The John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI.
J Am Med Dir Assoc. 2013 Sep;14(9):649-55. doi: 10.1016/j.jamda.2013.02.022. Epub 2013 Apr 30.
Weight loss and poor nutrition are important quality measures in long term care. Long term care professionals need to identify factors associated with weight loss and poor nutrition to target high-risk patients.
The authors systematically searched Medline and CINAHL databases and included English language studies with more than 100 subjects analyzed, published after January 1, 1990, with data on factors associated with at least one of the following: weight loss, low body mass index (BMI), low Mini-Nutritional Assessment (MNA) score, or other standard measure of malnutrition. Data from all studies were systematically extracted onto a matrix table. The Critical Appraisal Skills Programme (CASP) questions were used to compare the quality of evidence extracted. Data from each article were then sorted and arranged into tables of factors associated with weight loss, low BMI, and malnutrition.
Sixteen studies met the inclusion criteria for the review. The factors most consistently associated with weight loss were depression, poor oral intake, swallowing issues, and eating/chewing dependency. Staffing factors were associated with weight loss in most studies. The factors most consistently associated with low BMI included immobility, poor oral intake, chewing problems, dysphagia, female gender, and older age. The factors most consistently associated with poor nutrition included impaired function, dementia, swallowing/chewing difficulties, poor oral intake, and older age.
Potentially modifiable factors consistently associated with increased likelihood of weight loss, low BMI, or poor nutrition included depression, impaired function, and poor oral intake. Nursing home medical directors may wish to target quality improvement efforts toward patients with these conditions who are at highest risk for weight loss and poor nutrition.
在长期护理中，体重减轻和营养状况不佳是重要的质量衡量标准。长期护理专业人员需要确定与体重减轻和营养状况不佳相关的因素，以便针对高风险患者。
作者系统地检索了 Medline 和 CINAHL 数据库，并纳入了 1990 年 1 月 1 日以后发表的、超过 100 名受试者分析的、有与以下至少一项相关因素的英语研究：体重减轻、低体重指数（BMI）、低微型营养评估（MNA）评分或其他营养不良标准测量值。将所有研究的数据系统地提取到矩阵表中。使用批判性评估技能计划（CASP）问题来比较提取的证据质量。然后，将从每篇文章中提取的数据按与体重减轻、低 BMI 和营养不良相关的因素进行分类和排列。
有 16 项研究符合综述的纳入标准。与体重减轻最常相关的因素是抑郁、口腔摄入不良、吞咽问题和饮食/咀嚼依赖。在大多数研究中，人员配备因素与体重减轻有关。与低 BMI 最常相关的因素包括活动能力下降、口腔摄入不良、咀嚼问题、吞咽困难、女性和年龄较大。与营养不良最常相关的因素包括功能受损、痴呆、吞咽/咀嚼困难、口腔摄入不良和年龄较大。
与体重减轻、低 BMI 或营养不良的可能性增加相关的潜在可改变因素包括抑郁、功能受损和口腔摄入不良。疗养院医疗主任可能希望将质量改进工作针对存在这些情况的患者，这些患者是体重减轻和营养不良风险最高的患者。
