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护理学报 ›› 2021, Vol. 28 ›› Issue (20): 1-6.doi: 10.16460/j.issn1008-9969.2021.20.001

• 研究生园地 •    下一篇

社区居家失能老人口腔吞咽现状及其对心理健康的影响研究

许文馨1a, 唐煦萌2, 曹松梅1a, 杨君1b, 谢莉玲3, 肖明朝1c, 赵庆华1a   

  1. 1.重庆医科大学附属第一医院 a.护理部;b.老年科;c.院办公室,重庆 400016;
    2.重庆医科大学附属口腔医院 VIP门诊部,重庆 401120;
    3.重庆医科大学附属第一医院第一分院 护理部,重庆 400010
  • 收稿日期:2021-04-02 出版日期:2021-10-25 发布日期:2021-11-10
  • 通讯作者: 赵庆华（1963-）,女,四川南充人,本科学历,主任护师。E-mail：qh20063@163.com
  • 作者简介:许文馨（1997-）,女,重庆人,本科学历,硕士研究生在读,护师。
  • 基金资助:
    重庆市科卫联合医学科研项目（2021MSXM054）; 中华护理学会2020年度立项科研课题项目（ZHKY202020）

Current Status of Swallowing Function and Its Influence on Psychological Health of Community-dwelling Disabled Elders

XU Wen-xin1a, TANG Xu-meng2, CAO Song-mei1a, YANG Jun1b, XIE Li-ling3, XIAO Ming-zhao1c, ZHAO Qing-hua1a   

  1. 1a. Dept. of Nursing Administration; b. Dept. of Geriatrics; c. Administrative Office, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China;
    2. VIP Center, Stomatological Hospital of Chongqing Medical University, Chongqing 401120, China;
    3. Dept. of Nursing Administration, the First Branch of the First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
  • Received:2021-04-02 Online:2021-10-25 Published:2021-11-10

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摘要： 目的 调查社区居家失能老人口腔吞咽现状,并分析其对心理健康的影响。方法 采用方便抽样法,对207名社区居家失能老人进行问卷调查。结果 社区居家失能老人口腔健康状况得分（8.45±3.51）分,前3位口腔问题为天然齿缺如、口腔卫生状况不佳、义齿破损或未正确佩戴;吞咽功能得分3（1,9）分,功能正常94名（45.4%）,功能异常113名（54.6%）;心理健康状况得分（18.26±7.41）分,良好102名（49.3%）,异常105名（50.7%）;失能老人口腔健康、吞咽功能、心理健康三者间呈正相关（P<0.001）;口腔健康状况不佳（OR=1.155,P<0.05）、吞咽功能异常（OR=4.155,P=0.001）是失能老人心理健康的独立危险因素。结论 社区居家失能老人口腔吞咽现状不容乐观,应重视社区层面上的失能老人口腔健康及吞咽功能评估,以尽早筛查并识别口腔疾病及吞咽安全风险,维持或促进其心理健康。

关键词: 失能老人, 口腔健康, 吞咽功能, 心理健康

Abstract: Objective To investigate the swallowing function of community-dwelling disabled elders and analyze its influence on psychological health. Methods With convenience sampling method, 207 community-dwelling disabled elders were surveyed by questionnaires. Results The total score of oral health was 8.45±3.51 and the most prominent oral problems were the deficiency of natural teeth, poor oral hygiene, denture breakage or incorrect denture wearing. The swallowing function score was 3(1,9) andit was normal in 94 cases (45.4%) and abnormal in 113 cases (54.6%). The total score of mental health was 18.26±7.41, with 102 normal cases (49.3%) and 105 abnormal cases (50.7%). Oral health and swallowing function and psychological health were positively correlated with each other (P<0.001). Poor oral health (OR=1.155, P<0.05) and abnormal swallowing function (OR=4.155, P=0.001) were independent risk factors for mental health of the disabled elderly. Conclusion Swallowing function of community-dwelling disabled elders are not optimistic. We should pay attention to the assessment of oral health and swallowing function of disabled elderly in the community, so as to screen and identify oral diseases and swallowing safety risks in time, and maintain or promote their psychological health.

