臺灣博碩士論文加值系統

隨著人口高齡化，老化使器官衰退，易導致認知衰弱症，是造成不良健康結果，甚至死亡的重要因素。營養為改善許多疾病進展的關鍵因素，研究指出當長者飲食品質越好認知衰弱症的風險越低。「營養識能」常被用來描述與健康飲食行為相關的能力，但文獻上少有探討營養識能與認知衰弱症風險的相關性研究。因此，本研究之研究目的擬以營養的知識、態度、行為為內涵，融入布魯姆(Bloom)的認知領域，以健康識能的概念發展出營養識能(Nutrition Literacy, NL)問卷，招募225名65歲以上大台北地區社區長者，探討社區長者營養識能、自我感知健康狀況與認知衰弱症風險之相關性。本研究採問卷調查法，研究工具包含：基本資料、營養識能、身體活動量、自我感知健康狀況、SOF衰弱量表及MMSE六大部分，以SPSS 26版本進行資料分析。結果顯示，大台北地區社區長者認知衰弱症風險為7.1%。整體自我感知健康狀況與營養識能總分(相關係數: 0.199)呈正相關；顯示當長者整體自我感知健康狀況分數越好時，整體營養識能分數會越高，也觀察到自我感知健康狀況有助於降低衰弱風險(OR：0.51, 95% CI : 0.38-0.69)，但沒有觀察到自我感知健康狀況與認知衰弱症風險降低有關(p=0.324)。當長者整體營養識能分數越高(OR：0.92, 95%CI：0.88-0.96)，「獲取」(OR：0.63, 95% CI : 0.47-0.84)、「理解」(OR：0.82, 95% CI : 0.69-0.96)、「應用」(OR：0.82, 95% CI : 0.69-0.96)、「分析」(OR：0.70, 95% CI : 0.57-0.85)、「評價」(OR：0.61, 95% CI : 0.47-0.79)面向的能力越好，有助於降低認知衰弱症風險。與低程度營養識能相比，高程度營養識能與認知衰弱症風險(OR：0.08, 95% CI : 0.03-0.48)的降低有關。整體而言，本研究發現社區長者的營養識能可作為預測認知衰弱症風險的重要因子，因此未來建議加強長者營養觀念及食物選擇的課程及宣導，減少長者發生認知衰弱症的風險。

As the population ages, organ decline due to aging can lead to cognitive frailty, resulting in adverse health outcomes and even death. Nutrition is a key factor in improving the progression of many diseases, and studies indicate that better dietary quality in older adults is associated with a lower risk of cognitive frailty. "Nutrition literacy" often describes the ability related to healthy eating behaviors, but there is little research exploring the correlation between nutrition literacy and the risk of cognitive frailty.Therefore, the purpose of this study is to develop a Nutrition Literacy (NL) questionnaire based on knowledge, attitudes, and behaviors related to nutrition, incorporating Bloom's cognitive domain, and the concept of health literacy. This study recruited 225 community-dwelling older adults aged 65 and above from the Greater Taipei area to explore the relationship between nutrition literacy, self-perceived health status, and the risk of cognitive frailty. This study used a questionnaire survey method, with research tools including: basic information, nutrition literacy, physical activity, self-perceived health status, SOF index, and MMSE. Data analysis was conducted using SPSS version 26. The results showed that the risk of cognitive frailty among community-dwelling older adults in the Greater Taipei area was 7.1%. The overall self-perceived health status is positively correlated with the total score of nutrition literacy (correlation coefficient: 0.199), indicating that when the self-perceived health status score of the elderly is better, the overall nutrition literacy score will be higher. It is also observed that perceived health status helps reduce the risk of frailty (OR: 0.51, 95% CI: 0.38-0.69), but no association was found between self-perceived health status and the risk reduction of cognitive frailty (p=0.324).When older adults had higher overall nutrition literacy scores (OR: 0.92, 95% CI: 0.88-0.96), and better abilities in "obtain" (OR: 0.63, 95% CI: 0.47-0.84), "understand" (OR: 0.82, 95% CI: 0.69-0.96), "apply" (OR: 0.82, 95% CI: 0.69-0.96), "analysis" (OR: 0.70, 95% CI: 0.57-0.85), and "evaluation" (OR: 0.61, 95% CI: 0.47-0.79), it helped reduce the risk of cognitive frailty. Compared with low level nutrition literacy, high level nutrition literacy was associated with a reduced risk of cognitive frailty (OR: 0.08, 95% CI: 0.03-0.48). Overall, this study found that the nutrition literacy of community elders can serve as an important factor in predicting the risk of cognitive frailty.Therefore, it is important to enhance courses and advocacy on nutritional concepts and food choices for older adults to reduce the risk of cognitive frailty.

