正視吞嚥老化與口咽吞嚥困難

Confronting Presbyphagia and Oropharyngeal Dysphagia

有效與安全的吞嚥能力，乃為維持人體營養、水合狀況、健康與生活品質的要素。吞嚥功能涉及複雜的自發與非自發性之心理、感覺、與運動行為的協調過程（Balou, Herzberg, Kamelhar, ＆ Molfenter, 2019）。健康老化所引發的頭頸部解剖構造，與吞嚥功能的生理、神經機轉之變化，統稱為吞嚥老化（presbyphagia| Cichero, 2018）。吞嚥老化的進展，可能會降低人身體面對生理壓力的調適能力。咀嚼與吞嚥障礙是老年症候群之一，世界衛生組織特別將口咽吞嚥困難（oropharyngeal dysphagia）標示於國際疾病與相關健康問題的統計分類（International Statistical Classification of Diseases and Related Health Problems, ICD）中，分屬代號為787.2 ICD9與R13.10 ICD10（Centers for Disease Control and Prevention, 2015）。不同研究，或調查對象、地點不同，老年人罹患口咽吞嚥困難的盛行率也不同（Ortega, Cabré, ＆ Clavé, 2014），例如11％−60 ％的社區健康長者有咀嚼、吞嚥障礙（Di Pede, Mantovani, Del Felice, ＆ Masiero, 2016），而口咽吞嚥困難是造成老年人營養不良與吸入性肺炎的重要因素（Imaizumi et al., 2020）。

The ability to swallow efficiently and safely is essential to maintaining nutrition, hydration, health status, and quality of life. The process of swallowing requires coordination among a complex series of psychological, sensory, and motor behaviors that are both voluntary and involuntary (Balou, Herzberg, Kamelhar, & Molfenter, 2019). Presbyphagia refers to the changes associated with natural, healthy aging in the head and neck anatomy and in the physiologic and neural mechanisms that underpin the function of swallowing (Cichero, 2018). This progression of change contributes, in part, to a natural decline in the ability of the body to adapt to physiological stress.