老年人营养不良筛查和评估工具临床应用及存在的问题

The Clinical Application and Problems of Screening and Assessment Tools for Malnutrition in Elderly

21世纪是全球老龄化时代,营养不良是全球范围内老年人面临的主要健康问题之一,可导致诸多不良的临床后果。目前,营养不良标准的定义和统一的诊断标准尚未形成,临床上需要使用各种营养不良筛查和评估工具对患者进行识别诊断。营养筛查工具临床常见,快速、易于使用,常用于筛查营养不良或营养不良风险的人群,并可确定这一人群是否需要进一步营养评估和干预。营养评估工具是一类多维度、综合的评估工具,不同于营养筛查工具,需要由有资质的卫生专业人员实施,常用于诊断营养不良。鉴于住院老年患者使用不同的营养不良评估工具可能得出不同的营养不良患病率,以及临床上非营养专科的临床医生针对不同患者选择何种营养不良筛查和评估工具进行营养不良筛查和评估感觉困惑,本研究梳理了目前临床常用的营养筛查和评估工具的特点、适用范围及临床应用情况,总结出临床应用的问题,提出每种工具各有特点,每种工具针对不同环境中老年患者的效度验证也仍需大量的临床试验证实,以期引起临床医生对老年患者营养不良的重视,为临床诊断和改善营养不良提供循证依据。

The 21st century is the era of global aging.Malnutrition is a major health problem for the elderly worldwide and can lead to adverse clinical consequences.However,at present,there is no definition of malnutrition standards and unified diagnostic standards.Clinically,various malnutrition screening and assessment tools are needed to identify and diagnose patients.Malnutrition screening tools are clinically common,fast,and easy-to-use,which are often used to screen people who are at risk of malnutrition or malnourished people,and can determine whether this population needs further malnutrition assessment and intervention.With difference from malnutrition screening tools,malnutrition assessment tools are a type of multi-dimensional and comprehensive assessment tools,which need to be implemented by qualified health professionals and are often used to diagnose malnutrition.In view of the use of different malnutrition assessment tools for hospitalized elderly patients,different prevalence of malnutrition may be derived,and clinically non-nutrition specialist clinicians feeling confused about selecting malnutrition screening and assessment tools for different patients to perform malnutrition screening and assessment.This study combed the characteristics and clinical applications of commonly used malnutrition screening and malnutrition tools in clinical practice,and summarized the problems of clinical application.It is proposed that each tool has its own characteristics,and the validity of each tool for elderly patients in different environments still needs a large number of clinical trials to confirm,in order to attract clinicians to pay attention to malnutrition in elderly patients,and provide reference for clinical diagnosis and improvement of malnutrition.