1攝取量顯著低於長期照護機構全體老人，其熱量、巨量營養素及微量營養素均顯著高於長期照護機構全體老人，此外兩者在鈉的攝取量均偏高，且以長期照護機構全體老人高於居家全體老人。居家男性老人維生素E及維生素B1攝取量顯著低於長期照護機構男性老人，其它各營養素除維生素A及維生素C攝取量無差異，其餘均顯著高於長期照護機構男性老人。居家女性老人之膳食纖維、維生素B6、維生素C及礦物質攝取量顯著高於長期照護機構女性老人，維生素E及維生素B1攝取量顯著低於長期照護機構女性老人，其它各營養素間並無顯著差異。居家全體、男性及女性老人之日常生活活動(activities of daily living；ADL)值及複雜性日常生活活動(instrumental activities of daily living；IADL)值均顯著高於長期照護機構全體、男性及女性老人，而簡易老年人憂鬱量表(geriatric depression scale；GDS)值以長期照護機構全體、男性及女性老人顯著高於居家全體、男性及女性老人。綜合以上結果顯示嘉義地區居家及長期照護機構老人營養不良及潛在營養不良比率分別為4.8-17.7%及35.7-51.7%，且長期照護機構老人營養不良比率高於居家老人，推測與其熱量、醣類及微量營養素攝取不足有關。建議嘉義地區居家及長期照護機構老人應注意熱量攝取並補充足夠的奶類、五衛�及其相關製品，來改善其營養狀況。

The purpose of this study was to assess comprehensively the nutrition status of elderly individuals in homebound and to compare it with institutionalized elderly in Chiayi area. A total of 231 elderly persons (homebound 84, institutionalized 147), 65 years old and older were included in the study, their nutritional status was assessed by anthropometric measurements, mini nutritional assessment (MNA) and dietary food intake for a 3-day period, dietary intake was analyzed by food composition software. Energy, macro and micronutrient intakes were compared with dietary reference intakes (DRIs) as appropriate. Total and male elderly in the homebound had significantly higher height, weight and calf circumference (CC) values than those institutionalized elderly, and the female elderly in homebound also had higher CC value than with institutionalized female elderly (p<0.05). The prevalence of underweight in institutionalized elderly and both genders was greater than those in homebound. On the other hand, the prevalence of obesity of total and female elderly in homebound was higher than those institutionalized elderly. Malnutrition proportion were higher in institutionalized elderly and both genders than those homebound elderly. Mean intakes of carbohydrate and micronutrient vitamin E, vitamin B6, calcium and magnesium were lower than DRIs for whole participants. Farther, inadequate intake with energy, vitamin B2, phosphorous and iron was noted in institutionalized elderly. Total homebound elderly had higher energy, macro and micro nutrient intakes than with institutionalized elderly, except for vitamin E and vitamin B1. Furthermore, excess sodium consumption was noted in both groups, the institutionalized elderly take more sodium than in homebound elderly. Higher energy, macronutrient and mineral intakes were observed in homebound male elderly than in institutionalized male elderly except for vitamin A, vitamin E, vitamin B1 or vitamin C. There were no significant differences or lower energy and nutrient intakes for females between both groups, except for fiber, vitamin B6 , vitamin C and mineral which were significantly higher in homebound female elderly. The homebound elderly and both genders had higher ADL and IADL values and lower GDS value than those institutionalized elderly. In summary, the results of the present study showed the proportion of malnutrition or at risk malnutrition was 4.7-17.7% or 35.7-51.7 % detected by the MNA in Chiayi area, it was also found that elder people living in institutionalized have more risk for malnutrition, these individuals are more likely to have a decrease energy, carbohydrate and micronutrient intakes. It is recommended that to increased energy, cereal and cereal products, milk and milk products intakes for both homebound and institutionalized elderly in Chiayi area.

