- 期刊
運用斜倚運動於吞嚥困難老人之實證護理經驗
The Experience of Recline Exercise for an Elderly with Dysphagia
摘要
背景：老人進食常因吞嚥異常造成嗆咳，若警覺性降低可能會加速吸入性肺炎風險，同時，當個體吞嚥困難時會明顯影響營養，營養不良又會影響神經肌肉功能，而使吞嚥困難更嚴重，老人很容易陷入此惡性循環，故需要實證照護介入方案以有效改善老人吞嚥困難。目的：本文主要探討運用斜倚運動（Recline Exercise, RE），協助居家老人改善吞嚥功能之實證護理經驗，並透過持續性照護的歷程，評價此介入的效果。方法：針對某社區的高齡個案執行持續性照護的歷程，透過周全性老人評估，進行吞嚥測試後結果為「未通過」，應用實證照護的5A原則進行實證文獻整理，選用斜倚運動（Recline Exercise, RE）發展訓練運動（每天執行至少3次，每週執行5日，共持續練習6週），並以吞水測試及功能性口腔進食狀態量表（Functional Oral Intake Scale, FOIS）進行成效追蹤。結果：該個案的主要護理問題為「營養狀態改變：少於身體需要／與吞嚥困難及認知障礙有關」，設計斜倚運動方案結合多媒體影音，個案自主訓練的困難得以克服，經過介入4週後，個案通過吞水測試，FOIS由level 1至level 3，且自覺可重新經由口進食的生活習慣感到滿意。結論與建議：本實證方案介入後，社區該高齡個案不但改善吞嚥功能，延緩晚期日常生活功能的下降，並增加由口進食的能力，此方案可供社區老人發展吞嚥困難老人之吞嚥訓練參考。
並列摘要
Background: Older adults with dysphagia often suffer from choking especially when they are low in the mindfulness that results in increased risk of aspiration pneumonia. Dysphagia notably affects nutrient intake, malnutrition affects neuromuscular functions, therefore further aggravates dysphagia and the cause and results becomes a vicious cycle. Evidence-based intervention programs are required to address dysphagia problems among older adults. Objective: This study explored the nursing experience of using recline exercise (RE) to help community-based older adults improve their dysphagia. Through continuous care processes to assess the effect of the proposed evidence-based interventions. Methods: 1. Procedure and Intervention: In a community, performed comprehensive geriatric assessment and continuous care processes of an older adult who did not pass the swallow test. Used the five "A's" principles of evidence-based practice to compile empirical literature. Combined RE with multimedia materials to train the participant (at least 3 sessions per day and five days per week for 6 consecutive weeks). 2. Measurements: (1) Water swallow tests. (2) Functional Oral Intake Scale (FOIS.) Results: The primary care problem of the participant was nutrition condition lower than physical demand, which was relevant to dysphagia and cognitive impairment. An RE program combined with multimedia materials helped the participant to overcome difficulties in independent training. After 4 weeks of intervention, the participant passed the water swallow test and the FOIS outcome was improved from Level 1 to Level 3. The participant perceived satisfactory with the resumed oral intake in life, and had confidence of reducing NG feeding frequency.