Johansson Yvonne, Bachrach-Lindström Margareta, Carstensen John, Ek Anna-Christina
Department of Medical and Health Sciences, Division of Nursing Science, Faculty of Health Science, Linköping University, Linköping, Sweden.
J Clin Nurs. 2009 May;18(9):1354-64. doi: 10.1111/j.1365-2702.2008.02552.x. Epub 2008 Dec 11.
To prospectively investigate and describe the prevalence and incidence of malnutrition among home-living older people, related to demographic and medical factors, self-perceived health and health-related quality of life. Another aim was to find predictors for developing risk of malnutrition.
Risk factors for malnutrition have previously been identified as diseases, several medications, low functional status, symptoms of depression and inadequate nutrient intake. Most studies are cross-sectionally performed at hospitals or in nursing care settings.
A prospective study with a sample of 579 home-living older people, randomly selected from a local national register. Examinations were performed at baseline and yearly follow-ups two to four times.
Questionnaires validated and tested for reliability, to detect risk of malnutrition (Mini Nutritional Assessment), symptoms of depression (Geriatric Depression Scale-20), cognitive function (Mini Mental State Examination), health-related quality of life (Nottingham Health Profile), well-being (Philadelphia Geriatric Center Multilevel Assessment Instrument) self-perceived health, demographic factors, anthropometry and biochemical examinations. Predictors were searched for through multiple logistic regression analysis with the MNA as dependent factor.
The prevalence of risk for malnutrition was 14.5%, according to the MNA. Two risk factors for malnutrition were lower handgrip strength and lower self-perceived health. The incidence of risk for malnutrition at follow-ups was between 7.6% and 16.2%. Predictors for developing malnutrition were higher age, lower self-perceived health and more symptoms of depression. Men with symptoms of depression had a higher risk of developing malnutrition.
Lower self-perceived health had the highest power to predict risk for malnutrition, with increased number of depression symptoms and higher age as second and third predictors.
A regular and combined assessment using the Mini Nutrition Assessment, Geriatric Depression Scale-20 and self-perceived health as a base for identifying people in need, is one way to prevent the development of malnutrition.
前瞻性调查并描述居家老年人中营养不良的患病率和发病率，及其与人口统计学和医学因素、自我感知健康状况以及健康相关生活质量的关系。另一个目的是找出营养不良风险发展的预测因素。
营养不良的风险因素先前已被确定为疾病、多种药物、功能状态低下、抑郁症状和营养摄入不足。大多数研究是在医院或护理机构中进行的横断面研究。
一项前瞻性研究，样本为从当地国家登记册中随机选取的579名居家老年人。在基线时进行检查，并每年进行两到四次随访。
使用经过效度验证和信度测试的问卷，以检测营养不良风险（微型营养评定法）、抑郁症状（老年抑郁量表-20项）、认知功能（简易精神状态检查表）、健康相关生活质量（诺丁汉健康量表）、幸福感（费城老年中心多级评估工具）、自我感知健康状况、人口统计学因素、人体测量学和生化检查。通过以微型营养评定法为因变量的多元逻辑回归分析寻找预测因素。
根据微型营养评定法，营养不良风险的患病率为14.5%。营养不良的两个风险因素是握力较低和自我感知健康状况较差。随访期间营养不良风险的发病率在7.6%至16.2%之间。营养不良发展的预测因素是年龄较大、自我感知健康状况较差和抑郁症状较多。有抑郁症状的男性发生营养不良的风险更高。
自我感知健康状况较差对预测营养不良风险的影响力最大，抑郁症状数量增加和年龄较大分别为第二和第三大预测因素。
定期综合使用微型营养评定法、老年抑郁量表-20项和自我感知健康状况作为识别有需要人群的基础进行评估，是预防营养不良发展的一种方法。