摘要 I
Abstract III
致謝 V
中英文對照表 VII
目錄 VIII
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的 6
第三節 研究問題 6
第二章 文獻回顧 7
第一節 台灣高齡人口現況 7
第二節 老年人衰弱症與認知衰弱症之診斷與評估 9
一、 衰弱症定義之診斷與評估 9
二、 認知衰弱症定義之診斷與評估 11
三、 認知衰弱症類型 13
第三節 老年人衰弱症與認知衰弱症之盛行率及影響 14
第四節 營養識能與衰弱症、認知衰弱症 18
一、營養識能定義 18
二、營養識能評估 20
2-1、評估工具 20
2-2、布魯姆認知領域 21
三、衰弱症與營養 23
3-1、衰弱症與飲食品質 24
3-2、衰弱症與營養不良 24
四、認知衰弱症與營養 25
4-1、認知衰弱症與飲食品質 25
4-2、認知衰弱症與營養不良 26
第五節 老年人認知衰弱症與自我感知健康狀況 28
第三章 研究材料與方法 30
第一節 研究架構 30
第二節 研究對象 30
第三節 研究工具 32
第四節 研究流程 40
第五節 統計分析 41
第四章 結果 44
第一節 認知衰弱症風險盛行率及社會人口學特徵 44
第二節 營養識能 48
第三節 社區長者自我感知健康狀況與營養識能之關係 53
第四節 社區長者營養識能與認知衰弱症風險之關係 54
一、 社區長者營養識能(總分、面向)與衰弱分數、認知分數之關係 54
二、 社區長者營養識能在不同認知功能與衰弱程度之差異 55
三、 社區長者營養識能總分與衰弱風險、認知功能及認知衰弱症風險之預測 57
四、 NL六面向與衰弱風險、認知功能及認知衰弱症風險之預測 58
五、營養識能程度對衰弱風險、認知功能及認知衰弱症風險之預測 60
第五節 社區長者自我感知健康狀況與衰弱風險、認知功能及認知衰弱症風險之關係 62
第五章 討論 64
第一節 認知衰弱症之盛行率 64
第二節 不同營養識能程度之社會人口學特徵 64
第三節 自我感知健康狀況與營養識能、衰弱風險、認知功能及認知衰弱症風險之關係 66
一、自我感知健康狀況與營養識能之關係 66
二、自我感知健康狀況與衰弱風險、認知功能及認知衰弱症風險之關係 67
第四節 營養識能與衰弱風險、認知功能及認知衰弱症風險之關係 68
第五節 研究優勢與限制 74
第六章 結論 75
參考文獻 76
附件1 輔仁大學人體研究倫理委員會通過證明 87
附件2 受試者知情同意書 88
附件3 完整版問卷 90

表目錄
表 1 老年人衰弱症的五項臨床指標 10
表 2 SOF的三項指標 11
表 3 認知衰弱症評估方式 12
表 4 認知衰弱症定義 13
表 5 營養識能問卷中各面向定義描述 32
表 6 專家審查名冊 33
表 7 營養識能問卷之信度分析 34
表 8 營養識能問卷之效度分析 35
表 9 身體活動量換算公式 36
表 10 自我感知健康狀況-第一部分 37
表 11 自我感知健康狀況-第二部分 37
表 12 衰弱症問卷題目 38
表 13 研究參與者的社會人口學特徵 46
表 14 營養識能分數之相關性 52
表 15 自我感知健康狀況與營養識能分數之相關性 53
表 16 營養識能分數與SOF衰弱量表分數、MMSE分數之相關性 54
表 17 營養識能在不同衰弱程度與認知功能差異 56
表 18 營養識能分數對衰弱風險、認知障礙及認知衰弱症風險之預測 57
表 19 NL六面向與衰弱風險、認知功能及認知衰弱症風險之預測 59
表 20 營養識能程度與衰弱風險、認知功能及認知衰弱症風險之預測 61
表 21 自我感知健康狀況與SOF衰弱量表分數、MMSE分數之關係 62
表 22 自我感知健康狀況對衰弱症、認知障礙及認知衰弱風險之預測 63

圖目錄
圖 1 認知衰弱症之操作型分類 14
圖 2 布魯姆教育目標-認知領域 22
圖 3 研究架構圖 30
圖 4 研究流程圖 40

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