銀髮族咀嚼初篩與照護良策

Chewing Screen and Interventions for Older Adults

10.6224/JN.202008_67(4).02

葉淑惠(Shu-Hui YEH)；潘沐萱(Mu-Hsuan PAN)

銀髮族 ； 長照機構 ； 咀嚼障礙 ； 吞嚥障礙 ； 活躍老化 ； older adults ； long-term care facilities ； chewing disorders ； dysphagia ； active aging

護理雜誌

67卷4期（2020 / 08 / 01）

6 - 13

繁體中文

銀髮族入住安養機構最為人們詬病的是看到鼻胃管林立，以鼻胃管餵食銀髮族不僅是食物色、香、味覺的剝奪，也會造成營養不良和吸入性肺炎。研究發現長期照護機構鼻胃管留置的住民高達43%，其中不少鼻胃管留置的住民有顯著的營養不良及水分攝取較所需的少及身體質量指數、血中白蛋白下降情形。因為老化、牙齒缺損或中風導致長者發生吞嚥咀嚼障礙的盛行率高達60%以上，他們多以流質食物為生，而易缺乏纖維、蔬果和五穀類的攝取，引發許多健康問題，例如缺少植物類黃酮造成慢性發炎。本文旨在介紹銀髮族咀嚼篩檢、機能飲食的選擇及製備、活躍老化的餐前運動、咀嚼吞嚥照護及成效評值；期望未來跨領域的長期照護工作人員，協力合作以改善長照機構住民的口腔、咀嚼、吞嚥訓練與照護模式，提升銀髮族進食的輔具與環境、進食的選擇及滿意度；避免不必要的鼻胃管留置，以減少吸入性肺炎的發生，全面增進銀髮族的身心健康。

Seeing older adults with nasogastric (NG) tubes in nursing homes is an unfortunately widespread phenomenon in Taiwan. NG tubes deprive the wearer of the tastes, smells, and joys of food and have been associated with malnutrition and increased susceptibility to aspiration pneumonia. In our studies, we found that 43% of nursing home residents in Taiwan are intubated with an NG tube and revealed a significant lower body mass index and hypoalbuminemia in these residents. In addition, the prevalence of dysphagia in residents of long-term care institutions was found to be greater than 60%. Older adults with dysphagia usually rely on liquid diets, which are frequently low in fiber, fruit, vegetable, and cereal contents. It is well known that diets low in fiber and vegetables increase the risks of constipation and cardiovascular events in older adults. A low intake of plant flavanols may also make older adults more susceptible to chronic inflammation. A high intake of red meats, eggs, or seafood may nurture gut microorganisms that catabolize carnitine and choline to trimethylamine-N oxide and which have been significantly linked to cardiovascular diseases and increased mortality. In contrast, eating plant vegetables and cereals is known to nurture better microbiota that produce short chain fatty acids, which, in turn, nurture enterocytes and improve immunity and brain health. Thus, the aims of this article are to demonstrate how to assess elders with chewing difficulty and dysphagia and to provide functional food scales for the classification, training, and care of active-aging nutrition. Through this article, we anticipate helping long-term care caregivers master key techniques for training and caring for elders with chewing difficulties and/or dysphagia. This article is also expected to 1) improve the nutrition of elders and satisfaction with feeding, 2) improve chewing and dysphagia care and training in long-term care institutions, and 3) avoid NG tube institution and aspiration pneumonia. The suggestions of this article may be used in the future to assist long-term care units across the interdisciplinary care providers teams to promote chewing instruction, swallowing care training, and active aging, appropriate nutrition, and health in older adult populations.

