年老衰弱症的營養處置

Nutritional Management for Senile Frailty

老化是一種連續不斷的生理變化過程，許多器官功能漸漸退化。老化衰弱會引起一連串問題，而引發整體功能的下降，其中老年厭食症（senile anorexia）會減低食物攝取，引發疾病及惡病質、肌少症（sarcopenia）等而引起失能，進而引起老年衰弱（senile frailty）。台灣地區的歲以上社區老人發生衰弱症和衰弱前期分別為4.9%和40%。均衡足夠的熱量及優質蛋白質攝取走預防老年衰弱症和增進老年生活機能的重要方法之一。歐洲臨床營養代謝學會（ESPEN）和PROT-AGE研究小組建議的歲以上健康老人要維持和增加肌肉，每日每公斤體重需要攝取1.0-1.2公克蛋白質；對於急性或慢性疾病的老人，則需要將蛋白質攝取提高至1.2-1.5公克，熱量需求為30-40大卡／公斤體重。適時給予高蛋白高熱量點心，濃縮型口服營養補充品或添加食物香味劑，可有效地改善老年人的營養狀況。老年人也易發生維生素D_3缺乏，可能引起肌肉強力和骨質流失，增高跌倒及死亡的風險。歐洲骨質疏鬆和骨關節炎臨床經濟學會（ESCEO）建議，骨質疏鬆的老年人每日應攝取1000毫克鈣質，80IU維生素D_3及1.0-1.2公克蛋白質／公斤體重。攝取足量蛋白質，搭配適合的運動，可改善老年人肌肉流失和肌肉蛋白合成。PROT-AGE研究小組建議，每日應做到分鐘耐力運動和每週2-3次10-15分鐘肌力運動。此篇綜合整理老年厭食、非刻意性體重下降及衰弱症之營養處置策略。

Aging is a continuous changing process in physiological status. As aging, many organs' function gradually degrades. Aging frailty results in a series of problems, furthermore, caused decline in overall function, among which senile anorexia reduces food intake, incurs diseases, cachexia and sarcopenia, followed by disability. Multifaceted causes lead to senile frailty. In Taiwan, prevalence of frailty and pre-frailty among elderly aged 65 years old and above in community old was 4.9% and 40%, respectively. Balanced, adequate energy and high quality protein intake is an important strategy to prevent from senile frailty and to improve physical function of elderly. ESPEN and PROT-AGE study group recommended that protein intake for healthy elderly is 1.0-1.2 g/kg body weight (BW)/day to achieving muscle's maintenance and enhancement. For elderly with critical or chronic illness, the protein intake and energy intake should increase to 1.2-1.5 g/kg BW/day and 30-40 kcal/kg BW/day, respectively. Promptly supplying high protein and high energy snack, concentrated oral nutritional supplements or food flavorings effectively improve nutritional status of the elderly. Vitamin D3 deficiency is common in the elderly and may cause loss of muscle strength and bone leading to increased risk of falls and mortality. ESCEO recommends that daily calcium intake for elderly with osteoporosis is 1000 mg; vitamin D3 is 800IU; protein need is 1.0-1.2 g/kg BW/day. Adequate protein intake and safe and well-tolerated exercise may improve muscle loss and muscle synthesis. PROT-AGE recommends daily 30 minutes endurance exercise and 10-15 minutes resistance exercise for older people. This paper reviews nutritional management for senile anorexia, unintentional weight loss and senile frailty.