浙江省内各级医院医务人员对老年营养的认识和实践情况研究

王安鸽; 陈晶; 李晗宇; 张勤

doi:10.16766/j.cnki.issn.1674-4152.003222

浙江省内各级医院医务人员对老年营养的认识和实践情况研究

doi: 10.16766/j.cnki.issn.1674-4152.003222

王安鸽¹,
陈晶^{1, 2},
李晗宇¹,
张勤^{1, 2, ,}

1.
浙江大学医学院附属第一医院老年医学科，浙江杭州 310003
2.
浙江大学医学院附属第一医院浙江省增龄与理化损伤重点实验室，浙江杭州 310003

基金项目:

浙江省科技计划项目 2022C03161

国家重点研发计划项目 2018YFC2000301

详细信息

通讯作者:
张勤，E-mail: zhangqin1978@zju.edu.cn

中图分类号: R153.3 R192
计量
- 文章访问数: 161
- HTML全文浏览量: 50
- PDF下载量: 14
- 被引次数: 0
出版历程
- 收稿日期: 2022-04-22
- 网络出版日期: 2023-11-23

Perceptions and practices of geriatric nutrition among medical staff of various levels in Zhejiang Province

WANG Ange¹,
CHEN Jing^{1, 2},
LI Hanyu¹,
ZHANG Qin^{1, 2
, ,}

1.
Department of Geriatrics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China

摘要

摘要: 目的调查各级医院医务人员的营养知识掌握水平，营养筛查、评估、干预实施情况，探讨医务人员对老年营养认识的不足之处，为开展继续教育培训提供参考。方法以老年患者临床营养管理指南和共识为依据设计调查问卷，2021年4月对参与2021年浙江省某医学学术年会的248名医护进行问卷调查，以了解各级医院对老年营养的认识和实践情况。结果共回收有效问卷237份，来自三甲医院134份(56.54%)，非三甲医院(不包含社区医院)65份(27.43%)，社区医院38份(16.03%)。调查结果显示，社区医生更倾向于低估存在营养不良风险的老年住院患者比例。各级医院中开展营养筛查的情况有明显差异，每个患者都完成筛查或经常进行营养筛查的比例在三甲医院为86.57%(116/134)，社区医院为10.52%(4/38)。各级医院营养筛查工具、营养评估指标的选择比较单一。在营养干预前膳食调查实施情况社区医院(47.37%，18/38)较三甲医院(86.57%，116/134)低。对调查问卷中临床营养干预知识部分的分析发现，在营养目标量、营养技能、营养干预并发症等方面，社区医生相对更为薄弱。结论各级医务人员对老年营养重要性认识不足，营养筛查、评估实施不到位，营养干预知识掌握程度有待于进一步提高。提高社区医师对老年营养的重视和掌握程度，使老年人在社区就能享受完整的营养筛查、评估、干预，将是未来一段时间内努力的目标。
- 营养 /
- 老年人 /
- 社区医生 /
- 继续教育
Abstract: Objective To investigate the nutritional knowledge, nutritional screening, assessment and intervention implementation of medical staff in hospitals at all levels, and to explore the deficiencies of medical staff ' s understanding of nutrition for the elderly, so as to provide reference for continuing education and training. Methods A questionnaire was designed based on the guidelines and consensus on clinical nutrition management for elderly patients. In April 2021, a questionnaire survey was conducted among 248 doctors and nurses who participated in a medical academic annual meeting in Zhejiang Province, so as to understand the understanding and practice of elderly nutrition in hospitals at all levels. Results A total of 237 valid questionnaires were returned, 134 (56.54%) from Level A tertiary hospitals, 65 (27.43%) were from non-Level A tertiary hospitals and 38 (16.03%) from community hospitals. The results showed that primary care physicians tend to underestimate the proportion of older hospitalized patients at risk of malnutrition. There was a significant difference in the frequency of nutritional screening, 86.57% (116/134) Level A tertiary hospitals always or frequently screen patients for malnutrition, while only 10.52% (4/38) primary hospitals do so. The indicators chosen for nutritional screening and assessment are inflexible. Dietary assessment prior to nutritional intervention is less common in community hospitals (47.37%, 18/38) than in Level A tertiary hospitals (86.57%, 116/134). Analysis of questions related to nutritional intervention showed inadequate detection and non-standard nutritional support therapy among community hospitals. Conclusion There was insufficient recognition of the importance of nutrition in older patients among primary care physicians. Nutritional screening and assessment were lacking, and knowledge of nutritional intervention needs to be further improved. Strengthening the training of community physicians in nutritional knowledge and providing the whole process of nutritional screening, assessment and intervention for the elderly will be the focus of our efforts for some time to come.
- Nutrition /
- The aged /
- Primary care physicians /
- Continuing education

