요양병원 장기 입원 노인환자에서 영양교육 실시에 따른 영양개선 효과평가

Abstract

This study was conducted to evaluate nutritional improvement following nutrition education for elderly patients hospitalized for a long time, with 61 elderly ones(18 males and 43 females) at N nursing home located on Naju city, Jeollanam-do. The subjects' general characteristics and physical conditions were investigated first and then a regular nutrition education was conducted for four weeks. Changes in subjective health condition, quality of life, recognition on depression, diet habit, nutritional knowledge and risk factors of nutritional condition before and after the education were examined. The age of females(78.8±6.7) was older than that of males (76.7±9.6). For cohabitation types, both of males living alone and living only with spouses were 44.4% of total male subjects respectively and 46.5% of the female ones lived alone so the rate of females living alone was significantly higher than that of the males living alone(p〈0.01). When the subjects' occupation was investigated, agriculture and stock breeding accounted for more compared to any other significantly in both of the males and the females(50.0% and 51.2% respectively)(p〈0.01). BMI of the males and the females was 20.0±2.3 kg/m2 and 22.0±4.1 kg/m2 respectively and BMI of females was higher than that of the males. In examining changes of recognition on health condition after the four-week nutrition education considering results of a preliminary survey, the scores of the male subjects rose significantly from 2.9±1.0 points before the education to 3.3±1.0 ones after it by 0.3 points(p〈0.05) and those of the female ones also increased significantly from 2.8±1.0 to 3.2±0.9 by 0.3(p〈0.001). For quality of life, the scores grew significantly from 3.1±0.9 to 3.5±0.7 by 0.4(p〈0.01) in the males and from 3.2±0.8 to 3.4±0.6 by 0.2(p〈0.01) in the females. When the degree of depression felt for last four weeks was investigated, that of the males deceased significantly from 2.6±1.5 points to 2.2±0.7 points by 0.3 ones(p〈0.05) and that of the females also declined significantly from 2.6±1.0 to 2.3±0.8 by 0.3(p〈0.001). For changes of diet habit after the nutrition education, the scores were enhanced significantly from 29.6±3.6 to 32.1±2.0 by 2.5 points(p〈0.001) in the males and from 27.7±2.8 to 30.9±1.9 by 3.2(p〈0.001) in the females. The item showing the biggest change was intake habit of milk and vegetables. When changes in knowledge of nutrition after the education were evaluated, the scores were improved significantly from 19.8±1.3 to 21.3±1.1 by 1.5(p〈0.001) and from 19.8±1.5 to 21.3±1.0 by 1.5(p〈0.001) in the males and the females respectively. While the scores of knowledge of salt, diabetes, water and alcohol were reduced even after the education, those of knowledge of effects of exercise and roles of iron and calcium grew most largely. The scores of risk of nutrition intake decreased significantly after the education from 6.0±3.4 to 5.7±3.3 by 0.3 in the males(p〈0.05) and from 7.7±3.6 to 7.1±3.6 by 0.6(p〈0.001) in the females. The items producing the biggest changes were taking a meal alone and taking regular three meals. When changes of intakes according to nutrients after the education were investigated, calories increased significantly from 1,333.9±162.3 kcal to 1,524.1±172.5 kcal by 190.3 kcal(p〈0.001) in the male subjects and from 1,213.3±222.2 kcal to 1,370.3±240.6 kcal by 157.0 kcal(p〈0.001) in the female ones. In comparison with an estimated necessary amount of energy, it was enhanced from 65.7% to 75.0% and from 75.8% to 85.6% in the males and the females respectively. When compared with recommended intakes, nutrients which intakes grew after the education, were proteins, dietary fiber, calcium, phosphorus, iron, sodium, zinc, vitamin A, thiamin, riboflavin, vitamin B6, niacin, vitamin C, folic acid and vitamin E while potassium intake was reduced. The intake ratio of carbohydrate : protein : lipid changed significantly from 61.7 : 17.4 : 20.9 to 59.7 : 17.9 : 22.4 in the males and from 60.3 : 17.8 : 21.9 to 58.9 : 18.1 : 22.9 in the females(p〈0.001). From the results after the four-week nutrition education, if a continuous education including actual participation and practice rather than education simply delivering knowledge of nutrition was performed for the elderly, their wrong nutritional intake would be improved. That was considered to lead to the decease of medical cost following a growing aged population and the expansion of disability adjusted life expectancy.