全人多專科團隊照護介入對吞嚥障礙衰弱病人復原力及幸福感之成效

Effectiveness of Multidisciplinary Team Care on the Resilience and Well-Being of Frail Patients with Dysphagia

高玉音(Yu-Yin Kao) ； 王怡萍(I-Ping Wang) ； 謝佳珍(Chia-Chen Hsieh) ； 王素玫(Shu-Mei Wang) ； 薛水上(Shui-Shang Hsueh) ； 鄭維德(Wei-De Cheng) ； 許心華(Hsin-Hua Hsu) ； 陳乃菁(Nai-Ching Chen) ； 李建德(Chien-Te Lee) ； 李禎祥(Chen-Hsiang Lee)

《台灣老年醫學暨老年學會雜誌》 17卷1期 (2022/02) Pp. 14-31

https://doi.org/10.29461/TGGa.202202_17(1).0002

摘要

目的：急性住院之衰弱病人因衰弱無力而無法順利吞嚥，使營養攝入不足造成衰弱問題更加嚴重，進而影響病人之復原力與幸福感。希望透過全人多專科團隊照護介入，可改善吞嚥障礙衰弱病人之復原力及幸福感。方法：本研究採隨機分派對照組及實驗組，對照組接受常規照護；實驗組除了接受常規照護並加入每週平均3-5次，每次1小時，共增加8-12小時全人多專科團隊照護介入，照護介入措施包含語言治療師、營養師、復健師、多專科醫師及其他職類針對吞嚥障礙問題提供的個人化診治協助。結果：實驗組及對照組各32人，男性佔65.6%、平均年齡67.45±14.62歲、平均住院天數為12.15±7.31。介入前，復原力與幸福感於兩組病人並無差異。本研究發現實驗組在介入後的改善顯著高於對照組，其中復原力為121.2±36.28vs. 95.12±27.11（p=.002）；幸福感為88.23±15.59 vs. 78.97±14.56（p=.017）。若各組前後測來比較，實驗組後測之復原力與幸福感皆顯著高於前測，而對照組僅復原力後測顯著高於前測。結論：透過全人多專科團隊照護，可有效減緩衰弱病人於急性住院中整體的吞嚥困難，減低病人進食過程中異物吸入或嗆咳之風險，進而提升其復原力及幸福感。

關鍵字

全人多專科團隊照護 ； 衰弱病人 ； 吞嚥障礙 ； 復原力 ； 幸福感

並列摘要

Purpose: Patients with frailty and swallowing problems may develop debility due to insufficient nutrition, thereby affecting their resilience and well-being. Methods: We conducted a randomized controlled trial to explore the effectiveness of holistic care on the resilience and well-being of patients with frailty and dysphagia. The experimental group received routine care plus the intervention of multidisciplinary team care, whereas the control group received only routine care. The multidisciplinary team included a speech therapist, dietitian, rehabilitation therapist, and physicians, who performed personalized medical intervention (3-5 hours a week for a total of 8-12 hours) on each patient in the experimental group. Results: A total of 32 patients (65.6% men, average age: 66.98±17.37 years, and average hospitalization period: 12.15±7.31 days) were enrolled and placed in either the experimental or the control group. No significant difference in resilience and well-being was observed between the experimental and control groups before the intervention. After the intervention, the resilience scale was 121.2±36.28 in the experimental group and 91.56±27.11 in the control group, indicating a significant difference (p=0.002). Moreover, the well-being scale after the intervention was 88.23±15.59 and 78.97±14.56 in the experimental and control groups, respectively, indicating a significant difference (p=0.017). The resilience and well-being of the experimental group showed significant improvement after the intervention. On the other hand, in the control group, only resilience reported significant post-intervention improvement. Conclusion: Multidisciplinary team care for patients with frailty and swallowing disorders effectively slows down their frailty and enhances their resilience and well-being.

並列關鍵字

Holistic care ； frail patients ； dysphagia ； resilience ； well-being