失智症吞嚥困難患者的營養照護

Nutritional Care of Dysphagia in Dementia Patients

近年來失智症的盛行率隨著台灣人口的老化而逐年增加，失智症所伴隨的營養問題也逐漸被大家所重視，其中包含無法準備食物、抗拒進食、吞嚥困難、對食物認知混亂等，這些問題會導致失智症患者有較高的營養風險，增加照顧者的負荷。研究指出約13-57%的失智症患者會衍生吞嚥困難的症狀，是臨床上常見的問題之一。面對吞嚥困難的失智症患者臨床上較常使用的處置方式包含:吞嚥復健、調整食物的食團、進食擺位、餵食技巧、口腔清潔等，以增加進食安全及進食的效能，降低吸入性肺炎的風險。儘管研究不建議末期失智症使用經管營養，但在台灣我們仍用經管營養來處理失智症患者的吞嚥問題，失智症患者的進食方式應該考慮病人的個人意願、家屬的支持度及照顧資源，提供最完整的建議給家屬，以期病人可以獲得良好的照護品質。

Recent years, the prevalence of dementia has been increasing due to the aging of Taiwan. The nutritional problems associated with dementia have gradually attracted the attention, including inability of food preparing, refuse to eat, dysphagia, confusion about foods. These problems can cause higher nutritional risks and caregiver burden. Studies have pointed out that 13-57% of patients with dementia have dysphagia, which is one of the common clinical problems. Facing dysphagia patients with dementia, the common treatment methods include: swallowing training, food bolus adjustment, feeding posture, feeding skills and oral hygiene which to increase eating safety and efficiency, and reduce the risk of aspiration pneumonia. Although studies suggest that end-stage dementia should not use enteral nutrition, we still use enteral nutrition to deal with the dysphagia patients with dementia. The nutritional support of dementia patients should consider the patient's will, family support and care resources. Medical staffs should provide complete advice to family members, so that patients can have a good quality of life.