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急诊科老年患者吞咽困难系统筛查——一项可行性研究

Systematic Dysphagia Screening of Elderly Persons in the Emergency Department-A Feasibility Study.

作者信息

Melgaard Dorte, Sørensen Line R, Lund Diana, Leutscher Peter, Ludwig Marc

机构信息

Centre for Clinical Research, North Denmark Regional Hospital, DK-9800 Hjoerring, Denmark.

Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark.

出版信息

Geriatrics (Basel). 2020 Oct 12;5(4):75. doi: 10.3390/geriatrics5040075.

Abstract

Identification of elderly patients in risk of dysphagia as early as possible upon hospital admission seems warranted due to the risk of aspiration pneumonia, dehydration, length of stay, and increased mortality. This study aimed to evaluate the feasibility and outcome of dysphagia screening of elderly persons admitted to the emergency department (ED). Inclusion criteria were age ≥ 60 years. A nurse applied the Simple Water Swallow test within one hour of admission. Subsequent assessment was performed by an occupational therapist (OT) using Volume Viscosity Swallow Test and Minimal Eating Observation Form. Of 113 eligible participants (median age 78 years), 75 (66%) were screened in the ED by the nurse, and among those, 12 (16%) were detected with dysphagia. Twenty of the patients not screened in the ED due to critical illness were tested by the OT in the ward after clinical stabilization and 15 patients (75%) were identified with dysphagia. This study demonstrated that it is feasible to perform dysphagia screening of elderly persons by a nurse in the ED, but there are severe limitations according to screening patients with critical illness and patients fasting before surgery in the ED. These patients have a high prevalence of dysphagia and should be screened as early as possible after hospitalization, as it will rarely be possible in the ED.

摘要

鉴于存在误吸性肺炎、脱水、住院时间及死亡率增加的风险,在老年患者入院时尽早识别有吞咽困难风险的患者似乎是必要的。本研究旨在评估对急诊科(ED)收治的老年患者进行吞咽困难筛查的可行性及结果。纳入标准为年龄≥60岁。一名护士在入院后1小时内应用简单水吞咽试验。随后由一名职业治疗师(OT)使用容量黏度吞咽试验和最小进食观察表进行评估。在113名符合条件的参与者(中位年龄78岁)中,75名(66%)由护士在急诊科进行了筛查,其中12名(16%)被检测出有吞咽困难。20名因病情危急未在急诊科接受筛查的患者在临床病情稳定后由职业治疗师在病房进行了检测,15名患者(75%)被确定有吞咽困难。本研究表明,护士在急诊科对老年患者进行吞咽困难筛查是可行的,但在筛查急诊科的重症患者和术前禁食患者方面存在严重局限性。这些患者吞咽困难的患病率很高,应在住院后尽早进行筛查,因为在急诊科很少能够做到。

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本文引用的文献

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