Nonimaging Clinical Assessment of Impaired Swallowing in Community-Dwelling Older Adults in Taiwan

以非影像方式評估台灣社區老人之吞嚥障礙

陳妙言(Miao-Yen Chen) ； 林麗嬋(Li-Chan Lin)

《The Journal of Nursing Research》 20卷4期 (2012/12) Pp. 272-280

https://doi.org/10.1097/JNR.0b013e31827364ec

摘要

背景　吞嚥障礙常出現於腦神經功能損傷、退化性疾病以及老年病患者。社區老人的吞嚥問題應用簡易精確的評估方式確認其吞嚥障礙，及早提供吞嚥照護計畫，以提升居家長者的生活品質。目的　透過簡易吞嚥評估方式，以非影像方式評估社區高齡個案吞嚥功能及估計吞嚥障礙盛行率。方法　採調查研究法，主要評估工具為吞嚥檢查及問卷量表、吞嚥測試以及末梢動脈血氧飽和分析器與喉部表面肌電圖等，以瞭解高齡族群吞嚥功能及其吞嚥障礙盛行率。研究對象為台灣北部某行政區年齡大於65歲以上之社區民眾，進行吞嚥評估，共收案216位。結果　以吞嚥問卷檢查表及吞嚥測試（water test）進行吞嚥功能檢測發現，吞嚥障礙比率為9.5％。以年齡區分發現，四組比較年齡越大其吞嚥速度越緩慢。One-way ANOVA分析四組間之吞嚥速度達統計顯著差異（F＝6.478, p＜.00），以Scheffe事後比較發現，吞嚥時間在年齡60－69歲組與70－79歲、80－89歲組間有統計之顯著差異。吞嚥障礙與研究變項之複迴歸分析發現，年齡標準化相關係數為0.163，達統計之顯著差異（t＝2.328; p＝.021）。羅吉式迴歸統計分析自變項中年齡的Wals檢定值達統計之顯著差異（p＝.007）；而吞嚥障礙與SaO2下降＞2％同意度分析Kappa＝0.307。結論／實務應用　年齡越大吞嚥功能越容易退步，本研究成果能提供台灣社區老人發生吞嚥障礙比率，可作為臨床護理指引並提供評估吞嚥障礙客觀性之參考。

關鍵字

社區老人 ； 吞嚥障礙 ； 吞嚥評估

並列摘要

Background: Impaired swallowing is common in elderly patients as well as those with neurological disorders and degenerative diseases. Convenient and accurate assessments should be available to community-dwelling older adults to diagnose and provide early management and care of swallowing difficulties, an important factor of influence on elderly life quality.Purpose: This study used convenient nonimaging methods to assess swallowing functions in community-dwelling older adults and estimated the prevalence of swallowing difficulties.Methods: The study adopted a survey method and recruited 216 community-dwelling older adults over 65 years old in northern Taiwan. Researchers used tools including a swallowing test, questionnaire, water test, peripheral arterial pulse oximeter, and laryngeal S-EMG to assess participant swallowing functions and the prevalence of impaired swallowing.Results: We found a 9.5% prevalence of impaired swallowing based on swallow questionnaire and water test results. Age correlated negatively with swallowing speed. A one-way ANOVA showed a significant difference in swallowing speed among the four age groups (F=6.478, p＜.00). A post hoc Scheffe comparison showed significant differences in swallowing time between the 60- to 69- and 70- to 79-year-old groups and 60- to 69- and 80- to 89-year-old groups. Multiple regression of impaired swallowing on various independent variables showed a significant standardized coefficient of 0.163 for age (t=2.328, p=.021). Logistic regression showed a significant Wals test value for age (p=.007). The Kappa value was 0.307 for agreement analysis between impaired swallowing and SaO2 value reduction of more than 2%.Conclusions/Implications for Practice: Swallowing function deteriorates with age. Results of this study provide an assessment of the prevalence of impaired swallowing in community-dwelling older adults in Taiwan. Results can help guide clinical nurses to enhance their objective assessment of impaired swallowing to improve patient quality of life.

並列關鍵字

community-dwelling older adults ； impaired swallowing ； swallow assessment

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