Key words: disabled elder, oral health, swallowing function, psychological health

中图分类号: 

  • R473.2
[1] World Health Organization.World Report on Ageing and Health[R/OL].(2015-09-29)[2021-08-12].http://apps.who.int/iris/bitstream/handle/10665/186468/WHO_FWC_ALC_15.01_eng.pdf;jsessionid=1B9CFF91B8474C5E23AECE4E04FB7E43?sequence=1.
[2] Kuo HC, Wang RH, Wang JC,et al.Assessing A Conceptual Model with Both Oral Health and Health Related Quality of Life in Community-dwelling Elders[J]. Arch Gerontol Geriatr,2018,79:27-31.DOI:10.1016/j.archger.2018.07.011.
[3] 李超,张梦清,窦祖林,等.中国特定人群吞咽功能障碍的流行病学调查报告[J].中华物理医学与康复杂志, 2017,39(12):937-943.DOI:10.3760/cma.j.issn.0254-1424.2017.12.014.
[4] 中国老年保健医学研究会老龄健康服务与标准化分会.中国社区吞咽功能障碍康复护理与照护专家共识[J].中国老年保健医学,2019,17(4):7-15.DOI:10.3969/j.issn.1672-2671.2019.04.003.
[5] Kayser-Jones J,Bird WF,Paul SM,et al.An Instrument to Assess the Oral Health Status of Nursing Home Residents[J].Gerontologist,1995, 35(6):814-824.DOI:10.1093/geront/35.6.814.
[6] 赵彩均,丁福.Kayser-Jones简明口腔健康检查表的汉化及信度、效度研究[J].中国护理管理,2016,16(1):38-41.DOI:10.3969/j.issn.1672-1756.2016.01.011.
[7] Belafsky PC, Mouadeb DA,Rees CJ,et al.Validity and Reliability of the Eating Assessment Tool (EAT-10)[J].Ann Otol Rhinol Laryngol,2008,117(12):919-924.DOI:10.1177/000348940811701210.
[8] Bahat G, Yilmaz O,Durmazoglu S,et al.Association between Dysphagia and Frailty in Community Dwelling Older Adults[J].J Nutr Health Aging,2019, 23(6):571-577.DOI:10.1007/s12603-019-1191-0.
[9] Igarashi K, Kikutani T,Tamura F.Survey of Suspected Dysphagia Prevalence in Home-dwelling Older People Using the 10-Item Eating Assessment Tool(EAT-10)[J].PLoS One,2019,14(1):e0211040.DOI:10.1371/journal.pone.0211040.
[10] 中国吞咽障碍康复评估与治疗专家共识组.中国吞咽障碍评估与治疗专家共识(2017年版)第一部分评估篇[J].中华物理医学与康复杂志,2017, 39(12):881-892.DOI:10.3760/cma.j.issn.0254-1424.2018.01.001.
[11] Kessler RC, Andrews G, Colpe LJ, et al.Short Screening Scales to Monitor Population Prevalences and Trends in Non-specific Psychological Distress[J]. Psychol Med,2002,32(6):959-976.DOI:10.1017/s0033291702006074.
[12] 徐凌忠,王建新,孙辉,等.Kessler 10在我国的首次应用研究及其重要意义[J].卫生软科学,2005(6):410-412.DOI:10.3969/j.issn.1003-2800.2005.06.013.
[13] Lindmark U, Jansson H,Lannering C,et al.Oral Health Matters for the Nutritional Status of Older Persons-A Population-based Study[J].J Clin Nurs,2018,27(5-6):1143-1152.DOI:10.1111/jocn.14146.
[14] Shao R, Hu T, Zhong YS,et al.Socio-demographic Factors, Dental Status and Health-related Behaviors Associated with Geriatric Oral Health-related Quality of Life in Southwestern China[J].Health Qual Life Outcomes,2018,16(1):98.DOI:10.1186/s12955-018-0925-8.
[15] Castrejón-Pérez RC,Jiménez-Corona A,Bernabé E,et al.Oral Disease and 3-Year Incidence of Frailty in Mexican Older Adults[J].J Gerontol A Biol Sci Med Sci,2017,72(7):951-957.DOI:10.1093/gerona/glw201.
[16] Christmas C, Rogus-Pulia N.Swallowing Disorders in the Older Population[J].J Am Geriatr Soc,2019,67(12):2643-2649.DOI:10.1111/jgs.16137.
[17] Rech RS, Baumgarten A, Colvara BC,et al.Association between Oropharyngeal Dysphagia, Oral Functionality, and Oral Sensorimotor Alteration[J]. Oral Dis, 2018,24:664-672.DOI:10.1111/odi.12809.
[18] Takeuchi K, Furuta M,Okabe Y,et al.Swallowing Disorders and 1-Year Functional Decline in Community-dwelling Older Adults Receiving Home Care[J]. J Oral Rehabil,2017,44(12):982-987.DOI:10.1111/joor.12577.
