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研究生:廖秋映
研究生(外文):Liao Chiu-Ying
論文名稱:簡易營養評估(MNA)台灣修訂版比原版更精準判別護理之家住民的營養狀況
論文名稱(外文):Adoption of population-specific anthropometric cut-points improves the functionality of the Mini Nutritional Assessment in nursing home residents in Taiwan
指導教授:蔡仲弘蔡仲弘引用關係
指導教授(外文):Alan C. Tsai
學位類別:碩士
校院名稱:亞洲大學
系所名稱:長期照護研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
語文別:中文
論文頁數:58
中文關鍵詞:簡易營養評估營養風險體位測量老年人
外文關鍵詞:Mini Nutritional AssessmentNutritional riskAnthropometric measurementsElderly
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目的:本研究比較簡易營養評估(Mini Nutritional Assessment, MNA)原版及兩台灣修訂版評估護理之家住民營養狀況之功能並分析其預測因子。
方法:以中部某護理之家入住30天以上,無急性疾病或感染之住民103位為研究對象。以問卷訪談、體位測量及血液生化指標檢測收集資料。
結果:以MNA原版、修訂一及修訂二評估住民的營養狀況,顯示營養不良者依序為29, 23及27%,具營養風險為51.5, 47.6及41.7%,營養良好為19.4, 29 及31%。以Friedman Test及Wilcoxon符號等級檢定分析三版本所測之結果,顯示原量表與修訂一及二所評之結果具顯著差異(Z = -6.922, P<0.001及Z = -4.836, P<0.001),但修訂一與二所評之結果則無差異(Z = -0.618, P = 0.536)。血清白蛋白、日常生活功能、憂鬱量表、生活滿意度、慢性病數、急診次數及住院天數等指標均與三版本之總分呈顯著相關(P<0.05),且多與修訂二之相關最強,修訂一次之。這些結果顯示兩修訂版本之評估功能比原版強而兩修訂版間則無差異。於回歸分析中顯示日常生活功能(B = -0.422, P<0.0001)、慢性病數(B = -0.366, P>0.0001)、血清白蛋白(B = 0.167, P<0.05)及年齡(B = -0.149, P>0.05)可有效預測MNA得分,其整體解釋變異量為59.4% (F = 21.87, P<0.0001)。
結論:台灣修訂版MNA具有比原版量表更強之評估功能,MNA修訂二(不需BMI)可更精確的判別護理之家住民的營養狀況,是更簡便、準確的營養評估工具。護理之家住民約有七成營養不良或具風險,日常生活功能、慢性病數、血清白蛋白及年齡為營養狀況主要預測因子,可提供日後營養不良之預防及介入之參考。
Objective: The study aimed to investigate the functionalities of the original and modified MNA (Mini Nutritional Assessment) in assessing the nutritional status of nursing home residents and to identify the factors associated with the nutritional status.
Methods: With a purposive design, the study recruited 103 >65 y residents who were free of acute disease/infection and had a >3 months residence of a nursing home in Central Taiwan as study subjects. An on-site face-to-face interview was carried out on each subject to elicit personal data, health condition and answers to questions in the MNA and CNAQ (Council on Nutrition Appetite Questionnaire). Anthropometrical indicators were also measured. Serum biochemical parameters were obtained from their routine measurements which were maintained by the institution. Subjects' nutritional status was assessed with three versions of the MNA, the original, the MNA-TI which adopted population-specific anthropometric cut-points, and the MNA-TII which further eliminated BMI from the scale and adjusted the scoring. The study protocol was approval by Asia University.
Results: The original version graded 27% malnourished, 52% at risk of malnutrition and 20% normal; MNA-TI graded 18.5, 53 and 23%, and MNA-TII graded 23, 47 and 30%, respectively. Analysis with Frieman Test and Wilcoxon Signed-rank post hoc tests showed that the distribution of nutritional status graded with the original MNA was different from that of the two modified versions, but results between the two modified versions were not different from each other. Results also showed that serum albumin, calf circumference, the number of chronic diseases and activities of daily living were significantly correlated with MNA scores. Regression analysis indicates that activities of daily living and calf-circumference are the two major predictors while number of chronic diseases and serum albumin are also significant predictors of the nutritional status.
Discussion: Results suggest that MNA modified according to population-specific anthropometric cut-points has improved functionality over the original version. It also shows that MNA-TII which is without BMI can function at least equally well as MNA-TI. Approximately 70% of nursing home residents are at risk of malnutrition. Results of this study suggest that the MNA is useful as a tool for routine monitoring of the nutritional status of nursing home elderly.
前言 1
理論基礎 5
研究方法 10
研究結果 13
討論 17
參考文獻 26
中文
內政部統計資訊服務網 (2007,8月9日)。近年我國老年人口數一覽表。2007年11月1日,取自http://sowf.moi.gov.tw/04/07/1/1-03.htm
內政部統計資訊服務網 (2008,3月6日)。九十七年第十週內政統計通報-96年底老人長期照護、養護及安養機構概況。2008年4月1日,取自http://www.moi.gov.tw/stat/index.asp
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李素貞、郭憲文、戴玉慈 (1997)。中部三縣市長期照護機構與照護人力特性之調查。公共衛生,24(3),179-191。
吳淑如、杜敏世 (2001)。護理之家住民健康問題探討。長期照護雜誌,5(1),54-65。
蔡秀玲、張素瓊、郭靜香 (2006)。迷你營養評估量表應用於護理之家老人營養狀況評估。中華民國營養學會雜誌,30(3),135-145。
戰臨茜、高森永、金惠民、李美璇 (2002)。北台灣社區與機構中老人的營養狀況及其預測因子。中華民國營養學會雜誌,27(3),147-158。
簡怡雯、黃美智、廖芳瑄、陳佳君、謝明哲 (2003)。住院病人營養評估新模式之建立。中華民國營養學會雜誌,28(4),200-209。

外文
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1. 李素貞、郭憲文、戴玉慈 (1997)。中部三縣市長期照護機構與照護人力特性之調查。公共衛生,24(3),179-191。
2. 李素貞、郭憲文、戴玉慈 (1997)。中部三縣市長期照護機構與照護人力特性之調查。公共衛生,24(3),179-191。
3. 吳淑如、杜敏世 (2001)。護理之家住民健康問題探討。長期照護雜誌,5(1),54-65。
4. 吳淑如、杜敏世 (2001)。護理之家住民健康問題探討。長期照護雜誌,5(1),54-65。
5. 蔡秀玲、張素瓊、郭靜香 (2006)。迷你營養評估量表應用於護理之家老人營養狀況評估。中華民國營養學會雜誌,30(3),135-145。
6. 蔡秀玲、張素瓊、郭靜香 (2006)。迷你營養評估量表應用於護理之家老人營養狀況評估。中華民國營養學會雜誌,30(3),135-145。
7. 戰臨茜、高森永、金惠民、李美璇 (2002)。北台灣社區與機構中老人的營養狀況及其預測因子。中華民國營養學會雜誌,27(3),147-158。
8. 戰臨茜、高森永、金惠民、李美璇 (2002)。北台灣社區與機構中老人的營養狀況及其預測因子。中華民國營養學會雜誌,27(3),147-158。
9. 簡怡雯、黃美智、廖芳瑄、陳佳君、謝明哲 (2003)。住院病人營養評估新模式之建立。中華民國營養學會雜誌,28(4),200-209。
10. 簡怡雯、黃美智、廖芳瑄、陳佳君、謝明哲 (2003)。住院病人營養評估新模式之建立。中華民國營養學會雜誌,28(4),200-209。
 
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