Doctoral Student in Doctor of Public Health (International Program), Faculty of Public Health, Mahidol University, Bangkok, Thailand.
Department of Nutrition, Faculty of Public Health, Mahidol University, 420/1 Ratchawithi RD., Ratchathewi District, Bangkok10400, Thailand.
Public Health Nutr. 2022 Mar;25(3):565-577. doi: 10.1017/S1368980021004250. Epub 2021 Oct 8.
This study aimed to develop and validate protein energy malnutrition (PEM) screening tool for older adults in public residential homes, and to test its practicality.
This cross-sectional study consisted of two phases: tool development/validation and tool practicality evaluation. In Phase 1, the questionnaire was developed based on literature review and tested for content validity. Older residents were interviewed using this questionnaire to identify potential PEM risk factors. A 24-h recall was used to collect dietary data, and body composition and serum albumin were measured. In Phase 2, practicality of new PEM screening tool was evaluated by intended users. Data were analysed by χ2 test, Fisher's exact test, t-test, Mann-Whitney U test and multiple logistic regression. Akaike Information Criterion (AIC) was used to estimate the best fit model.
Four public residential homes in central region, Thailand.
249 older residents residing in public residential homes and eight intended users.
26·9 % had PEM (serum albumin <3·5 g/dl). According to multiple logistic regression and AIC values, PEM predictors were having pressure ulcer, experiencing significant weight loss and taking ≥ 9 types of medicine daily. These predictors were included in PEM screening tool. Regarding the tool performance test, area under the ROC curve was 0·8 (P < 0·001) with sensitivity and specificity of 83·9 and 45·5 %, respectively. For its practicality, eight intended users reported that it was useful and easy to use.
New screening tool may be capable of identifying PEM in older residents, and further testing is required before being recommended for use.
本研究旨在为公立养老院的老年人开发和验证蛋白质能量营养不良（PEM）筛查工具，并检验其实用性。
这项横断面研究分为两个阶段：工具开发/验证和工具实用性评估。在第 1 阶段，根据文献综述开发问卷，并进行内容有效性测试。使用该问卷对老年居民进行访谈，以确定潜在的 PEM 风险因素。使用 24 小时回顾法收集饮食数据，并测量身体成分和血清白蛋白。在第 2 阶段，由预期使用者评估新 PEM 筛查工具的实用性。通过卡方检验、Fisher 确切检验、t 检验、Mann-Whitney U 检验和多因素逻辑回归分析来分析数据。采用赤池信息量准则（AIC）来估计最佳拟合模型。
泰国中部四个公立养老院。
249 名居住在公立养老院的老年人和 8 名预期使用者。
26.9%的老年人患有 PEM（血清白蛋白 <3.5 g/dl）。根据多因素逻辑回归和 AIC 值，PEM 的预测因素包括患有压疮、经历显著体重减轻和每天服用≥9 种药物。这些预测因素被纳入 PEM 筛查工具。在对工具性能测试中，ROC 曲线下面积为 0.8（P<0.001），灵敏度和特异性分别为 83.9%和 45.5%。在实用性方面，8 名预期使用者报告称，该工具既有用又易于使用。
新的筛查工具可能能够识别老年人中的 PEM，在推荐使用之前还需要进一步测试。