中文摘要------------------------------------------------------------------------------Ⅰ-Ⅱ
英文摘要------------------------------------------------------------------------------Ⅲ-Ⅳ
目錄------------------------------------------------------------------------------------Ⅴ-Ⅹ
第一章 緒論-----------------------------------------------------------------------------1
第一節 研究背景及重要性-----------------------------------------------------1-2
第二節 研究動機與目的-----------------------------------------------------------3
第三節 文獻回顧--------------------------------------------------------------------4
1.3.1.老年人定義及現況-------------------------------------------------------4
1.3.2.長期照護機構概況-----------------------------------------------------4-5
1.3.3.老化的理論--------------------------------------------------------------5-6
1.3.4.老年期的生理變化-----------------------------------------------------6-8
1.3.5.老年期的心理變化-------------------------------------------------------8
1.3.6.老年人的營養需求-----------------------------------------------------8-9
1.3.4.老年人營養評估方法---------------------------------------------------10
1.3.7.1.體位測量-----------------------------------------------------------10-11
1.3.7.2.生化檢查------------------------------------------------------------11-12
1.3.7.3.量表營養評估---------------------------------------------------------12
1.3.7.3.1.迷你營養評估量表---------------------------------------------12-13
1.3.7.3.2.簡易社區營養評估量表-------------------------------------------13
1.3.7.3.3.主觀整體營養評估量表---------------------------------------13-14
1.3.7.3.4.Nutritional form for the elderly（NUFFE）----------------------14
1.3.8.4.飲食評估---------------------------------------------------------------14
1.38.4.1.二十四小時回憶法--------------------------------------------------14
1.3.8.4.2.食物頻率問卷法----------------------------------------------------15
1.3.8.4.3.食物記錄或食物日誌----------------------------------------------15
1.3.9.身體弁鉞�估--------------------------------------------------------15-16
1.3.10.心理弁鉞�估----------------------------------------------------------16
1.3.11.老人營養狀況----------------------------------------------------------17
1.3.11.1.體位測量之營養狀況-------------------------------------------17-21
1.3.11.2.迷你營養評估量表之老人營養狀況評估-------------------21-22
1.3.11.3.飲食中營養素攝取狀況--------------------------------------------22
1.3.11.3.1.熱量與蛋白質、脂肪及醣類之攝取量----------------------22-26
1.3.11.3.2.膳食纖維素之攝取量---------------------------------------------26
1.3.11.3.3.維生素及礦物質之攝取量-----------------------------------26-28
1.3.12. 老人的健康弁鄋洩p------------------------------------------------29
第二章 材料與方法-------------------------------------------------------------------30
第一節 研究架構------------------------------------------------------------------30
第二節 研究材料與方法---------------------------------------------------------31
2.2.1.研究對象------------------------------------------------------------------31
2.2.2.研究工具------------------------------------------------------------------31
2.2.2.1.問卷------------------------------------------------------------------31-33
2.2.2.2.體位測量之方法---------------------------------------------------33-35
2.2.2.3.食飲記錄----------------------------------------------------------------35
2.2.3.統計方法--------------------------------------------------------------35-36
2.2.4.研究倫理--------------------------------------------------------------36-37
第三章 結果------------------------------------------------------------------------38-45第四章 討論------------------------------------------------------------------------46-56
第五章 結論----------------------------------------------------------------------------57
建議---------------------------------------------------------------------------------------58
參考文獻------------------------------------------------------------------------------59-73
附表----------------------------------------------------------------------------------------74
表一 居家老人與長期照護機構老人基本資料----------------------------------75
表二 比較居家及長期照護機構全體老人、男性老人及女性老人之體位各項測量值------------------------------------------------------------------------76
表三 居家及長期照護機構全體老人、男性老人及女性老人之身體質量指數評估值分組比率------------------------------------------------------------77
表四 比較居家及長期照護機構全體老人、男性老人及女性老人之迷你營養量表評估值------------------------------------------------------------------78
表五 比較居家及長期照護機構全體老人、男性老人及女性老人之熱量、巨量營養素及膳食纖維素每日平均攝取量--------------------------------------79
表六 居家及長期照護機構全體老人、男性老人及女性老人之蛋白質、脂肪及醣類熱量佔總熱量之比率---------------------------------------------80
表七 比較居家及長期照護機構全體老人、男性老人及女性老人之維生素每日平均攝取量---------------------------------------------------------------81
表八 比較居家及長期照護機構全體老人、男性老人及女性老人之礦物質每日平均攝取量---------------------------------------------------------------82
表九 比較居家及長期照護機構全體老人、男性老人及女性老人之ADL、IADL及GDS測量值----------------------------------------------------------83
表十 迷你營養評估量表評分值與ADL值、IADL值及GDS值之相關係數------------------------------------------------------------------------------------84
附圖----------------------------------------------------------------------------------------85
圖一 居家與長期照護機構老人之各種疾病罹患率----------------------------86
圖二 居家與長期照護機構全體老人、男性老人及女性老人之身體質量指數評估值分組比率-----------------------------------------------------------87
圖三 比較居家及長期照護機構全體老人、男性老人及女性老人之MNA評估值---------------------------------------------------------------------------------88
圖四 居家與長期照護機構老人、男性老人及女性老人之MNA分組比率------------------------------------------------------------------------------------89
圖五 比較居家及長期照護機構全體老人、男性老人及女性老人之ADL評估值------------------------------------------------------------------------------90
圖六 比較居家及長期照護機構全體老人、男性老人及女性老人之IADL評估值---------------------------------------------------------------------------------91
圖七 比較居家及長期照護機構全體、男性及女性老人之GDS評估值------------------------------------------------------------------------------------92
附錄----------------------------------------------------------------------------------------93
附錄一 國人膳食營養素參考攝取量------------------------------------------94-95
附錄二 同意書-------------------------------------------------------------------------96
附錄三 基本資料問卷表-------------------------------------------------------------97
附錄四 體位測量記錄表-------------------------------------------------------------98
附錄五 迷你營養評估記錄單-------------------------------------------------------99
附錄六 日常活動弁鉞�估表-----------------------------------------------------100
附錄七 工具性日常活動弁鉞�估-----------------------------------------------101
附錄八 飲食評估---------------------------------------------------------------102-103
附錄九 老年人精神抑鬱量表-----------------------------------------------------104

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