Kato Lisako, Eltaybani Sameh, Shinohara Masumi, Igarashi Ayumi, Sumikawa Yuka, Inagaki-Asano Asa, Takeuchi Yoshinori, Yamamoto-Mitani Noriko
Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan.
Global Nursing Research Center, The University of Tokyo, Tokyo, Japan.
Res Nurs Health. 2025 Aug;48(4):478-486. doi: 10.1002/nur.22471. Epub 2025 May 27.
Body mass index (BMI) is an inexpensive, easy-to-calculate, and noninvasive marker of malnutrition. Few studies have examined the longitudinal effects of BMI on the incidence of unfavorable physical health outcomes (UPHOs) among older adults receiving homecare nursing. Therefore, this prospective cohort study examined the longitudinal effects of low BMI on the occurrence of UPHOs at multiple time points (i.e., 1-, 3-, and 6-months) among older adults (≥ 75 years) receiving homecare nursing across Japan. Using an online questionnaire, homecare nurses reported clients' height and weight, as well as socio-demographic characteristics (e.g., age and gender) and health conditions (e.g., diagnosis and dependency level). The occurrence of seven UPHOs (urinary tract infection, respiratory infection, pressure ulcer or skin tear, dehydration, poor dyspnea control, poor pain control, and traumatic fall) was also reported. The longitudinal effects of low BMI on the total number of UPHOs at 1-, 3-, and 6-months follow-ups were examined using a Restricted Moment Model (RMM) with a log link function. Among 660 participants included in the analysis, 42.12% were males, 36.96% had dementia, and 44.09% had low BMI. Adjusting for client's characteristics and the number of UPHOs at the baseline, low BMI at the baseline could increase the incidence of UPHOs at 1-, 3- and 6-month follow-ups (incidence rate ratio [95% confidence interval]:1.59 [1.21, 2.07], 1.57 [1.18, 2.07], 1.35 [1.02, 1.79], respectively). Adequate management of low BMI among older adults receiving homecare nursing would have a favorable effect on reducing the occurrence of UPHOs, thereby reducing the deterioration of overall physical conditions.
体重指数（BMI）是一种衡量营养不良的低成本、易于计算且非侵入性的指标。很少有研究探讨BMI对接受家庭护理的老年人不良身体健康结局（UPHOs）发生率的纵向影响。因此，这项前瞻性队列研究考察了低BMI在多个时间点（即1个月、3个月和6个月）对日本各地接受家庭护理的老年人（≥75岁）发生UPHOs的纵向影响。家庭护理护士通过在线问卷报告了客户的身高和体重，以及社会人口学特征（如年龄和性别）和健康状况（如诊断和依赖程度）。还报告了七种UPHOs的发生情况（尿路感染、呼吸道感染、压疮或皮肤撕裂、脱水、呼吸困难控制不佳、疼痛控制不佳和外伤性跌倒）。使用具有对数链接函数的受限矩模型（RMM）研究了低BMI在1个月、3个月和6个月随访时对UPHOs总数的纵向影响。在纳入分析的660名参与者中，42.12%为男性，36.96%患有痴呆症，44.09%的BMI较低。在调整了客户特征和基线时的UPHOs数量后，基线时的低BMI会增加1个月、3个月和6个月随访时UPHOs的发生率（发生率比[95%置信区间]：分别为1.59[1.21，2.07]、1.57[1.18，2.07]、1.35[1.02，1.79]）。对接受家庭护理的老年人的低BMI进行适当管理，将对减少UPHOs的发生产生有利影响，从而减少整体身体状况的恶化。
