臺灣博碩士論文加值系統

居家照護個案與其他長期照護之所有個案均屬營養不良的高危險群，目前在國內尚無全面性執行之居家營養篩檢與評估工具。居家版基本資料庫(MDS-HC)是國際化的居家個案完整評估工具，在國外已有將其用於營養狀況之篩檢與評估。若能藉由適切的長期照護評估工具，於居家照護個案收案之初，及早篩檢出營養不良之個案，給予適當的營養介入，將可以有效避免營養不良之發生或延續。本研究目的在於以迷你營養評估量表(MNA)為基準，探討MDS-HC台灣版用於評估居家照護個案營養狀況之適用性。本研究為橫斷面研究設計，採方便取樣方式，針對台北地區居家照護個案(平均年齡74.6±13.6，男性42.9%，女性57.1%)進行探討。本研究利用居家護理師出訪時，對個案進行基本資料及營養評估量表資料之收集，包括MDS-HC營養引發項目相關因子問卷、Charlson Index、MNA量表、巴氏量表及人體測量項目等。利用描述性統計、t-test、卡方檢定等統計方法進行分析，同時亦計其敏感性與特異性。研究結果發現居家照護個案以MDS-HC營養引發項目=1為切點時，營養不良組有62位(63.3%)，非營養不良組36位(36.7%)，兩組間在年齡、體重、納入居家照護時間、BMI、SF-MNA分數與MNA分數，均有顯著差異。以MNA評估本研究居家照護個案營養狀況，個案營養不良的比例達51%；再以MNA分數為基準，當MDSNRS=1時，敏感性與特異性分別為0.86與0.60。其陽性預測值與陰性預測值為0.70與0.81。當MDSNRS=2時，敏感性與特異性分別為0.12與1.0。其陽性預測值與陰性預測值為1.0與0.55。本研究顯示，MDS-HC可以做為國內居家照護個案納入時之有效營養篩檢工具。建議未來建立本土性居家照護基本資料庫時可以參考MDS-HC 之營養引發項目，以利早期針對個案進行營養篩檢與介入，提升居家照護品質與個案之營養狀況。

Just like all other long-term care subjects, home-based care recipients were regarded as a high risk group of malnutrition. There was still no comprehensive assessment tool for nutrition status assessing on home care clients in Taiwan. The Minimum Data Set for Home Care (MDS-HC), a comprehensive, international instrument for assessing home care clients, is potentially useful for assessing for assessing nutritional status. Hence, the purpose of the study was to examine the validity of nutrition status assessment for home care clients with MDS-HC under Mini Nutritional Assessment (MNA). Totally, we interviewed 98 patients (with 74.6±13.6 y in age, 57.1% in female, 42.9% in male) enrolled to home care services of the Home Care Agency of Taipei. The MDS-HC and MNA Form were completed for all home care clients by well-trained nurses. Information relevant to completing the Minimum Data Set Nutrition Rating Scale (MDSNRS) was gathered from the MDS-HC. The Barthel Index of Activities of Daily Living (ADL), the Charlson Index of comorbidity and anthropometric measurements were also evaluated by trained home care nurses. We analyzed and showed demographic data, mean, percentage, scale score correlation, and ability to identify client with MNA. The results were shown as several folds. 36.7% of the home care clients were classified as adequate nutritional status(MDSNRS=0); 63.3% of the clients were classified as malnutrition(MDSNRS ≧1). Based on this cut-off level, we could figure out its sensitivity could to be 0.86, specificity 0.61, and predictive value 0.70. The MDSNRS could be performed validated under the reference of MNA. It showed that MDS-HC can be a useful and practiced tool to screen nutrition status among home care client. Those with malnutrition status and at risk of malnutrition should be early detected with a pertinent tool in order to improve their nutrition status.

致 謝 ……………………………………………………………………… Ⅰ
中文摘要 ……………………………………………………………………… Ⅱ
英文摘要 ……………………………………………………………………… Ⅲ
目 錄 ……………………………………………………………………… Ⅳ
圖表目次 ……………………………………………………………………… Ⅴ
第一章　 緒論　
第一節 研究背景、緣起及動機 ……………………………………… 1
第二節 研究重要性 …………………………………………………… 2
第三節 研究目的 ……………………………………………………… 3
第四節 研究問題 ……………………………………………………… 4
第二章　 文獻回顧 　
　 第一節 居家照護 ……………………………………………………… 5
第二節 造成老年人營養不良的相關因子 …………………………… 8
第三節 老年人的營養評估工具 ……………………………………… 15
　 第三節 MDS-HC之發展與應用及其營養相關引發項目 …………… 18
　 第四節 名詞定義 ……………………………………………………… 20
第三章 研究方法
　 第一節 研究設計 ……………………………………………………… 21
　 第二節 研究架構 ……………………………………………………… 21
　 第三節 研究流程 ……………………………………………………… 22
第四節 研究對象 ……………………………………………………… 22
　 第五節 研究工具 ……………………………………………………… 22
第六節 資料分析方法 ………………………………………………… 28
第七節 倫理考量 ……………………………………………………… 28
第四章 研究結果
第一節 居家個案屬性 ………………………………………………… 29
第二節 居家個案營養狀況 …………………………………………… 35
第三節 MDS-HC營養引發項目評估營養狀況閾值 ………………… 45
第五章 討論
第一節 居家照護個案人口學背景 …………………………………… 48
第二節 居家照護個案的營養狀況探討 ……………………………… 51
第三節 MDS-HC用於篩檢居家個案營養狀況引發項目探討 ……… 53
第四節 研究限制 ……………………………………………………… 56
第六章 結論與建議 ………………………………………………………… 57
參考文獻 ……………………………………………………………………… 60
附錄
附錄一 MDS-HC台灣版用於評估居家照護個案營養狀況研究訪員訓練手冊 76
附錄二 MDS-HC台灣版中文評估量表─營養相關引發項目 …………… 85
附錄三 迷你營養評估量表 ………………………………………………… 90
附錄四 巴氏量表 …………………………………………………………… 91
附錄五 Charlson Index ……………………………………………………… 92
附錄六 同意書 ……………………………………………………………… 94


圖表目錄　　　　　　　 　　　　　　　　　　　　　　 頁次
表一 營養引發項目操作型定義及MDS項目編碼 …………………… 27
表二 表二 MNA分組營養狀況與居家照護個案基本人口學資料 ………… 32
表三 MNA分組營養狀況與居家照護個案健康功能狀況 …………… 33
表四 疾病分佈、Charlson Index與營養狀況分組 …………………… 34
表五 居家照護個案在MNA量表中各題目答題分布比較 …………… 37
表六 迷你營養評估分組與居家個案年齡、身高、體重、BMI
與Charlson Index ………………………………………………… 39
表七 性別與體重分布情形 …………………………………………… 40
表八 MDS引發項目分組與居家照護個案個案基本資料 …………… 43
表九 MDS 營養引發項目與居家照護個案年齡、身高、體重、BMI、
MNA總分及Charlson Index積分之差異 ……………………… 44
表十 MDSNRS切點為一，敏感性、特異性、陽性預測值、陰性預測
值的計算 ………………………………………………………… 46
表十一 MDSNRS切點為二，敏感性、特異性、陽性預測值、陰性預測
值的計算 ………………………………………………………… 46
表十二 MDS營養引發項目與迷你營養評估量表的關係 ……………… 47
圖一 研究架構 ………………………………………………………… 21
圖二 BMI與MNA散佈圖 ……………………………………………… 40

中文部分
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