高齡者口腔衛生教育介入效果之研究──以社區及長照機構長者為例

Effect of oral health education for the elderly in the community and long-term care institutions

目標：探討高齡口腔衛生教育介入對於社區及長照機構長者的進食、口腔衛生狀況、咀嚼力與口腔機能之影響調查。方法：以類實驗研究法立意取樣收集台北市社區與長照機構65歲以上長者232位，以非對等控制組設計，將社區126位與長照機構106位，區分為社區實驗組68位、社區對照組58位、長照機構實驗組53位與長照機構對照組53位，實驗組皆採12週健口操訓練與4次口腔衛教課程介入，對照組則無，經由牙醫師進行口腔檢測及訪員結構式問卷調查，分析介入前後成效。結果：機構長者在吞嚥、機能發音、鼓起雙頰及咀嚼力的表現上明顯較社區長者差。在介入成效上，高齡者對口腔狀況自評、舌苔、牙菌斑牙面比例、吞嚥秒數、咀嚼力，實驗組結果較對照組佳。合併社區及機構實驗組在舌苔及牙菌斑牙面比例有顯著後測改善。整體及機構實驗組在吞嚥秒數有改善，咀嚼力則發現整體及機構對照組後測較前測差，但實驗組沒有差異。結論：高齡者口腔衛生教育介入對長者舌苔、牙菌斑與口腔機能有改善或維持。建議社區及長照機構應持續鼓勵長者進行口腔健康促進活動，並協調口腔保健資源及其護理人員，規劃不同生理功能老年人的教育模式。 Objectives: To investigate the influence of oral health education intervention on eating, oral health, chewing, and oral function of elderly in community and long-term care institutions. Methods: A quasi-experimental study involving a non-equivalent control group design was conducted in the community and long-term care institutions in Taipei City. Two hundred thirty-two elderly > 65 years of age were recruited; 126 were community residents (experimental group [n=68] and control group [n=58]) and 106 were from long-term care institutions (experimental group [n=53] and control group [n=53]). The intervention for the experimental group included 12 weeks of oral training and 4 oral hygiene courses; no intervention was provided to the control group. Dentists and oral hygienists collected a survey before and after the intervention, and a questionnaire on oral function and oral hygiene was administered. Results: The elderly in the institutional group was significantly worse than the community group with respect to swallowing, pronunciation, motor activity of the cheeks, and chewing function. The entire experimental group had significant improvement in self-evaluation of oral health, tongue coating, dental plaque, swallowing time, and chewing function compared to the control group. With respect to dental plaque check and tongue coating, the entire experimental group exhibited statistically significant improvement. The entire and institutional experimental groups had improved swallowing function. The entire and institutional control group had worse chewing function, but no difference was observed in the experimental group. Conclusions: Oral health education promotes improved tongue coating, dental plaque, and oral function in the elderly. Based on the current study, it is recommended that community and long-term care institutions should continue to carry out oral health promotion, coordinate oral health care resources, and plan the education mode of different physiologic functions for the elderly.