台北某社區老人之吞嚥障礙

Swallowing Disorder in the Elderly of a Taipei Community

吞嚥障礙是老人族群常見的問題，了解老人族群的吞嚥功能，將有助於治療這特殊族群之吞嚥障礙。本研究的目的在於利用問卷及臨床的喝水試驗來評估社區老人之吞嚥功能，以了解社區老人吞嚥障礙的比例及吞嚥功能的變化。本研究包括289位至本院接受老人體檢之社區高齡民眾(65~95歲）。所有受試者皆接受問卷評估、3次10mL喝水測驗及l00mL喝水速度測驗以評估其吞嚥功能。受試者依外齡被分成A組（65〜70歲），B組（71～75歲），C組（76～80歲）及D組（大於80歲），另有十名年齡低於40成的正常受試者做為對照組。吞嚥障礙定義為於以下三項評估中有二項為不正常，包括l00mL 喝水速度<5mL/sec、受試者在主觀上有吞嚥異常、及l0mL或l00mL喝水測驗時有嗆咳現象。結果顯示，受檢之社區老人有12.8%有吞嚥障礙。在289名受試者中有63名(21.8%)平常進食時每週至少有3次發生嗆咳，但其中有35名（55.6%)其臨床評估為正常；反之，平時進食沒問題的226名受試者有39名(17.3%)其喝水速度明顯下降，並有20名(8.8%)有嗆咳現象。在喝水速度方面，B組明顯比C組較快（平均10.5+4.9 vs 8.9±5.6mL/sec P<0.05）而AB組及CD組喝水速度相同。由本研究結果，我們認為社區老人約有12%有吞嚥障礙，其吞嚥功能在高於75歲組有較明顯下降。

Swallowing problems are increasing recognized in the elderly population of developed country. Understanding the change of swallowing function in the elderly might benefit the management of dysphagia in this group patient.The aim of this study is to investigate the prevalence and severity of swallowing impairment in the community elderly relative to their age and symptoms. Ten mL water test to evaluate the swallowing reflex and 100 mL timed water test for detecting the swallowing speed were performed in 289 consecutive community elderly aged 65-95 years old. Each patient was asked and recorded how frequently they are choked in daily mealtime. The subjects were categorized by age into four group: A: between 65 to 70 years old (n=19), B: between 71 to 75 years old (n=140), C: between 76 to 80 years old (n=84), and D: greater than 80 years old (n=46). Ten young individuals under 40 years old underwent the same tests as control. The swallowing speed less than 5 mL/ sec was defined as abnormal. The swallowing disorder included choking in daily mealtime, slowed swallowing speed, and choking in water test. The individuals having at least two of the three disorders were defined dysphagia. The result showed that 12.8 % of the elderly suffered dysphagia. Sixty-three among the 289 tested individuals had choking at least three times per week. However, thirty-five of them had normal clinical water test. In the 226 persons with subjectively normal swallowing, 39 of them had reduced swallowing speed and 20 of them developed choking in the water test. The swallow speed as well as the amount of swallow per mouth, of C group was significantly less than that of the B group (10.5± 4.9 mL/sec vs 8.9 ± 5.6mL/sec, p< 0.05), while no significant difference was noticed between A or B groups, and C and D groups. We concluded that 12 % of community elderly (above 65 years old) had dysphagia and the individuals greater than 75 years old might have deteriorated swallowing function.