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接受家庭护理的社区居家老年人的吞咽障碍与1年功能衰退

Swallowing disorders and 1-year functional decline in community-dwelling older adults receiving home care.

作者信息

Takeuchi K, Furuta M, Okabe Y, Suma S, Takeshita T, Akifusa S, Adachi M, Kinoshita T, Kikutani T, Yamashita Y

机构信息

Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.

OBT Research Center, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.

出版信息

J Oral Rehabil. 2017 Dec;44(12):982-987. doi: 10.1111/joor.12577. Epub 2017 Oct 16.

Abstract

The purpose of this study was to clarify the effect of swallowing disorders on functional decline in community-dwelling older adults receiving home care. This was a 1-year follow-up survey of 176 individuals ≥60 years living at home and receiving homecare services, without total dependence in basic daily living activities, in two mid-sized municipalities in Fukuoka, Japan. Functional decline was measured using the Barthel index (BI), and the primary outcome was total dependence in basic daily living activities (BI ≤ 20 points). Swallowing function was assessed using cervical auscultation, and the primary predictor was swallowing disorders. Logistic regression models were used to assess univariate and multivariate associations between baseline swallowing function and functional decline during follow-up. During follow-up 16 (9.1%), the participants became totally dependent in basic daily living activities. The participants with swallowing disorders had 6.41 times higher odds of total dependence in basic daily living activities compared to participants with normal swallowing function. After adjusting for potential confounders, swallowing disorders were significantly associated with higher odds of total dependence in basic daily living activities (odds ratio = 5.21, 95% confidence interval = 1.33-20.44). Regarding swallowing disorders, the corresponding population attributable fraction (%) of the incidence of total dependence in basic daily living activities was 50.4%. The current findings demonstrated that swallowing disorders were associated with greater risk of functional decline in basic daily living activities among older adults living at home and receiving home nursing care. Maintenance and improvement of swallowing function may prevent late-life functional decline.

摘要

本研究的目的是阐明吞咽障碍对接受家庭护理的社区居家老年人功能衰退的影响。这是一项对日本福冈县两个中等规模城市中176名年龄≥60岁、居家生活且接受家庭护理服务、在基本日常生活活动中并非完全依赖他人的个体进行的为期1年的随访调查。使用巴氏指数(BI)来衡量功能衰退情况,主要结局指标是在基本日常生活活动中完全依赖他人(BI≤20分)。通过颈部听诊评估吞咽功能,主要预测因素是吞咽障碍。使用逻辑回归模型评估基线吞咽功能与随访期间功能衰退之间的单变量和多变量关联。在随访期间,16名(9.1%)参与者在基本日常生活活动中变得完全依赖他人。与吞咽功能正常的参与者相比,有吞咽障碍的参与者在基本日常生活活动中完全依赖他人的几率高出6.41倍。在对潜在混杂因素进行调整后,吞咽障碍与在基本日常生活活动中完全依赖他人的较高几率显著相关(比值比=5.21,95%置信区间=1.33 - 20.44)。关于吞咽障碍,在基本日常生活活动中完全依赖他人发生率的相应人群归因分数(%)为50.4%。当前研究结果表明,吞咽障碍与居家接受家庭护理的老年人在基本日常生活活动中功能衰退的风险增加有关。维持和改善吞咽功能可能预防晚年功能衰退。

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