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在宅自立前期高齢者における摂食嚥下機能およびフレイルに関する研究

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Title: 在宅自立前期高齢者における摂食嚥下機能およびフレイルに関する研究
Other Titles: Field research : Oral, swallowing functions, and frailty in independent elderly individuals
Authors: 元川, 賢一朗1 Browse this author
Authors(alt): Motokawa, Kenichiro1
Keywords: 在宅自立前期高齢者
聖隷式嚥下質問紙
摂食嚥下機能
フレイル
the independent elderly individuals
seirei dysphagia screening questionnaire
eating swallowing function
frailty
Issue Date: Mar-2018
Publisher: 北海道歯学会
Journal Title: 北海道歯学雑誌
Volume: 38
Issue: 2
Start Page: 185
End Page: 194
Abstract: 【目的】急速な高齢化により生活習慣病や認知症などによる要介護者が増加し,医療費の増加や介護施設不足といった問題は,深刻な社会問題になっている.したがって,要介護者を減らし健康寿命を延ばすことが極めて重要である.摂食嚥下機能の維持・向上は,健全な経口摂取を保ちかつ栄養状態を向上させるという点で,健康寿命を延伸させる重要な因子である.今回の調査では,自立前期高齢者の聖隷式嚥下質問紙による摂食嚥下機能スクリーニングと口腔・嚥下機能,フレイルとの関連を検討した.【対象と方法】対象は埼玉県嵐山町の前期高齢者283名(男性121名,女性162名)で,平均年齢は69.6歳であった.なお, 本研究では舌圧測定のため総義歯および前歯部が欠損している31名(男性14名, 女性17名)は対象から除外している.嚥下障害の有無は,聖隷式嚥下質問紙の15の嚥下に関する質問に対し,1項目でも 「しばしば」,「たいへん」等の重い症状と答えた者を嚥下障害疑いあり群(障害群)とし,その他を嚥下障害疑いなし群(健常群)とした.嚥下機能検査として咀嚼能力,舌圧,Repetitive Saliva Swallowing Test(以下RSST),水飲み試験,OralDiadochokinesis(以下OD)の5項目を評価した.被験者には事前に聖隷式嚥下質問紙を配布し,調査当日に咀嚼能力を除く4項目を測定した.咀嚼能力は三浦らの咀嚼能力チェックリストを用いてスコア化(0~18)した.口腔内診査として残存歯数,口腔乾燥,義歯の有無,咬合支持域を調査した.その上で,聖隷式嚥下質問紙による障害群と健常群における嚥下機能検査および口腔内診査の各項目との関連を検討した.さらに,この2群とフレイルとの関連を評価した.フレイルの分類にはShimadaらの基準を使用し,体重減少,疲労度,歩行速度,握力,生活活動度を評価した.①~⑤の項目で0項目:健康,1~2項目:プレフレイル,3項目以上:フレイルとした.【結果】聖隷式嚥下質問紙で被験者を選別した結果,健常群は91.9%(260名),障害群8.1%(23名)であった.聖隷式嚥下質問紙で選別した各群の咀嚼能力は,健常群16.8±0.2,障害群13.5±0.6であり,健常群では障害群に比べて有意に咀嚼能力が高かった. また, 各群の最大舌圧は,健常群33.3±0.4kpa,障害群30.3±1.3kpaであり,健常群は障害群に比べて有意に最大舌圧が高かった.また,健常群と比較し障害群では有意にフレイルの割合が高かった(健常群4.6%,障害群30.4%).【結論】摂食嚥下機能を維持するためには咀嚼能力,舌圧の維持が必要であることが示唆された.また,健常群の方がフレイルの割合が有意に低く,摂食嚥下機能を維持することでフレイルを減少できる可能性が示唆された.
Purpose : People often require nursing care because the severity of lifestyle-related disease or dementia increases due to aging. The shortage of nursing facilities and an increase in medical expenses are serious social problems. Thus, it is extremely important to decrease dependence on nursing care and extend healthy life expectancy.  To this end, retaining and improving oral and swallowing function is important. These factors may contribute to extend healthy life expectancy by maintaining healthy oral intake, which improves the nutritional status of the elderly. In this study, we investigated the correlation of the Seirei Hospital Questionnaire for dysphagia screening, oral and swallowing function, and frailty in independent elderly individuals. Subjects and Methods : The participants comprised 283 independent elderly individuals (males : 121, females : 162) in Ranzan-machi, Saitama Prefecture. The mean age was 69.6 years. Owing to the difficulty in measuring tongue pressure in patients missing anterior teeth, 31 participants (14 males and 17 females), were excluded from this study. Presence or absence of dysphagia was determined using the Seirei Dysphagia Screening Questionnaire comprising 15 items. Subjects who marked “Many times” or “Obviously” to one or more items were classified in the dysphagia impaired group. The remaining participants were classified as normal, and placed in the control group.  Swallowing function was evaluated according to 5 items : masticatory ability ; tongue pressure ; the repetitive saliva swallowing test (RSST) ; water swallowing test ; and oral diadochokinesis test. On the day of testing, all items except masticatory ability were measured. Masticatory ability was scored using the masticatory ability checklist by Miura et al. (0-18 points). Oral function was evaluated according to the number of remaining teeth, xerostomia, with or without dentures, and occlusion support area.  We used frailty classifications by Shimada et al. The frailty phenotype postulates 5 indicators: weight loss, exhaustion, slow walking speed, low grip strength, and low physical activity. A person with none of the indicators is considered to be fit, one with 1 or 2 indicators is considered to be pre-frailty, and one with 3 or more indicators is considered in the frailty group. Results : There were 23 subjects (8.1 %) in the impaired group, and 260 subjects (91.9 %) in the control group. A significant difference in masticatory ability was noted between the two groups, with scores of 13.5 ± 0.6 points for the impaired group, and 16.8 ± 0.2 points for the control group. In addition, a significant difference in tongue pressures was noted between the two groups, with scores of 30.3 ± 1.3 kpa for the impaired group, 33.3 ± 0.4 kpa for the control group. The impaired group had a significantly higher frailty ratio (30.4 %), compared to the control group (4.6 %). Conclusion : These results suggest that it may be possible to prevent oral- pharyngeal dysphagia and increased frailty by maintaining and improving masticatory ability and tongue pressure through regular oral functional screening and dental treatment.
Type: article
URI: http://hdl.handle.net/2115/68804
Appears in Collections:北海道歯学雑誌 > 第38巻 第2号

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