專業間協力合作在長期照顧之吞嚥訓練

Interprofessional Collaborative Practice in Long-Term Care: Swallow Training

10.6224/JN.202202_69(1).03

梁風琦(Feng-Chi LIANG)；卓明慧(Ming-Hui CHO)

老年營養 ； 吞嚥訓練 ； 長期照顧 ； elder nutrition ； swallow training ； long-term care

護理雜誌

69卷1期（2022 / 02 / 01）

12 - 17

繁體中文

吞嚥障礙常見於長期照顧機構的長輩，當出現較嚴重的吞嚥障礙影響由口進食攝取時，多數會使用鼻胃管以替代正常進食的方式。吞嚥訓練一般是由語言治療師來執行，依其障礙程度與進展，每階段需使用不同的食物質地作為訓練食材，食物量及質地的調製則由營養師依照長輩進食能力作配置。現行的照顧模式，專業間各自執行，缺乏完整的討論與計畫，導致訓練成效無法達到預期。本文論述對於長照機構無法執行安全吞嚥的長者，如何執行營養師與語言治療師的專業間整合，設訂增進個案營養狀況及安全由口進食為目標，共同制定每一階段的吞嚥訓練及飲食質地調整，設計並指導照顧者製備定量飲食，藉以提升個案吞嚥訓練的成效。期望本文的全人照護模式，能提升個案生活品質，符合個案及家屬的照護期待，實踐「以個案為中心」的專業核心價值。

Oropharyngeal dysphagia is common in elders living in long-term care facilities. Nasogastric tubes are used in place of normal eating when severe swallowing disorders affect oral intake. Swallowing training is usually delivered by a speech therapist who uses different food textures for training at different stages, depending on the severity and progression of the disorder. The amount and texture of foods are adjusted by the dietitian based on an elder's ability to eat. The current care model allows the specific preferences and experiences of the implementing specialist to guide delivery of swallowing training and thus lacks comprehensive discussion and planning, which may result in interventions failing to achieve their expected effect. In this study, we discuss how to implement the professional integration of dietitians and speech therapists, set goals for nutrition improvement and safe oral eating for the elderly with swallowing disorders in long-term care facilities. Swallowing training protocols and diet for each stage, texture adjustment, design, and caregiver guidance to prepare quantitative diets are provided to enhance the effectiveness of swallowing training. It is expected that implementation of the holistic care model presented in this study will improve quality of life in patients with oropharyngeal dysphagia, meet the expectations of both patients and family members, and help realize the professional core value of ＂case-centered＂.

