リハ病院の高齢入院患者では低栄養に注意

今日はオーストラリアのリハ病院における高齢者の低栄養の頻度を調査した論文を紹介します。

Charlton KE, et al: Older rehabilitation patients are at high risk of malnutrition: evidence from a large Australian database. J Nutr Health Aging. 2010;14(8):622-8.

オーストラリアの2つのリハ病院に入院した65歳以上の患者2076人、平均年齢80.6歳を対象にMNAとMNA-SFで栄養評価を行いました。

結果として33％が低栄養、51.5％が低栄養のリスクありで、栄養状態良好は15.5％しかいませんでした。低栄養やリスクありの群は、栄養状態良好群と比べて入院期間も有意に長いという結果でした。以上より、リハ病院では低栄養および低栄養のリスクありの患者が極めて多く、入院期間と関連するという結論です。

リハ病院では急性期病院と同様かそれ以上に低栄養や低栄養のリスクありの患者が多いため、すべての患者にMNA-SFなど栄養アセスメントまで行うべきです。そして低栄養の患者には、積極的なリハ栄養介入が必要になります。そうしなければ十分なリハの成果を引き出すことは困難です。

また、栄養状態が悪ければ入院期間が長くなりますが、これは原疾患の重症度がある程度は交絡になっていると考えます。脳卒中でも大腿骨頚部骨折でももとの疾患が重症であればそれだけ栄養状態は悪くなりますし、重症患者は入院期間が長くなります。

Abstract
Background/objectives: Routine nutrition screening is recommended for all older patients admitted to hospital however data on the prevalence of malnutrition in rehabilitation settings is sparse. This study assessed the nutritional status of older patients admitted to rehabilitation hospitals over a 5 year period and described the association between nutritional status and length of hospital stay (LOS) in this context. The usefulness of a recently revised version of the shortened MNA (MNA-SF) was also investigated. Methods: A retrospective analysis was conducted of patients aged 65 + y admitted to two rehabilitation hospitals in New South Wales, Australia between 1st March 2003 - 30th June 2004, and 11th January 2005 - 10th December 2008. Nutritional status was determined on admission by trained dieitians using the full MNA instrument and the MNA-SF. Information on diagnosis-related grouping and length of stay (LOS) was obtained. Results: Data was available for 2076 patients with a mean age of 80.6 (27.7) y. Thirty-three percent and 51.5 % of patients were classified as malnourished and at nutritional risk, respectively. Controlling for date of admission and diagnosis related grouping, LOS was higher in malnourished and at risk groups compared to their well nourished peers (P < 0.001) by 18.5 and 12.4 days, respectively. MNA-SF demonstrated high sensitivity but relatively low specificity against the full MNA. Conclusion: The majority of older patients in the rehabilitation setting are nutritionally compromised which adversely influences LOS. In order to encourage more widespread screening, the MNA-SF may be able to replace the full MNA.