臺灣博碩士論文加值系統

背景與目的：
高齡化社會已是全球趨勢，為減緩因高齡化造成國家整體醫療的龐大支出，高齡長者的健康促進格外重要。過去文獻指出高齡長者經常有營養攝取不足的狀況，容易罹患肌少症，增加跌倒、反覆住院以及死亡的風險。探究其營養攝取不足的原因，除了身體消化系統機能的退化，也與咀嚼吞嚥能力退化有關。過去研究中多以自評式問卷探討咀嚼能力，少有以測量肌電的方式來量化咀嚼能力並同時與營養、握力做相關性分析，本研究的主要目的在於探討由口進食的住院高齡長者之營養評估、肌力與咀嚼吞嚥能力之相關性。
方法：
本研究採橫斷面研究，招募120位於亞洲大學附屬醫院新住院之65歲以上高齡者。入住24小時內收集迷你營養評估量表分數、咀嚼肌表面肌電、握力、自評式吞嚥能力分數及臨床客觀資料。以SPSS 23統計軟體獨立t檢定、皮爾森相關等分析，並以二元邏輯斯迴歸預測分析數據。
結果：
120位個案中有56位男性(46.7%)，64位女性(53.3%)，平均年齡為75.1  7.8歲。有75位營養狀況良好(62.5%)、37位潛在性營養不良(30.8%)及8位營養不良(6.7%)；咀嚼肌靜止肌電較高者(咀嚼肌肌肉張力較高)，會有3.87倍的機會出現身體質量指數低於標準值18.5。而營養不良可預測握力不足的現象（P<0.001），營養不良導致握力不足的風險會增加3.47倍。
結論：
本研究結果顯示，高齡長者有較高的咀嚼肌肌肉張力可以做為營養攝取不足的預測因子，而營養攝取不足可預測肌少症的發生。為避免高齡長者因肌少症所衍生的健康問題，如跌倒、衰弱、反覆住院、死亡，使高齡者維持良好的咀嚼能力，應成為高齡營養健康促進的重要項目。

Background:
Aging society is a global trend. To reduce the medical economic burden, improving the health of the elderly is crucial. In the literature review, elderly people often suffer from insufficient nutrition intake that leads to increasing the risk of sarcopenia, fall, repeated hospitalization, and death. The causal factors include the degeneration of the digestive system and the masticatory and swallowing ability. Most of the previous studies quantify the masticatory ability by self-assessment questionnaires and rarely of them conducting the electromyography measurement. This study investigated the correlation analysis among nutritional status, handgrip strength, and electromyography data of the masticatory muscle to explore the correlation between nutrition assessment, muscle strength and chewing ability of hospitalized elderly elders.
Methods:
In this cross-sectional study, we enrolled 120 seniors aged 65 and above who are newly admitted to the Asian University Hospital. Within 24 hours they admitted to the hospital, we collected the Mini Nutritional Assessment scores, surface electromyography data, handgrip strength, self-assessment swallowing ability score, and clinical objective data. We performed the statistics for independent t-test, Pearson correlation analysis, and binary logistic regression with SPSS 23 software.
Results:
Of the 120 cases, 56 were male (46.7%) and 64 were female (53.3%), with an average age of 75.1±7.8 years. There are 75 patients with good nutritional status (62.5%), 37 with potential malnutrition (30.8%), and 8 with malnutrition (6.7%). The elderly who has higher resting electromyography data of masticatory muscles (high muscle tension) has 3.87 folds of increased risk of body mass index less than 18.5, and malnutrition predicts the low handgrip strength (P <0.001) , Malnutrition increases the risk of insufficient grip strength by 3.47 folds.
Conclusion:
The study outcomes provided reveals that higher masticatory muscle tension of the elderly is a predictor of insufficient nutrition intake, and insufficient nutrition intake can predict the incidence of sarcopenia. To avoid the health problems caused by sarcopenia for the elderly, including fall, frailty, repeated hospitalization, and death, maintaining the good masticatory function of the elderly should be taken as a crucial event in nutritional health promotion programs.

表 目 錄 ii
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 3
第二章 文獻探討 5
第一節 長者營養之相關研究 6
第二節咀嚼吞嚥能力之相關研究 10
第三章 研究方法 25
第一節 研究設計架構 25
第二節 研究流程與對象 26
第三節 研究指標定義與測量方法 27
第四節 研究工具 31
第五節 研究資料處理及分析: 34
第四章 研究結果 35
第一節住院長者人口學特性、身體測量資料分佈 35
第二節住院高齡者營養健康現況與相關影響因素 39
第三節 住院高齡者營養健康現況之相關性分析 48
第五章 討論 51
第一節住院長者營養狀況 51
第二節 住院長者肌力 54
第三節 營養之相關因素討論 62
第六章 結論與建議 63
第一節 結論 63
第二節 研究限制 63
第三節 未來的研究方向及實際應用 65
參考文獻 66
附錄1 71
附錄2 72
表 目 錄
表 1人口基本學統計資料與身體測量分佈 (N＝120) 38
表 2三組不同營養指標在營養相關因數差異 40
表 3住院高齡者營養風險各組間基本資料及身體測量之差異 42
表 4住院高齡者肌力－握力相關影響因素之差異 44
表 5住院高齡者營養狀態預測握力的風險機率 44
表 6住院高齡者肌力－小腿圍相關影響因素之差異 45
表 7住院高齡者咀嚼能力－靜止咀嚼肌電相關影響因素之差異 47
表 8咀嚼肌靜止肌電預測體重過低的風險機率 47
表 9 BMI和年齡與營養不良指標的相關性分析 50

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