1. Chen, M. Y.,Lin, L. C.(2012).Nonimaging clinical assessment of impaired swallowing in community-dwelling older adults in Taiwan.The Journal of Nursing Research,20(4),272-280.
   連結：
2. 相青琪, C. C.,胡月娟, Y. J.(2017)。口腔照護方案對口腔癌術後病人吞嚥功能之成效。護理雜誌，64(2)，88-98。
   連結：
3. 蕭玉霜, Y. S.,葉淑惠, S. H.(2018)。吞嚥障礙者營養照護之現況與展望。榮總護理，35(1)，2-9。
   連結：
4. Crary, M. A.,Humphrey, J. L.,Carnaby-Mann, G.,Sambandam, R.,Miller, L.,Silliman, S.(2013).Dysphagia, nutrition, and hydration in ischemic stroke patients at admission and discharge from acute care.Dysphagia,28(1),69-76.
5. Hollaar, V. R. Y.,van der Putten, G.-J.,van der Maarel-Wierink, C. D.,Bronkhorst, E. M.,de Swart, B. J. M.,de Baat, C.,Creugers, N. H. J.(2017).Nursing home-acquired pneumonia, dysphagia and associated diseases in nursing home residents: A retrospective, cross-sectional study.Geriatric Nursing,38(5),437-441.
6. Martín, A.,Ortega, O.,Clavé, P.(2018).Oropharyngeal dysphagia, a new geriatric syndrome.Spanish Journal of Geriatrics and Gerontology,53(1),3-5.
7. Okabe, Y.,Takeuchi, K.,Izumi, M.,Furuta, M.,Takeshita, T.,Shibata, Y.,Yamashita, Y.(2017).Posterior teeth occlusion and dysphagia risk in older nursing home residents: A cross-sectional observational study.Journal of Oral Rehabilitation,44(2),89-95.
8. Reilly, R.,Frankel, F.,Edelstein, S.(2013).Molecular gastronomy: Transforming diets for dysphagia.Journal of Nutrition Health & Food Science,1(1),1.
9. Takizawa, C.,Gemmell, E.,Kenworthy, J.,Speyer, R.(2016).A systematic review of the prevalence of oropharyngeal dysphagia in stroke, Parkinson’s disease, Alzheimer’s disease, head injury, and pneumonia.Dysphagia,31(3),434-441.
10. The Japanese Society of Dysphagia Rehabilitation(2013).Japanese Dysphagia Diet 2013 by the JSDR dysphagia diet committee.The Japanese Journal of Dysphagia Rehabilitation,17(3),255-267.
11. Tseng, Y. J.,Tsao, L. I.,Wang, H. P.,Wang, V.,Chen, M. H.,Wang, C. M.,Lin, Y. L.(2016).Negotiating the maze: Confronting dysphagia together with my stroke-afflicted family member.European Scientific Journal,12(24),63.
12. Wu, S. J.,Wang, H. H.,Chen, K. M.,Yeh, S. H.(2011).Nutritional status of nursing home residents in Taiwan.Biological Research for Nursing,13(2),189-195.
13. Zeisel, S. H.,Warrier, M.(2017).Trimethylamine N-oxide, the microbiome, and heart and kidney disease.Annual Review of Nutrition,37(1),157-181.
14. Zhang, L. S.,Davies, S. S.(2016).Microbial metabolism of dietary components to bioactive metabolites: Opportunities for new therapeutic interventions.Genome Medicine,8(1),46.
15. 何文惠, W. H.,李佳妮, C. N.,邱麗玲, L. L.(2018)。豬肉全質構分析實驗。臺灣飲食質地製備指引技術研討會，桃園市=Taoyuan City, Taiwan, ROC:
16. 何怡慧, Y. H.,劉秀月, H. Y.,黃純德, S. T.(2014)。復健期腦中風病患咀嚼吞嚥障礙盛行率及初步篩檢徵象之探討。護理雜誌，61(2)，54-62。
17. 李志明, C. M.,李明峰, M. F.,郭柏齡, P. L.,王亭貴, T. G.,連倚南, I. N.(2003)。以自製吞嚥動作儀評估食團溫度、體積及黏稠度對吞嚥功能的影響：先期研究。復健醫學會雜誌，31(2)，79-86。
18. 林以璿（2018，7月21日）．一個單字讓你記住憂鬱症的10個特徵．Heho健康．取自https://heho.com.tw/archives/18402 [Lin, Y. H. (2018, July 21). One word helps you remember the 10 characteristics of depression. Heho Health & Hope. Retrieved from https://heho.com.tw/archives/18402]
19. 林欣葦, S. W.,邱麗玲, L. L.(2018)。魚肉種類之全質構分析差異性比較。臺灣飲食質地製備指引技術研討會，桃園市=Taoyuan City, Taiwan, ROC:
20. 胡月娟、郭炯村、江青桂、陳瑋、陳蕙玲、林武佐⋯林至德（2019）．進食、吞嚥困難照護及指導方案指引手冊． 取自https://www.mohw.gov.tw/dl-58240-7db4bf9c5cc7-430a-841e-1760d967e21b.html [Hwu, Y. J., Kuo, C. T., Chiang, Q. G., Chen, W., Chen, H. L., Lin, W. J., ... Lin, J. D. (2019). Guidance manual for care and guidance of eating and swallowing difficulties. Retrieved from https://www.mohw.gov.tw/dl-58240-7db4bf9c-5cc7-430a-841e1760d967e21b.html]
21. 張源蓉, Y. J.(2016)。高雄醫學大學口腔衛生學系碩士班。
22. 莊明岫, M. H.,詹盈馨, Y. H.,邱麗玲, L. L.(2018)。白木耳作為天然增稠劑之增稠效果比較研究。臺灣飲食質地製備指引技術研討會，桃園市=Taoyuan City, Taiwan, ROC:
23. 陳怡伶, Y. L.,劉千華, C. H.,邱麗玲, L. L.(2018)。根莖類食物硬度比較研究—以地瓜為例。臺灣飲食質地製備指引技術研討會，桃園市=Taoyuan City, Taiwan, ROC:
24. 黃鈺涵, Y. H.,徐士涵, S. H.,邱麗玲, L. L.(2018)。臺灣常見水果種類之硬度比較研究。臺灣飲食質地製備指引技術研討會，桃園市=Taoyuan City, Taiwan, ROC:
25. 葉淑惠, S. H.,宋文杰, W. C.,王正方, Z. F.,楊崑德, K. D.(2019)。科技部108年度創新營運模式產學合作專案計畫科技部108年度創新營運模式產學合作專案計畫,新北市=New Taipei City, Taiwan, ROC:馬偕醫學院=MacKay Medical College。
26. 歐陽來祥, L. X.(2008).吞嚥困難評估和治療─臨床實用手冊.臺北市=Taipei City, Taiwan, ROC:心理=Psychological.

1. 陳靜瑤(Ching-Yao CHEN);王婷怡(Ting-Yi WANG);張佩琪(Pei-Chi CHANG);李紫萍(Tzu-Ping LEE);王淑敏(Shu-Ming WANG);吳昭燕(Chao-Yen WU);林淑麗(Su-Li LIN);吳徐慧(Hsu-Hui WU)(2021)。提升高齡長者進食安全指導執行率。護理雜誌。68(4)。72-80。