[19] Cademartori MG, Gastal MT, Nascimento GG,et al.Is Depression Associated with Oral Health Outcomes in Adults and Elders? A Systematic Review and Meta-Analysis[J].Clin Oral Investig, 2018, 22(8):2685-2702. DOI:10.1007/s00784-018-2611-y.
[20] Hybels CF, Bennett JM, Landerman LR,et al.Trajectories of Depressive Symptoms and Oral Health Outcomes in A Community Sample of Older Adults[J]. Int J Geriatr Psychiatry,2016,31(1):83-91.DOI:10.1002/gps.4292.
[21] Donnelly LR,MacEntee MI.Social Interactions, Body Image and Oral Health among Institutionalised Frail Elders: An Unexplored Relationship[J].Gerodontology,2012,29(2):28-33.DOI:10.1111/j.1741-2358.2011.00523.x.
[22] Langlois E, Desaeyer H, Petrovic M,et al.The Influence of Oral Health Status on Speech Intelligibility, Articulation and Quality of Life of Older Community-dwelling People[J].Gerodontology,2019,36(4):352-357.DOI:10.1111/ger.12420.
[23] Yang EJ, Kim MH, Lim JY, et al.Oropharyngeal Dysphagia in A Community-based Elderly Cohort: The Korean Longitudinal Study on Health and Aging[J]. J Korean Med Sci,2013,28(10):1534-1539.DOI:10.3346/jkms.2013.28.10.1534.
[24] Minshall S, Pownall S.Management of Swallowing Problems in Community Settings[J]. Br J Community Nurs,2019,24(7):323-327.DOI:10.12968/bjcn.2019.24.7.323.
[25] Watanabe K, Umegaki H,Huang CH,et al.Association between Dysphagia Risk and Unplanned Hospitalization in Older Patients Receiving Home Medical Care[J]. Geriatr Gerontol Int,2019,19(10):977-981.DOI:10.1111/ggi.13753.
[26] Morisaki N.Relationship between Swallowing Functions and Health-related Quality of Life among Community-dwelling Dependent Older Individuals[J].Jpn J Nurs Sci,2017,14(4):353-363.DOI:10.1111/jjns.12168.
[27] 申铁梅,陈凌,崔虹,等.冠心病合并焦虑/抑郁症的影响因素病例对照研究[J].护理学报,2019,26(18):68-71.DOI:10.16460/j.issn1008-9969.2019.18.068.
[28] Cichero JAY.Age-Related Changes to Eating and Swallowing Impact Frailty: Aspiration, Choking Risk, Modified Food Texture and Autonomy of Choice[J].Geriatrics (Basel),2018,3(4):69.DOI:10.3390/geriatrics3040069.
[29] 中华人民共和国国家卫生健康委员会.国家卫生健康委办公厅关于印发健康口腔行动方案(2019-2025年)的通知[EB/OL].(2019-02-15)[2021-03-17].http://www.nhc.gov.cn/jkj/s5878/201902/b049d0f3c9b44ee48ac4c936f41cbb0e.shtml.
[30] Tonetti MS,Bottenberg P,Conrads G,et al.Dental Caries and Periodontal Diseases in the Ageing Population: Call to Action to Protect and Enhance Oral Health and Well-being as An Essential Component of Healthy Ageing - Consensus Report of Group 4 of the Joint EFP/ORCA Workshop on the Boundaries between Caries and Periodontal Diseases[J].J Clin Periodontol,2017,44(18):135-144.DOI:10.1111/jcpe.12681.
[31] Baijens LW, Clavé P, Cras P, et al.European Society for Swallowing Disorders - European Union Geriatric Medicine Society White Paper: Oropharyngeal Dysphagia as A Geriatric Syndrome[J]. Clin Interv Aging,2016,11:1403-1428.DOI:10.2147/CIA.S107750.
[32] Namasivayam-MacDonald AM, Shune SE. The Influence of Swallowing Impairments as An Independent Risk Factor for Burden among Caregivers of Aging Parents: A Cross-sectional Study[J]. Geriatr Nurs, 2020,41(2):81-88.DOI:10.1016/j.gerinurse.2019.06.008.
[33] Institute for Healthcare Improvement.No Place Like Home: Advancing the Safety of Care in the Home[EB/OL].(2018-09-13)[2021-03-17].http://www.ihi.org/resources/Pages/Publications/No-Place-Like-Home-Advancing-Safety-of-Care-in-the-Home.aspx.
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