護士主導跨團隊介入對住院老年吞咽障礙患者成效的研究

The Effectiveness of a Multi-Disciplinary Intervention for Deglutition Disorders in Elderly Inpatients

背景：吞咽障礙（吞嚥障礙）危害老年人健康，跨團隊介入開始在老年吞咽障礙患者中運用，但是多集中於急性腦中風患者。因此，有必要對多病共存老年吞咽障礙患者跨團隊介入模式及其有效性進行研究和驗證。目的：驗證護士主導的跨團隊介入對住院老年吞咽障礙患者的效果。方法：對某大學附屬醫院145例老年吞咽困難患者進行了研究。隨機分為介入組（n = 73）和對照組（n = 72）。分別在入組初期（基線）、30天、90天分別進行資料收集。調查內容包括：人口學情況、Charlson合併症指數（Charlson comorbidity index）、急性生理與慢性健康評分Ⅱ（acute physiology and chronic health evaluation II）、簡易智力狀態問卷（short portable mental status questionnaire）、Barthel指數、標準吞咽功能評估（standardized swallowing assessment）、微型營養評估（short-form min-nutritional assessment）、吸入性肺炎的發生情況。結果：90天後，跨團隊介入組患者較對照組吞咽功能改善比例高（67.1% vs. 44.5%, p ＜ .05）、吸入性肺炎的發生率低（5.5% vs. 23.6%, p ＜ .05）、營養不良發生率低（2.7% vs. 11.1%, p ＜ .05），且均有統計學差異。介入組90天後自理能力較初期改善（83.3 ± 22.1 vs. 81.1 ± 22.1, p ＜ .017），相較對照組ADL（activities of daily living）改善（p ＜ .05），且具統計學差異。結論：護士主導的跨團隊管理介入模式可以用於住院老年患者功能性吞咽障礙的照護中，其能夠改善患者吞咽功能和自理能力，同時也能降低其吸入性肺炎和營養不良的發生率。 Background: While many studies have examined multidisciplinary interventions for swallowing disorder, most have focused on acute stroke patients. It is essential to confirm the efficacy of multidisciplinary interventions for all causes of swallowing disorder. Purpose: To investigate the efficacy of a nurse-led, multi-disciplinary intervention for hospitalized elderly patients with swallowing disorder. Methods: One hundred and forty-five elderly patients with swallowing problems from a well-respected affiliate hospital of a university were studied. Patients were randomly allocated using cluster sampling and opaque envelop into either the multi-disciplinary intervention group (n = 73) or the control group (n = 72). The participants were interviewed at baseline and at 30 and 90 days after the intervention. The questionnaires included: a demographics datasheet, Charlson Comorbidity index, Acute Physiology and Chronic Health Evaluation II, short portable mental status questionnaire, Barthel Index, Standardized Swallowing Assessment, Short-form min-nutritional assessment, and aspiration pneumonia. Results: The intervention group showed a significantly higher ratio of SSA (67.1% vs. 44.5%, p ＜ .05), lower aspiration pneumonia (5.5% vs. 23.6%, p ＜ .05), and lower incidence of malnutrition (2.7% vs. 11.1%, p ＜ .05) at 90 days than the intervention group. Moreover, the intervention group showed a significantly higher ADL (activities of daily living) score at 90 days (83.3 ± 22.1 vs. 81.1 ± 22.1, p ＜ .017) than the control group (p ＜ .05). Conclusions: A nurse-led, multi-disciplinary intervention is a potential option for elderly patients with deglutition disorder to improve swallowing function and ADL and to reduce the incidence of inhaled pneumonia and malnutrition.

Background: While many studies have examined multidisciplinary interventions for swallowing disorder, most have focused on acute stroke patients. It is essential to confirm the efficacy of multidisciplinary interventions for all causes of swallowing disorder. Purpose: To investigate the efficacy of a nurse-led, multi-disciplinary intervention for hospitalized elderly patients with swallowing disorder. Methods: One hundred and forty-five elderly patients with swallowing problems from a well-respected affiliate hospital of a university were studied. Patients were randomly allocated using cluster sampling and opaque envelop into either the multi-disciplinary intervention group (n = 73) or the control group (n = 72). The participants were interviewed at baseline and at 30 and 90 days after the intervention. The questionnaires included: a demographics datasheet, Charlson Comorbidity index, Acute Physiology and Chronic Health Evaluation II, short portable mental status questionnaire, Barthel Index, Standardized Swallowing Assessment, Short-form min-nutritional assessment, and aspiration pneumonia. Results: The intervention group showed a significantly higher ratio of SSA (67.1% vs. 44.5%, p ＜ .05), lower aspiration pneumonia (5.5% vs. 23.6%, p ＜ .05), and lower incidence of malnutrition (2.7% vs. 11.1%, p ＜ .05) at 90 days than the intervention group. Moreover, the intervention group showed a significantly higher ADL (activities of daily living) score at 90 days (83.3 ± 22.1 vs. 81.1 ± 22.1, p ＜ .017) than the control group (p ＜ .05). Conclusions: A nurse-led, multi-disciplinary intervention is a potential option for elderly patients with deglutition disorder to improve swallowing function and ADL and to reduce the incidence of inhaled pneumonia and malnutrition.