1. Ballesteros-Pomar, M. D.,Cherubini, A.,Keller, H.,Lam, P.,Rolland, Y.,Simmons, S. F.(2020).Texture-modified diet for improving the management of oropharyngeal dysphagia in nursing home residents: An expert review.The Journal of Nutrition, Health & Aging,24(6),576-581.
2. Cederholm, T.,Jensen, G. L.,Correia, M. I. T. D.,Gonzalez, M. C.,Fukushima, R.,Higashiguchi, T.,Baptista, G.,Barazzoni, R.,Blaauw, R.,Coats, A.,Crivelli, A.,Evans, D. C.,Gramlich, L.,Fuchs-Tarlovsky, V.,Keller, H.,Llido, L.,Malone, A.,Mogensen, K. M.,Morley, J. E.,GLIM Working Group(2019).GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community.Clinical Nutrition,38(1),1-9.
3. Chen, Y.-J.,Chen, Y.-T.,Lin, L.-C.,Chen, S.-C.,Wang, C.-T.,Hsieh, C.-M.(2021).Effects of olfactory stimulation on swallowing function in Taiwanese older adults.Gerontology and Geriatric Medicine,7
4. Chou, H.-H.,Tsou, M.-T.,Hwang, L.-C.(2020).Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: A prognosis comparison.BMC Geriatrics,20(1),Article 60.
5. Cichero, J. A. Y.,Lam, P.,Steele, C. M.,Hanson, B.,Chen, J.,Dantas, R. O.,Duivestein, J.,Kayashita, J.,Lecko, C.,Murray, J.,Pillay, M.,Riquelme, L.,Stanschus, S.(2017).Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: The IDDSI framework.Dysphagia,32(2),293-314.
6. Clavé, P.,Shaker, R.(2015).Dysphagia: Current reality and scope of the problem.Nature Reviews. Gastroenterology & Hepatology,12(5),259-270.
7. Elmståhl, S.,Bülow, M.,Ekberg, O.,Petersson, M.,Tegner, H.(1999).Treatment of dysphagia improves nutritional conditions in stroke patients.Dysphagia,14(2),61-66.
8. Goes, V. F.,Mello-Carpes, P. B.,de Oliveira, L. O.,Hack, J.,Magro, M.,Bonini, J. S.(2014).Evaluation of dysphagia risk, nutritional status and caloric intake in elderly patients with Alzheimer’s.Revista Latino-Americana de Enfermagem,22(2),317-324.
9. Jensen, G. L.,Cederholm, T.,Correia, M. I. T. D.,Gonzalez, M. C.,Fukushima, R.,Higashiguchi, T.,de Baptista, G. A.,Barazzoni, R.,Blaauw, R.,Coats, A. J. S.,Crivelli, A.,Evans, D. C.,Gramlich, L.,Fuchs-Tarlovsky, V.,Keller, H.,Llido, L.,Malone, A.,Mogensen, K. M.,Morley, J. E.,Van Gossum, A.(2019).GLIM criteria for the diagnosis of malnutrition: A consensus report from the global clinical nutrition community.Journal of Parenteral and Enteral Nutrition,43(1),32-40.
10. Rothenberg, E.,Wendin, K.(2015).Texture modification of food for elderly people.Modifying food texture
11. Shimizu, A.,Maeda, K.,Koyanagi, Y.,Kayashita, J.,Fujishima, I.,Mori, N.(2019).The global leadership initiative on malnutrition-defined malnutrition predicts prognosis in persons with stroke-related dysphagia.Journal of the American Medical Directors Association,20(12),1628-1633.
12. Ueshima, J.,Momosaki, R.,Shimizu, A.,Motokawa, K.,Sonoi, M.,Shirai, Y.,Uno, C.,Kokura, Y.,Shimizu, M.,Nishiyama, A.,Moriyama, D.,Yamamoto, K.,Sakai, K.(2021).Nutritional assessment in adult patients with dysphagia: A scoping review.Nutrients,13(3),Article 778.
13. World Health Organization(2010).Framework for action on interprofessional education and collaborative practice.
14. 小山珠美, K.,陳光棻（譯）, K.-F.(Trans.),蔣君莉（譯）, C.-L.(Trans.)(2020).咀嚼吞嚥困難多職類整合照護全書.如果=Asif Publishing.
15. 劉淑娟（編）, S.-J.(ed.),林宜璁（編）, Y.-T.(ed.),蔡佩渝（編）, P.-Y.(ed.),吳明順（編）, M.-S.(ed.),譚延輝（編）, Y.-H.(ed.),李季黛（編）, C.-T.(ed.),蔡佩凌（編）, P.-L.(ed.),陳淑梅（編）, S.-M.(ed.),黃畹藀（編）, W.-Y.(ed.),黃秀華（編）, H.-H.(ed.),吳鴻順（編）, H.-S.(ed.),江秀玲（編）, H.-L.(ed.),洪婉純（編）, W.-C.(ed.),李梅英（編）, M.-Y.(ed.),吳景寬（編）, C.-K.(ed.),梁亦杉（編）, I.-S.(ed.),李佩怡（編）, P.-Y.(ed.),蔡芳文（編）, F.-W.(ed.)(2017).長期照顧：跨專業團隊整合暨案例分析.華杏=Farseeing.