老年人吞嚥障礙之評估與處置

Evaluation and Management of Dysphagia in the Elderly

10.6317/LTC.200812_12(4).0001

施至遠(Chih-Yuan Shih)；陳人豪(Jen-Hau Chen)

吞嚥 ； 吞嚥障礙 ； 老人 ； 老化 ； swallowing ； dysphagia ； elderly ； aging

長期照護雜誌

12卷4期（2008 / 12 / 01）

337 - 346

繁體中文

吞嚥障礙在老年人中是常見的問題，吞嚥困難會對病患造成許多層面的影響，包括社會孤立、身體不適、營養不良、脫水、以及吸入性肺炎。無論是在門診、急性病房或長照機構中的醫護人員都必須了解老年人吞嚥困難的評估與處置。評估老年人的吞嚥困難需依賴詳細的病史詢問與身體檢查。老化會對吞嚥功能造成影響，而有一些老年人常見的神經系統疾病（例如：中風、失智症、巴金森氏症）亦會造成吞嚥障礙。對於懷疑有吞嚥困難的病患，初步可採用床邊吞嚥評估，有時需進一步安排吞嚥螢光攝影檢查或光纖內視鏡吞嚥檢查。吞嚥困難的處置包括：進食姿勢的調整、飲食質地的調整、控制飲食的速率與數量、使用輔具、藥物調整、口腔衛生、用餐環境、管灌餵食，在選擇是否採用管灌飲食時，必須參酌病患自主想法與家屬意見來做整體的考量。

Dysphagia is common in the elderly. The consequences of dysphagia include social isolation, physical discomfort, malnutrition, dehydration and aspiration pneumonia. Medical professionals in ambulatory, acute or long-term care settings must be familiar with the evaluation and management of dysphagia in the elderly. Detailed history and physical examination play a critical role in evaluating dysphagia. Age-related physiological changes may affect swallowing; some neurological diseases common in the elderly, such as stroke, dementia or parkinsonism, can cause dysphagia. The bed side evaluation is the first step in clinical evaluation. Sometimes, a video fluoroscopy swallow study and a fiberoptic endoscopic examination of swallowing are needed in establishing a diagnosis of dysphagia. Interventions for dysphagia include postural adjustment, diet modification, adjusting the rate and amount of food, using adaptive equipment, medication adjustment, maintaining oral hygiene, controlling mealtime atmosphere and tube feeding. The opinions of the patients and family should be considered in deciding tube feeding for dysphagia.