目的 调查宁波市养老院老年人吞咽障碍的现患率，分析其相关因素。 方法 2017年8月至2018年4月，抽取宁波市8家养老院60岁及以上老年人997例，采用一般调查问卷、洼田饮水试验、体质量指数及生活质量指数进行调查。采用Logistic回归分析吞咽障碍影响因素。 结果 997例中，共有吞咽障碍者259例(25.98%)，年龄、男性、高血压、糖尿病、高血脂、冠心病、脑卒中和骨折是吞咽障碍风险发生的危险因素(P < 0.01)；体质量过轻者占19.2%，吞咽障碍者中体质量过轻者占63.3%；生活质量指数总分随着年龄增长而显著下降(F = 18.706, P < 0.001)，男性总分高于女性(t = 2.516, P = 0.012)，有吞咽障碍者显著低于吞咽正常者(t = 7.176, P < 0.001)。 结论 宁波市养老院老年人吞咽障碍患病率较高，应及早采取干预措施。
Objective To investigate the prevalence of dysphagia in old people in nursing homes in Ningbo and analyze its related factors. Methods From August, 2017 to April, 2018, 997 people aged 60 or above were selected from eight nursing homes in four districts in Ningbo. They were investigated with general questionnaire, Kubota water swallowing test, body mass index (BMI) and Quality of Life Index (QLI), and the data were analyzed with Logistic regression. Results There were 259 (25.98%) persons with dysphagia. Age, male, hypertension, diabetes, hyperlipidemia, coronary heart disease, stroke and fracture were risk factors for dysphagia (P < 0.01). There were 19.2% with low BMI in total, and 63.3% for dysphagia. The total score of QLI decreased with age (F = 18.706, P < 0.001), more in males than in females (t = 2.516, P = 0.012), and less in those with dysphagia than with normal swallowing (t = 7.176, P < 0.001). Conclusion Dysphagia is prevalent in the old people in nursing homes in Ningbo, which needs early intervention.
1 肖卫红,吴碧玉. 脑卒中后吞咽障碍的康复研究进展[J]. 中国康复理论与实践, 2017, 23(7): 783-787.
2 ShiozuH, HigashijimaM, KogaT. Association of sarcopenia with swallowing problems, related to nutrition and activities of daily living of elderly individuals [J]. J Phys Ther Sci, 2015, 27(2): 393-396.
3 井上诚. 吞咽功能障碍的临床研究和新的挑战[J]. 中华物理医学与康复杂志, 2011, 33(12): 883-884.
4 RoyN, StempleJ, MerrillR M, et al. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects [J]. Ann Otol Rhinol Laryngol, 2007, 116(11): 858-865.
5 彭继海,张鸣生,李河,等. 高龄吞咽障碍患者影像学特征及误吸的危险因素分析[J]. 中华老年心脑血管病杂志, 2015, 17(1): 53-56.
6 张梅,姜勇,李镒冲,等. 2010年我国 ≥ 60岁老年人超重/肥胖流行特征[J]. 中华流行病学杂志, 2014, 35(4): 365-369.
7 韩维嘉. 老年吞咽障碍者的生活质理和营养评价[D]. 上海:复旦大学, 2011.
8 刘立明,瓮长水,贾建军,等. 3种吞咽障碍评定量表在老年吞咽障碍患者中的反应性[J]. 中国康复理论与实践, 2010, 16(3): 260-261.
9 CabreM, Serra-PratM, PalomeraE, et al. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia [J]. Age Ageing, 2010, 39(1): 39-45.
10 BaijensL W,ClaveP, CrasP, et al. European Society for Swallowing Disorders-European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome [J]. Clin Interv Aging, 2016, 12(11): 1403-1428.
11 NewmanR, VilardellN, ClavéP, et al. Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: white paper by the European Society for Swallowing Disorders (ESSD) [J]. Dysphagia, 2016, 31(2): 232-249.
12 StegemannS, GoschM, BreitkreutzJ. Swallowing dysfunction and dysphagia is an unrecognized challenged for oral drug therapy [J]. Int J Pharm, 2012, 430(1-2): 197-206.
13 YangE J, KimM H, LimJ Y, et al. Oropharyngeal dysphagia in a community-based elderly cohort: the Korean longitudinal study on health and aging [J]. J Korean Med Sci, 2013, 28(10): 1534-1539.
14 OharaY, HiranoH, WatanabeY, et al. Masseter muscle tension and chewing ability in older persons [J]. Geriatr Gerontol Int, 2013, 13(2): 372-377.
15 KawashimaK, MotohashiY, FujishimaI. Prevalence of dysphagia among community-dwelling elderly individuals as estimated using a questionnaire for dysphagia screening [J]. Dysphagia, 2004, 19(4): 266-271.
16 ByeonH. Analysis of dysphagia risk using the modified dysphagia risk assessment for the community-dwelling elderly [J]. J Phys Ther Sci, 2016, 28(9): 2507-2509.
17 陈艳秋. 上海老年患者吞咽障碍与营养风险及日常生活活动能力关系的研究[C]// 中国疾病预防控制中心达能营养中心. 膳食纤维与健康——达能营养中心第十七届学术年会会议论文集, 2014: 6.
18 李超,张梦清,窦祖林,等. 中国特定人群吞咽功能障碍的流行病学调查报告[J]. 中华物理医学与康复杂志, 2017, 39(12): 937-943.
19 阮顺莉,郭菊红,陈茜,等. 1025名居家60岁以上老年人吞咽障碍现状及其影响因素分析[J]. 护理学报, 2017, 24(20): 41-44.
20 WirthR, DziewasR, BeckA M, et al. Oropharyngeal dysphagia in older persons－from pathophysiology to adequate intervention: a review and summary of an international expert meeting [J]. Clin Interv Aging, 2016, 11: 189-208.
21 刘媛媛. 西安市城区老年人误吸发生及危险因素的现况调查[D]. 西安:第四军医大学, 2014.
22 JanssenI, HeymsfieldS B, WangZ M, et al. Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr [J]. J Appl Physiol, 2000, 89(1): 81-88.
23 李平,张艺军,何燕娴,等. 老年吞咽障碍病人的营养干预研究进展[J]. 实用老年医学, 2017, 31(2): 184-187.
24 TakeuchiK, AidaJ, ItoK, et al. Nutritional status and dysphagia risk among community-dwelling frail older adults [J]. J Nutr Health Aging, 2014, 18(4): 352-357.
25 ChernC J H, LeeS D. Malnutrition in hospitalized Asian seniors: an issue that calls for action [J]. J Clin Gerontol Geriatr, 2015, 6(3): 73-77.
26 CorishC A, KennedyN P. Protein-energy undernutrition in hospital in-patients [J]. Br J Nutr, 2000, 83(6): 575-591.