HTML全文

图 1 各级医院开展营养筛查情况

Figure 1. Nutritional screening in hospitals at different levels

下载: 全尺寸图片幻灯片

表 1 237名医护人员营养干预知识掌握情况[人(%)]

Table 1. Knowledge of nutritional interventions among 237 medical staff [person (%)]

营养干预问题	三甲医院	非三甲医院	社区医院
老年人每日应提供的热卡应该是多少	102(76.12)	49(75.38)	20(52.63)
老年人蛋白质的补充目标量应该是多少	94(70.15)	39(60.00)	17(44.74)
老年人膳食纤维的推荐量是多少	68(50.75)	32(49.23)	18(47.37)
下列哪项不是地中海营养模式的配方特点	107(79.85)	50(76.92)	27(71.05)
营养支持的方式有哪些	120(89.55)	55(84.62)	33(86.84)
肠内营养的禁忌证有哪些	69(51.49)	34(52.31)	21(55.26)
关于营养支持，哪个是正确的(营养支持方式的选择)	59(44.03)	32(49.23)	18(47.37)
以下描述不正确的是(管饲途径的选择)	111(82.84)	45(69.23)	18(47.37)
管饲时的体位要求是	104(77.61)	48(73.85)	21(55.26)
关于营养输注泵以下选项哪些正确	98(73.13)	49(75.38)	23(60.53)
以下对洼田试验描述不正确的是	92(68.66)	39(60.00)	25(65.79)
胃肠道功能受损时需要选择哪种营养制剂	104(77.61)	48(73.85)	21(55.26)
肠内营养如出现胃肠道腹泻并发症，要注意哪些方面	53(39.55)	31(47.69)	16(42.11)
预防肠外营养中导管相关性感染的措施有哪些	107(79.85)	45(69.23)	21(55.26)
再喂养综合征风险的老年人容易出现哪些电解质缺乏	62(46.27)	26(40.00)	15(39.47)

下载: 导出CSV

参考文献(16)

