失智患者進食困難探討

Exploration of Eating Difficulties of Patients With Dementia

10.6224/JN.63.4.128

王守訥(Shou-Na Wang)；張佳琪(Chia-Chi Chang)；李碧霞(Pi-Hsia Lee)

失智症 ； 進食困難 ； 老人 ； dementia ； eating difficulty ； the elderly

護理雜誌

63卷4期（2016 / 08 / 01）

128 - 134

繁體中文

失智症人數隨著人口老化亦逐年增加，而隨著失智症疾病進展，有一半以上的患者會面臨進食困難的問題，這也是造成家屬困擾的問題之一。病因大多是錯綜複雜，一旦病患有進食困難問題，緊接而來的是體重下降、營養不良、吸入性肺炎住院增加，甚至死亡。本文藉由失智症進食困難文獻回顧，將進食過程分為四個階段，如：辨識食物、拿取食物放入口中、咀嚼、吞嚥的過程，分別探討患者在各階段出現進食困難可能的因素及可能出現行為徵象，進而介紹改善進食困難問題的方法，提供給有進食困難問題的失智症患者或照顧者多項選擇方法。希望除了提升醫療人員及照顧者對失智症進食困難原因及呈現徵象更加了解外，更期待醫療團隊應該更謹慎評估病患整體狀況，提供最適切介入措施，讓病患獲得最舒適及最非侵入性的進食方式，改善病患進食品質，也使病患與家屬可獲得心靈安適。

The number of people living with dementia is growing as the average age of the population rises. Eating difficulties are a common problem for dementia patients and their caregivers. The etiology of these difficulties is often complicated. Weight loss, poor nutrition, aspiration pneumonia, and associated medical admissions or even mortality may occur as soon as an eating difficulty develops. This paper presents a literature review of the eating difficulties of dementia patients. The process of eating involves four stages: recognizing food, taking food into the mouth, chewing, and swallowing. We discuss the causes and clinical manifestations of eating difficulties at each of these stages and introduce an intervention for overcoming eating difficulties, aiming at providing choices of methods to improve eating behavior. The author hopes that this review will help medical personnel / caregivers enhance their understanding of the etiology and the clinical manifestation of eating difficulties in dementia patients, evaluate the overall condition of their patient(s), and provide an appropriate intervention in order to help these patients experience the most comfortable and non-invasive ways of eating or feeding, improve their quality of eating, and realize with their family improved spiritual well-being.

