高齡者口腔衛生教育介入效果之研究-以臺北市為例

本研究旨在運用社會認知理論（Social Cognitive Theory, SCT）做為研究理論基礎，研發與驗證一套高齡者口腔衛生教育之課程，探討高齡口腔衛生教育介入對於臺北市長者的進食、口腔衛生狀況、咀嚼力與口腔機能之成效。本研究以類實驗研究法立意取樣收集臺北市社區與長照機構65歲以上長者232位，以非對等控制組設計，將社區126位與長照機構106位，區分為社區實驗組68位、社區對照組58位、長照機構實驗組53位與長照機構對照組53位，實驗組皆採12週健口操訓練與4次口腔衛教課程介入，對照組則無，經由牙醫師進行口腔檢測及訪員結構式問卷調查，分析長者的進食品質、口腔衛生與口腔機能介入前後成效。本研究重要結論與建議如下：一、本研究對象有14.2%的長者屬於全口無牙，牙菌斑控制指數達72.6%，沒有雙側功能的後牙咬合接觸者占53%，顯示高齡者口腔衛生與功能維持的預防保健是重要問題。二、高齡者口腔衛生教育介入對長者口腔狀況自評、舌苔、牙菌斑、吞嚥秒數、生活品質有改善；對咀嚼力之口腔機能可維持。建議應持續鼓勵長者進行口腔健康促進活動，並整合口腔保健資源及其照護人員，規劃不同生理功能老年人的教育模式。三、研究結果發現高齡者在牙菌斑控制指數，實驗組與對照組均有顯著改善；顯示對照組再次接受牙醫師口腔檢查，亦產生同步重視潔牙的行為效應。四、進一步針對社區及長照機構65歲以上長者進行口腔狀況調查，結果顯示機構長者在口腔衛生、功能、潔牙行為與就醫資源均較社區長者低。五、藉由實證研究，建立高齡者口腔衛生教育的模式，以提昇政策面、執行面及社區長者或機構照顧者對口腔保健的重視，並擴大推廣至全國老人據點及長照機構。

關鍵字

口腔衛生教育；牙菌斑；健口操；咀嚼力；老年人

並列摘要

The purpose of this study was to create and evaluate the effect of oral health education intervention program, based on Social Cognitive Theory, among the elderly. Objectives: To investigate the influence of oral health education intervention on eating, oral health, chewing, and oral function of elderly in the Taipei city. Methods: A quasi-experimental study involving a non-equivalent control group design was conducted in the community and long-term care institutions in Taipei City. Two hundred thirty two elderly > 65 years of age were recruited; 126 were community residents (experimental group [n=68] and control group [n=58]) and 106 were from long-term care institutions (experimental group [n=53] and control group [n=53]). The intervention for the experimental group included 12 weeks of oral training and 4 oral hygiene courses; no intervention was provided to the control group. Dentists and oral hygienists collected a survey before and after the intervention, and a questionnaire on oral function and oral hygiene was administered. The main research findings are as follows: (1) Prevalence of edentulous of the subjects in this study 14.2%, plaque control record (O'Leary) reached 72.6%. 53% no bilateral occlusal function. It reveals the prevention of oral health and functional maintenance is important for elderly people. (2) Oral health education for the elderly improved the oral self-assessment, tongue coating, dental plaque, swallowing seconds and quality of life; the oral function of chewing can be maintained. Based on the current study, it is recommended that community and long-term care institutions should continue to carry out oral health promotion, coordinate oral health care resources, and plan the education mode of different physiologic functions for the elderly. (3) The results showed that the proportion of dental plaque in the elderly patients was significantly improved in the experimental group and the control group. It was shown that the control group received oral examination by the dentist again, also produced the behavioral effect of simultaneous attention to cleaning teeth. (4) Further investigate the oral status, the results showed that in oral hygiene, function, dental cleaning behavior and dental resources, the elderly in the institutions were lower than the community elders. (5) Through empirical research, an oral care network for elderly people was established to increase the importance of oral health care on policies, executives, and community elders or institutional caregivers, and to expand the promotion to national elderly strongholds and long-term institutions.