[1]	ORGANIZATION W H. World report on ageing and health[M]. World Health Organization, 2015.
[2]	ESQUIVEL M K. Nutritional assessment and intervention to prevent and treat malnutrition for fall risk reduction in elderly populations[J]. Am J Lifestyle Med, 2017, 12(2): 107-112.
[3]	崔红元, 朱明炜, 陈伟, 等. 中国老年住院患者营养状态的多中心调查研究[J]. 中华老年医学杂志, 2021, 40(3): 364-369. doi: 10.3760/cma.j.issn.0254-9026.2021.03.019 CUI H Y, ZHU M H, CHEN W, et al. A multicenter study on nutritional status of elderly inpatients in China[J]. Chinese Journal of Geriatrics, 2021, 40(3): 364-369. doi: 10.3760/cma.j.issn.0254-9026.2021.03.019
[4]	VOLKERT D, BECK A M, CEDERHOLM T, et al. Management of malnutrition in older patients-current approaches, evidence and open questions[J]. J Clin Med, 2019, 8(7): 974. doi: 10.3390/jcm8070974
[5]	VOLKERT D, BECK A M, CEDERHOLM T, et al. ESPEN practical guideline: clinical nutrition and hydration in geriatrics[J]. Clin Nutr, 2022, 41(4): 958-989. doi: 10.1016/j.clnu.2022.01.024
[6]	中华医学会肠外肠内营养学分会老年营养支持学组. 中国老年患者肠外肠内营养应用指南(2020)[J]. 中华老年医学杂志, 2020, 39(2): 119-132. Chinese society for parenteral and enteral nutrition elderly nutrition support group. Guidelines for the application of parenteral and enteral nutrition in elderly patients in China[J]. Chinese Journal of Geriatrics, 2020, 39(2): 119-132.
[7]	张晓伟, 程雪娇, 石汉平. 医务人员肿瘤营养知识-态度-行为现状及既往对比分析[J]. 肿瘤代谢与营养电子杂志, 2021, 8(4): 393-397. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLDX202104014.htm ZHANG X W, CHENG X J, SHI H P. Investigation and analysis of knowledge-attitude-practice of oncology nutrition among Chinese medical staff[J]. Electronic Journal of Metabolism and Nutrition of Cancer, 2021, 8(4): 393-397. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLDX202104014.htm
[8]	NOH H M, SONG H J, PARK Y S, et al. Fall predictors beyond fall risk assessment tool items for acute hospitalized older adults: a matched case-control study[J]. Sci Rep, 2021, 11(1): 1503. doi: 10.1038/s41598-021-81034-9
[9]	DENT E, HOOGENDIJK E O, VISVANATHAN R, et al. Malnutrition screening and assessment in hospitalised older people: a review[J]. J Nutr Health Aging, 2019, 23(5): 431-441. doi: 10.1007/s12603-019-1176-z
[10]	CORISH C A, BARDON L A. Malnutrition in older adults: screening and determinants[J]. Proc Nutr Soc, 2019, 78(3): 372-379. doi: 10.1017/S0029665118002628
[11]	XU J Y, ZHU M W, ZHANG H, et al. A cross-sectional study of GLIM-defined malnutrition based on new validated calf circumference cut-off values and different screening tools in hospitalised patients over 70 years old[J]. J Nutr Health Aging, 2020, 24(8): 832-838. doi: 10.1007/s12603-020-1386-4
[12]	BELLANTI F, LO BUGLIO A, QUIETE S, et al. Comparison of three nutritional screening tools with the new GLIM criteria for malnutrition and association with sarcopenia in hospitalized older patients[J]. J Clin Med, 2020, 9(6): 1898. doi: 10.3390/jcm9061898
[13]	SAFFEL-SHRIER S, JOHNSON M A, FRANCIS S L. Position of the academy of nutrition and dietetics and the society for nutrition education and behavior: food and nutrition programs for community-residing older adults[J]. J Acad Nutr Diet, 2019, 119(7): 1188-1204.
[14]	CRUZ-JENTOFT A J, BAHAT G, BAUER J, et al. Sarcopenia: revised European consensus on definition and diagnosis[J]. Age Ageing, 2019, 48(1): 16-31. doi: 10.1093/ageing/afy169
[15]	马越, 田韵仪, 付元庆, 等. 单样本随机对照试验: 精准营养研究的新利器[J]. 中国临床研究, 2022, 35(7): 894-898. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202207002.htm MA Y, TIAN Y Y, FU Y Q, et al. A new approach for precision nutrition research: N-of-1 trials[J]. Chinese Journal of Clinical Research, 2022, 35(7): 894-898. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202207002.htm
[16]	杨蓉, 方宁远, 金花, 等. 上海市全科医生对专科疾病的诊疗现状研究[J]. 中华全科医学, 2020, 18(8): 1251-1255. doi: 10.16766/j.cnki.issn.1674-4152.001478 YANG R, FANG N Y, JIN H, et al. Study on the current situation of the diagnosis and treatment of specialist diseases by general practitioners in Shanghai[J]. Chinese Journal of General Practice, 2020, 18(0): 1251-1255. doi: 10.16766/j.cnki.issn.1674-4152.001478