進食功能的復能介入對於社區老年人在吞嚥功能改善狀況之研究

An Investigation of an Eating Function Reablement Program on Swallowing Function in Community-Dwelling Older Adults

背景與研究目的：衛生福利部統計顯示65歲老年人口吞嚥障礙盛行率為12.8%。研究證實下巴抗阻力運動訓練可以提升舌骨上肌群肌肉收縮力量，進而改善吞嚥功能。長照復能多著重移行訓練，然而，進食及吞嚥功能亦至關重要。研究目的有二個：（一）瞭解社區老年人吞嚥障礙之狀況；（二）探討進食功能復能服務介入，對於社區老年人吞嚥改善之成效。研究方法：本研究為類實驗設計，分為實驗組及對照組，實驗組採用復能訓練（結合吞嚥肌力訓練及進食生活功能的復能訓練），以每週一次，一次50分鐘，共四週，對照組採用口腔運動衛教單張。使用立意取樣，以社區關懷據點老年人為對象，共招募47位個案，實驗組28人，對照組19人。共有兩次測量，分別為前測，四週後後測，測量變項為個人變項、疾病變項、口腔狀態變項、吞嚥能力及自評式咀嚼能力。統計方法採用描述性統計、T檢定及迴歸分析。結果：研究對象中有14.89%具有吞嚥障礙，近三成社區老年人自評咀嚼能力有問題。在組內前後測方面，進食功能復能服務介入對於實驗組的吞嚥能力（前測0.86±1.15；後測0.39±1.69；p = 0.03）有顯著改善；而對照組的吞嚥能力（前測0.68±1.46；後測0.74±1.37；p = 0.84）則無顯著。自評式咀嚼能力，實驗組和對照組的組內前後測皆未達到顯著差異。在組間平均變化量比較方面，實驗組和對照組無論在吞嚥能力或自評式咀嚼能力皆無顯著差異。迴歸分析顯示，復能介入對於社區老年人的吞嚥能力及自評式咀嚼能力皆無顯著差異（β= -0.584，p = 0.086；β=1.067，p = 0.113）。討論與結論：下巴抗阻力運動在提升社區老年人吞嚥功能方面可能有改善的效果，但在校正多重因素後，下巴抗阻力運動無法改善社區老年人的吞嚥障礙問題。建議未來在研究社區老年人進食功能時，應同步考量吞嚥與咀嚼的相關因素。在復能服務方面應延長介入期間及個別化介入，以提升介入的效果。

Background and Research Objectives: According to statistics from the Ministry of Health and Welfare, the prevalence of dysphagia among individuals aged 65 and older is 12.8%. Studies have demonstrated that chin resistance exercise training can enhance the contraction strength of the suprahyoid muscles, thereby improving swallowing function. While long-term care reablement primarily focuses on mobility training, eating and swallowing functions are equally crucial. This study has two objectives:1. To investigate the prevalence of dysphagia among older adults in the community.2.To examine the effectiveness of reablement intervention for eating function in improving swallowing ability among community-dwelling older adults. Research methods: This study employs a quasi-experimental design, with participants divided into an experimental group and a control group. The experimental group underwent reablement training, which integrated swallowing muscle strength training with functional reablement for eating. The intervention was administered once a week, with each session lasting 50 minutes, for a total of four weeks. The control group received an educational pamphlet on oral exercises. Participants were recruited using purposive sampling from community care centers, with a total of 47 individuals enrolled (28 in the experimental group and 19 in the control group). Two measurements were conducted: a pre-test and a post-test after four weeks. The variables assessed included demographic characteristics, disease-related variables, oral health status, swallowing ability, and self-reported chewing ability. Statistical analyses included descriptive statistics, t-tests, and regression analysis. Results: Among the study participants, 14.89% were identified as having swallowing disorders, and nearly onethird of community-dwelling older adults reported impaired self-perceived masticatory ability. Withingroup pre- and post-test comparisons revealed a significant improvement in swallowing ability in the experimental group following the reablement intervention (pre-test: 0.86±1.15; post-test: 0.39±1.69; p = 0.03). In contrast, no significant changes were observed in the control group’s swallowing ability (pretest: 0.68±1.46; post-test: 0.74±1.37; p = 0.84). However, self-reported chewing ability did not show significant changes in either group. Between-group comparisons of mean changes indicated no significant differences between the experimental and control groups in terms of swallowing ability or self-reported chewing ability. Regression analysis further indicated that reablement intervention did not significantly improve swallowing ability (β= -0.584, p = 0.086) or self-reported chewing ability (β= 1.067, p = 0.113) among community-dwelling older adults. Discussion and Conclusion: Chin resistance exercise may have a potential effect in improving swallowing function among community-dwelling older adults. However, after adjusting for multiple factors, the intervention did not significantly alleviate dysphagia in this population. Future research on eating function in community-dwelling older adults should consider both swallowing and chewing-related factors. Moreover, extending the intervention duration and implementing individualized interventions may enhance the effectiveness of reablement services.