Johnson L E, Dooley P A, Gleick J B
Department of Family Medicine, University of Cincinnati Medical Center, OH 45267-0582.
J Am Geriatr Soc. 1993 Sep;41(9):947-52. doi: 10.1111/j.1532-5415.1993.tb06760.x.
To determine why elderly nursing home patients receive liquid oral protein supplements, what nutritional assessment is utilized, and whether there is evidence of effectiveness.
Retrospective, case control study comparing patients over 65 years of age, at two nursing homes, who were served oral supplements (OS) at least twice daily (n = 56), with a random sample of non-supplemented, non-tube fed patients (n = 53). Comparisons included medical diagnoses, medications, morbidity and mortality, weight changes, laboratory test results, and functional and behavioral status.
Nursing home patients were begun on OS (median time after admission = 2 months, range = 0-72 months) primarily because of weight loss (71%) and poor appetite (16%). Supplemented patients were below an age-adjusted body weight on admission, unlike controls, and continued to lose weight until OS were started. On OS, weight was slowly regained over 9-10 months in a majority of patients to approximate admission weight. Some patients on OS showed improvement in albumin, total lymphocyte count, cholesterol, or hemoglobin, but too few patients had sufficient lab tests to verify any consistent effect. Mortality was higher in OS patients (8 vs 2, P = 0.057), who were also somewhat older (87.9 vs 84.5 years), but there was no statistical difference in infection or hospitalization rate.
Nutritional assessment in these nursing homes consisted almost exclusively of (1) serial measurement of weight, (2) comparison of weight to (a) "ideal body weight" and (b) previous weight, and (3) a subjective evaluation of food consumption. No other anthropometric evaluations or laboratory tests were conducted for nutritional assessment.
The diagnosis of and intervention in under-nutrition in nursing home patients is frequently disorganized. In addition, nutritional assessment, either for screening or for following intervention, is hampered by the lack of convenient and unambiguous assessment tools. OS use is associated with weight gain in many nursing home patients and also improves other nutritional parameters in selected individuals.
确定老年疗养院患者接受口服液体蛋白质补充剂的原因、所采用的营养评估方法以及是否有有效性证据。
回顾性病例对照研究，比较两家疗养院中年龄超过65岁、每天至少接受两次口服补充剂（OS）的患者（n = 56）与未接受补充剂、未进行管饲的随机抽样患者（n = 53）。比较内容包括医学诊断、用药情况、发病率和死亡率、体重变化、实验室检查结果以及功能和行为状态。
疗养院患者开始接受OS（入院后中位时间 = 2个月，范围 = 0 - 72个月）主要是因为体重减轻（71%）和食欲不佳（16%）。与对照组不同，接受补充剂的患者入院时低于年龄调整后的体重，并且在开始使用OS之前体重持续下降。使用OS后，大多数患者在9 - 10个月内体重缓慢恢复至接近入院时的体重。一些使用OS的患者白蛋白、总淋巴细胞计数、胆固醇或血红蛋白有所改善，但进行充分实验室检查以证实任何一致效果的患者太少。接受OS的患者死亡率较高（8例 vs 2例，P = 0.057），他们的年龄也稍大一些（87.9岁 vs 84.5岁），但感染率或住院率无统计学差异。
这些疗养院的营养评估几乎完全包括：（1）连续测量体重；（）将体重与（a）“理想体重”和（b）先前体重进行比较；（3）对食物摄入量进行主观评估。未进行其他人体测量评估或实验室检查以进行营养评估。
疗养院患者营养不良的诊断和干预常常缺乏条理。此外，由于缺乏方便且明确的评估工具，营养评估无论是用于筛查还是用于跟踪干预都受到阻碍。在许多疗养院患者中，使用OS与体重增加相关，并且在部分个体中还改善了其他营养参数。
