高齢入院患者の栄養状態とADL・APDLの関連

高齢入院患者の栄養状態とADL・APDLの関連を横断研究でみた論文を紹介します。

Oliveira MR, Fogaça KC, Leandro-Merhi VA. Nutritional status and functional capacity of hospitalized elderly. Nutr J. 2009 Nov 17;8:54.

下記のHPで全文PDFで見れます。

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781024/pdf/1475-2891-8-54.pdf

栄養状態とADLの関連をみた論文はいくつかありますが、APDLも調査している論文は知りませんでした。60歳以上の入院患者で、入院後24-72時間以内に調査しています。入院後早期の調査なので、廃用症候群の要素は少ないと考えます。

高齢入院患者240人の栄養状態をMNAで調査した結果、33.8％が栄養状態良好、37.1%が低栄養の恐れあり、29.1%が低栄養と判定されました。低栄養の患者ほど、ADLとAPDLのすべての項目で自立度が低いという結果でした。食事動作が全介助もしくは一部介助だったのは、栄養状態良好で2.5%、低栄養の恐れありで13.4%、低栄養で半数以上（55.7%）でした。

これより栄養状態とADL・APDLの低下に関連があるといえます。栄養状態が悪いからADL・APDLが低下する、ADL・APDLの自立度が低いから栄養状態が悪化する、どちらもありえます。ただもっともありそうなのは、入院に至った原因疾患が重症のため、栄養状態もADL・APDLも低いという関連です。

Abstract
BACKGROUND: The nutritional status of the aging individual results from a complex interaction between personal and environmental factors. A disease influences and is influenced by the nutritional status and the functional capacity of the individual. We asses the relationship between nutritional status and indicators of functional capacity among recently hospitalized elderly in a general hospital.

METHODS: A cross-sectional study was done with 240 elderly (women, n = 127 and men, n = 113) hospitalized in a hospital that provides care for the public and private healthcare systems. The nutritional status was classified by the MNA (Mini Nutritional Assessment) into: malnourished, risk of malnutrition and without malnutrition (adequate). The functional autonomy indicators were obtained by the self-reported Instrumental Activity of Daily Living (IADL) and Activity of Daily Living (ADL) questionnaire. The chi-square test was used to compare the proportions and the level of significance was 5%.

RESULTS: Among the assessed elderly, 33.8% were classified as adequate regarding nutritional status; 37.1% were classified as being at risk of malnutrition and 29.1% were classified as malnourished. All the IADL and ADL variables assessed were significantly more deteriorated among the malnourished individuals. Among the ADL variables, eating partial (42.9%) or complete (12.9%) dependence was found in more than half of the malnourished elderly, in 13.4% of those at risk of malnutrition and in 2.5% of those without malnutrition.

CONCLUSION: There is an interrelationship between the nutritional status of the elderly and reduced functional capacity.