1. 台灣失智症協會（2016）．失智人口知多少？ 取自http://www.tada2002.org.tw/tada_know_02.html#01 [Taiwan Alzheimer Disease Association. (2016). What is the true extent of the dementia population? Retrieved from http://www.tada2002.org.tw/tada_know_02.html#01]
2. American Health Care Association. (2009). OSCAR data report: Nursing facility patient characteristics report. Retrieved from http://www.ahcancal.org/research_data/oscar_data/Pages/LTC%20Stats.aspx
3. American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee(2014).American geriatrics society feeding tubes in advanced dementia position statement.Journal of the American Geriatrics Society,62(8),1590-1593.
4. Chang, C. C.(2012).Prevalence and factors associated with feeding difficulty in institutionalized elderly with dementia in Taiwan.The Journal of Nutrition, Health & Aging,16(3),258-261.
5. Chang, C. C.,Lin, L. C.(2005).Effects of a feeding skills training programme on nursing assistants and dementia patients.JCN: Journal of Clinical Nursing,14(10),1185-1192.
6. Chang, C. C.,Roberts, B. L.(2008).Cultural perspectives in feeding difficulty in Taiwanese elderly with dementia.Journal of Nursing Scholarship,40(3),235-240.
7. Chang, C. C.,Roberts, B. L.(2011).Strategies for feeding patients with dementia.American Journal of Nursing,111(4),36-44.
8. Clarke, L. H.,Korotchenko, A.(2011).Aging and the body: A review.Canadian Journal on Aging / La Revue canadienne du vieillissement,30(3),495-510.
9. Dunne, T. E.,Neargarder, S. A.,Cipolloni, P. B.,Cronin-Golomb, A.(2004).Visual contrast enhances food and liquid intake in advanced Alzheimer's disease.Clinical Nutrition,23(4),533-538.
10. Edahiro, A.,Hirano, H.,Yamada, R.,Chiba, Y.,Watanabe, Y.,Tonogi, M.,Yamane1, G.(2012).Factors affecting independence in eating among elderly with Alzheimer's disease.Geriatrics & Gerontology International,12(3),481-490.
11. Grealy, J.、McMullen, H.、楊詠仁譯、蔡佳芬譯、高靜玲譯、湯麗玉譯、柯宏勳譯、張文芸譯(2009)。實用圖解失智症照護指引。台北市=Taipei City, Taiwan, ROC:合記圖書=Ho-Chi Book。
12. Hanson, L. C.,Ersek, M.,Lin, F. C.,Carey, T. S.(2013).Outcomes of feeding problems in advanced dementia in a nursing home population.Journal of the American Geriatrics Society,61(10),1692-1697.
13. Hsiao, H. C.,Chao, H. C.,Wang, J. J.(2013).Features of problematic eating behaviors among community-dwelling older adults with dementia: Family caregivers' experience.Geriatric Nursing,34(5),361-365.
14. Lin, L. C.,Huang, Y. J.,Su, S. G.,Watson, R.,Tsai, B. W. J.,Wu, S. C.(2010).Using spaced retrieval and Montessoribased activities in improving eating ability for residents with dementia.International Journal of Geriatric Psychiatry,25(10),953-959.
15. Lin, L. C.,Huang, Y. J.,Watson, R.,Wu, S. C.,Lee, Y. C.(2011).Using a Montessori method to increase eating ability for institutionalised residents with dementia: A crossover design.JCN: Journal of Clinical Nursing,20(21-22),3092-3101.
16. Liu, W.,Cheon, J.,Thomas, S. A.(2014).Interventions on mealtime difficulties in older adults with dementia: A systematic review.International Journal of Nursing Studies,51(1),14-27.
17. Mitchell, S. L.,Teno, J. M.,Kiely, D. K.,Shaffer, M. L.,Jones, R. N.,Prigerson, H. G.,Hamel, M. B.(2009).The clinical course of advanced dementia.The New England Journal of Medicine,361(16),1529-1538.
18. Miyamoto, K.,Higashino, S.,Mochizuki, K.,Goda, T.,Koyama, H.(2011).Evaluation of weight loss in the community-dwelling elderly with dementia as assessed by eating behavior and mental status.Asia Pacific Journal of Clinical Nutrition,20(1),9-13.
19. Richeson, N. E.,Neil, D. J.(2004).Therapeutic recreation music intervention to decrease mealtime agitation and increase food intake in older adults with dementia.American Journal of Recreation Therapy,3(1),37-41.
20. Shinagawa, S.,Honda, K.,Kashibayashi, T.,Shigenobu, K.,Nakayama, K.,Ikeda, M.(2016).Classifying eatingrelated problems among institutionalized people with dementia.Psychiatry and Clinical Neurosciences,70(4),175-181.
21. Simmons, S. F.,Keeler, E.,Zhuo, X.,Hickey, K. A.,Sato, H. W.,Schnelle, J. F.(2008).Prevention of unintentional weight loss in nursing home residents: A controlled trial of feeding assistance.Journal of the American Geriatrics Society,56(8),1466-1473.
22. Smith, H. A.,Kindell, J.,Baldwin, R. C.,Waterman, D.,Makin, A. J.(2009).Swallowing problems and dementia in acute hospital settings: Practical guidance for the management of dysphagia.Clinical Medicine,9(6),544-548.
23. Suominen, M. H.,Kivisto, S. M.,Pitkala, K. H.(2007).The effects of nutrition education on professionals' practice and on the nutrition of aged residents in dementia wards.European Journal of Clinical Nutrition,61(10),1226-1232.
24. van Bruchem-Visser, R. L.,Oudshoorn, C.,Raso, F. U. M.(2014).Letter to the editor/case report: Why should we not tube-feed patients with severe Alzheimer dementia?.Best Practice & Research Clinical Gastroenterology,28(2),255-256.
25. 利怡慧、陳淑銘、周嫚君、黃翠媛(2014)。以系統性文獻回顧檢視音樂介入在失智症老人護理實務的運用。護理雜誌，61(2)，84-94。
26. 吳樺姍、林麗嬋(2012)。間時提取訓練於失智患者之應用。護理雜誌，59(5)，79-83。
27. 施至遠、陳人豪(2008)。老年人吞嚥障礙之評估與處置。長期照護雜誌，12(4)，337-346。
28. 梁家欣、程蘊菁、陳人豪(2014)。失智症之重點回顧。內科學誌，25(3)，151-157。
29. 陳妙言、林麗嬋(2010)。吞嚥障礙之概念分析。護理雜誌，57(1)，100-105。

1. 劉建良,林乃玉(2020).重度與末期失智症者進食方式選擇－以台北市區域醫院經驗為例.長期照護雜誌,24(1),23-32.
2. 劉建良、林乃玉(2019)。醫病共享決策及決策輔助工具之發展－以「失智末期吞嚥困難之進食方式選擇」為例。榮總護理，36(2)，170-177。
3. 蕭華岑,趙慧珍,楊雅萍,陳乃菁(2021)。照護失智患者飲食能力量表發展與驗證。台灣公共衛生雜誌，40(6)，660-679。