Anada Satoshi, Matsumoto Takuya, Nakano Masaru, Yamada Satoru
Department of Rehabilitation.
Department of Gastroenterology and Hepatology.
Medicine (Baltimore). 2019 Jul;98(27):e16290. doi: 10.1097/MD.0000000000016290.
Patients who become malnourished during hospitalization because of illness or treatment often receive intervention from a nutrition support team (NST). The NST intervention not only enhances the nutritional status but also decreases medical expenses and catheter-related complications. However, the impact of the NST intervention on the home discharge of hospitalized community-dwelling older adults remains unclear. Hence, this study aims to investigate factors related to home discharge in malnourished community-dwelling older adults.In this retrospective longitudinal cohort study, examined 191 community-dwelling older adults aged ≥65 years (108 males; mean age: 80.9 ± 7.8 years) who received the NST intervention. All participants were categorized into two groups based on whether they were home discharged or not (home discharge group and non-home discharge group). We performed intergroup comparisons using serum albumin (Alb) as an index of the nutritional status and functional independence measure (FIM: motor and cognitive items) as an index of activities of daily living (ADL). Furthermore, we constructed a prognostic model of home discharge using the logistic regression analysis.The home discharge group had 94 participants, with a home discharge rate of 50.8%. Baseline body mass index (BMI), motor-FIM score, and cognitive-FIM score were significantly higher in the home discharge group compared with the non-home discharge group (P = .002, P < .001, P < .001, respectively). In the home discharge group, BMI declined significantly, Alb elevated significantly, and both motor-FIM and cognitive-FIM score enhanced significantly by the completion of the NST intervention (P < .001, P < .001, P < .001, P = .005, respectively). The adjusted logistic regression analysis extracted the baseline BMI (odds ratio [OR], 1.146; 95% confidence interval [CI]: 1.034-1.270), baseline motor-FIM score (OR, 1.070; 95% CI: 1.036-1.105), and extent of change in the motor-FIM score (OR, 1.061; 95% CI: 1.026-1.098) as independent factors that predict home discharge.This study highlights the significance of higher baseline BMI, higher baseline ADL level, ADL enhancements, and improvements in the nutritional status by the NST intervention in malnourished community-dwelling older adults considering home discharge.
因疾病或治疗而在住院期间出现营养不良的患者，通常会接受营养支持团队（NST）的干预。NST干预不仅能改善营养状况，还能降低医疗费用及与导管相关的并发症。然而，NST干预对住院社区居住老年人出院回家的影响仍不明确。因此，本研究旨在调查营养不良的社区居住老年人出院回家的相关因素。
在这项回顾性纵向队列研究中，研究人员考察了191名年龄≥65岁的社区居住老年人（108名男性；平均年龄：80.9±7.8岁），这些老人接受了NST干预。所有参与者根据是否出院回家分为两组（出院回家组和未出院回家组）。我们以血清白蛋白（Alb）作为营养状况指标，以功能独立性测量（FIM：运动和认知项目）作为日常生活活动（ADL）指标进行组间比较。此外，我们使用逻辑回归分析构建了出院回家的预测模型。
出院回家组有94名参与者，出院回家率为50.8%。出院回家组的基线体重指数（BMI）、运动FIM评分和认知FIM评分显著高于未出院回家组（P分别为0.002、<0.001、<0.001）。在出院回家组中，到NST干预结束时，BMI显著下降（P<0.001），Alb显著升高（P<0.001），运动FIM和认知FIM评分均显著提高（P分别为<0.001、0.005）。调整后的逻辑回归分析得出，基线BMI（比值比[OR]，1.146；95%置信区间[CI]：1.034 - 1.270）、基线运动FIM评分（OR，1.070；95%CI：1.036 - 1.105）以及运动FIM评分的变化程度（OR，1.061；95%CI：1.026 - 1.098）是预测出院回家的独立因素。
本研究强调了较高的基线BMI、较高的基线ADL水平、ADL的改善以及NST干预对营养不良的社区居住老年人营养状况的改善在考虑出院回家方面的重要性。
