高雄地區長期照護機構之中老年人咀嚼吞嚥障礙與營養相關探討

The relationship between dysphagia and nutrition status of institutionalized residents in kaohsiung area

王曉平(Hsiao-Pin Wang)

指導教授 ： 黃純德

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2011年)

https://doi.org/10.6832/KMU.2011.00120

摘要

背景：台灣45 至64 歲中壯年齡人口所占比率，將由97 年35.1%逐年增加，145 年為48.6%。65歲以上高齡人口占總人口比率將由97年10.4%，於106年增加為14.0%，達到聯合國所稱的高齡社會（aged society），145年更增加為37.5%。咀嚼吞嚥為進食的第一個步驟，需要有效的口腔運作，以獲得良好的營養攝取。
研究目的：本研究之目的在於探討四十五歲以上長期照護機構住民咀嚼吞嚥能力與營養問題及飲食偏差之相關性。
材料與方法：本研究為針對高雄地區長期照護機構共205家，採橫斷式集束取樣，取得21家長照機構同意，由研究調查員對四十五歲以上之住民，透過訪談進行問卷調查、口檢、吞水試驗，有效樣本數共452人。利用SPSS 18.0版本建檔及統計資料分析，檢視有無異常之資料，進行除錯、修正、整理、分析。
結果：高雄地區長期照護機構住民有咀嚼吞嚥障礙者高達60.40%；社會人口學上女性、年齡越大者；生活自理能力上無法自由走動、無人協助則無法進食、無法獨立生活者；生理上具有CVA、失智症者；口腔狀況上牙齒存留齒數越少、無對咬牙者、有全口無牙或假牙鬆動；咀嚼食物為糊狀及粥狀者；吞嚥後會咳嗽、喝水時嗆咳、吞水後會嗆咳或鼻腔逆流者，其咀嚼吞嚥障礙比率較高，統計學上都有顯著相關。且有咀嚼吞嚥障礙者，其營養狀況顯示MNA合計分數 <17分、篩檢分數≦11分、體重減輕3公斤以上、臂中圍＜21公分、小腿圍＜31公分、且血中Albumin、Cholesterol生化平均值偏低。CVA、失智症者中有咀嚼吞嚥障礙者各佔71.91%、74.65%。咀嚼吞嚥障礙與營養之相關性經性別、年齡調整後：MNA分數17-23.5分者為MNA分數>23.5者其咀嚼吞嚥障礙危險比為3.84倍，MNA<17分其咀嚼吞嚥障礙調整後危險比為7.29倍。Albumin不正常值其咀嚼吞嚥障礙調整後危險比為正常值3.04倍，有顯著相關； Cholesterol不正常值其咀嚼吞嚥障礙調整後危險比為正常值1.96倍，統計學上有顯著相關。
結論與建議:
長期照護機構住民的咀嚼吞嚥障礙與其口腔健康狀況、營養狀況與健康狀況息息相關；所以增加功能牙齒數及對咬功能齒數、加強口腔保健措施及口腔照護能力，教導咀嚼吞嚥復健訓練將可減少咀嚼吞嚥障礙的發生，進而改善營養狀況，提升整體健康及其生活品質。
關鍵字:中老年人、長期照護機構、咀嚼吞嚥功能、牙齒數、營養

關鍵字

中老年人 ； 長期照護機構 ； 咀嚼吞嚥功能 ； 牙齒數 ； 營養

並列摘要

Background: The proportion of elderly aged between 45- 64 years old in Taiwan was 35.1% of the total population in 2008 and it will increase to 48.6% in 2056. The proportion of elderly aged over 64 in Taiwan was 10.4% of total population in 2008 and it will increase to 14.0% in 2017. That meets the definition of an aging society set by the United Nations. And it will increase to 37.5% in 2056. Chewing (mastication) and swallowing (deglutition) is the first step of consumption, and requires good oral function in order to acquire sufficient nutrition intake.
Purpose: The purpose of this study is to analyse the correlation between chewing and swallowing ability, nutrition and diet deviation of those aged over 45 years old and residents of long-term care institutions.
Materials and Methods: This study used cross-sectional study sampling, obtained from 21 out of 205 long-term care institutions in the Kaohsiung area. Through interviews held by the study investigators, residents over the age of 45 were enrolled in a questionnaire survey, oral examination, and water swallowing test. The total valid samples were 452 people. SPSS version 18.0 was used to perform the archive and statistical analysis.
Results: There were 60.4% of the residents of the long-term care institutions who have dysphagia in the Kaohsiung area. The social demographic factors of female, older, those who were disabled of movement for self-care of daily living, those who are unable to eat without assistance, those who can not live independently, physiology with CVA (cerebral vascular accident), those who have dementia, fewer teeth in the mouth, no corresponding teeth, no teeth or loose dentures, chew food such as porridge, cough after swallowing, choke and cough after drinking water, choke and cough after swallowing water ot nasal reflux, the rate of dysphagia is higher and had a statistically significant correlation. With chewing swallowing disorders, nutritional status display of the total MNA score＜17 points, screening score≦11 points, more than 3 kg of body weight loss, arm circumference＜21 cm, calf circumference＜31 cm, the biochemistry average rate of albumin and cholesterol in the blood tend to be lower. Those who experienced CVA or dementia and have dysphagia are 71.91% and 74.65%, respectively. After adjusting for gender and age factors, the correlation between dysphagia and nutrition showed: The odds ratio of dysphagia in those residents with MNA scores between 17-23.5 was 7.29 times of those with MNA scores＜17. The odds ratio of dysphagia in abnormal albumin value group is 3.04 times more than normal albumin value group. The odds ratio of dysphagia in abnormal cholesterol value group is 1.96 times more than normal group. There is a significant correlation in statistics.
Conclusions and Recommendations: The oral health condition, nutrition condition are highly related with dysphagia of the residents of long-term care institutions. Increasing the functional teeth number, traning and rehabilitation chewing and swallowing function, will reduce the incidence of dysphagia, enhance the nutrition status, and then, improve oral, general health and quality of life of residents in long-term care institutions.
Keywords: elderly, long-term care institutions, swallowing funtion, number of teeth, nutrition

並列關鍵字

elderly ； long-term care institutions ； swallowing function ； number of teeth ； nutrtion

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