口腔運動對吞嚥障礙長者舌肌力之成效

根據世界衛生組織定義，65歲以上老年人口占總人口比率達到7％時稱為「高齡化社會」，達到14％是「高齡社會」，若達20％則稱為「超高齡社會」(內政部，2018)。據內政部統計爾後人口將呈現負成長，預計 2026 年老年人口將超過 20%，進入超高齡社會。專家指出老年人經常衍生高齡咀嚼、吞嚥功能退化問題(張世傑，2013)發生吞嚥障礙原因有很多，往往通常是因為疾病或漸漸老化造成肌無力而造成，肌肉力量變差，吞嚥速度會變慢，味覺、嗅覺也會變遲鈍。老化在吞嚥功能上依症狀與原因為:口水不足、口腔感覺功能衰退、口咽部肌肉無力、疾病相關因子、舌骨移位不足及舌骨會厭韌帶肌肉纖維減少，上述症狀皆是造成吞嚥障礙原因，吞嚥跟肌肉力量有相當大的關係，簡單的說：任何有傷害到吞嚥有關的神經或肌肉，都會造成老年人吞嚥困難的原因。本研究旨在探討口腔運動對吞嚥障礙長者舌肌力之成效，採類實驗研究設計(Quasi-experimental research design)，以中部某護理之家及長期照顧機構長者為研究對象，選取(1)意識清楚聽得懂指令之個案。(2)願意加入本研究並簽署同意書者。(3)年齡≧65歲。(4)喉嚨發聲吞嚥篩選≦4分，符合條件之長者，分為實驗組與對照組長者共36人。對照組採一般常規護理，實驗組介入口腔運動，包括發音體操、舌肌運動、唾液腺體操，每天二次，一次30分鐘，一週五天，持續12週，並以廣義估計模式 (Generalized Estimating Equations, GEE)，檢定各個時間點，成效觀測值的改變情形以檢視介入措施的成效。研究結果顯示，有吞嚥障礙長者(前測 vs 3個月後測)舌肌力之成效，實驗組10.56 kpa vs 12.61 kpa，對照組10.28 kpa vs 8.78 kpa。經廣義估計方程模式顯示，接受口腔運動介入吞嚥障礙長者舌肌力之成效皆優於對照組(p =.009)。

關鍵字

吞嚥障礙；口腔運動；舌肌力；老化

並列摘要

According to the definition of the World Health Organization, when the proportion of the elderly population over 65 years old reaches 7%, it is called "aged society", and 14% is "old age society". If it is 20%, it is called "super senior society" (Ministry of Interior, R.O.C. 2018). According to the statistics of the Ministry of the Interior, the population will show negative growth. It is expected that the elderly population will exceed 20% in 2026 and enter the ultra-age society. Experts point out that older people often develop advanced chewing and degenerative swallowing problems (Zhang, 2013). There are many causes of dysphagia, often caused by muscle weakness caused by disease or aging. When it is worse, the swallowing speed will be slower, and the taste and smell will become dull. The symptoms and causes of aging in swallowing function are insufficient saliva, deteriorating oral sensory function, muscle weakness of oropharynx, disease-related factors, insufficient transposition of the hyoid bone, and reduction of muscle fibers in the ligament of the hyoid bone. These symptoms are caused by dysphagia. The reason is that swallowing has a considerable relationship with muscle strength. Simply put: Any nerve or muscle that is damaged by swallowing will cause difficulty in swallowing in the elderly. The purpose of this study was to explore the effect of oral exercise on tongue muscle strength of elderly people with dysphagia. A quasi-experimental pretest-posttest research design was adopted, eligible residents were recruited from a long-term care institution as the research object and selecting (1) awareness cases that clearly understand the instructions. (2) Those who are willing to join this study and sign the consent form. (3) Age ≧65 years old. (4) The throat vocalization and swallowing screening ≦ 4 points. The elders who meet the conditions are divided into experimental group and control group of 36 persons. The comparison group received usual care only, and the experimental group received an oral exercise program, including pronunciation gymnastics, tongue muscle exercise, salivary gland gymnastics, for 30 minutes, twice per day, 5 days weekly for 12 weeks. Generalized Estimating Equations (GEE) was used for examining the changes in effectiveness observations at various points in time to examine the effectiveness of interventions. The results of the study showed that the effect of tongue strength in the elderly with dysphagia (pretest vs. 3 months later) was 10.56 kpa vs 12.61 kpa in the experimental group and 10.28 kpa vs 8.78 kpa in the control group. The GEE model shows that the effect of oral muscle intervention on the tongue strength of elderly patients with dysphagia is superior to the control group (p = .009).