Development of Dysphagia Nursing System for the Elderly Living at Home

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The purpose of this study was to establish dysphagia screening systems for elderly people living at home and to investigate the effectiveness of a self-controlled swallow training program. This study was approved by the ethical committee of the Aichi Prefectural College of Nursing & Health.As the first screening test, A questionnaire survey was performed using modified dysphagia risk self-assessment scale. The voluntary participants were 759 elderly people.As the second screening test, the repetitive saliva swallowing test, modified water swallowing test and food test were examined for 71 elderly people living at home who understood the purpose of this study and expressed their consent. Simultaneously, the surface electromyograms (EMGs) of the suprahyoid muscles and respirograms during swallowing were measured and recorded. Videofluorography was conducted as the gold standard. The results were as follows.Cronbach's α and test-retest correlation of the modified dysphagia risk assessment … More scale was 0.90 and 0.62 respectively, for overall scores. Cronbach's α of each factor was 0.70〜0.88. The validity and reliability were increased compared to before the improvement. When the cut-off point on the scale of the first and all second screening tests were put at 6 points, the sensitivity was 0.619 and the specificity was 0.569.The dysphagia risk family-assessment scale was investigated. Cronbach's α and test-retest correlation of the family-assessment scale were 0.89 and 0.78, respectively, for overall scores. The consistent rate and correlation coefficient between the self-assessment scale and family- assessment scale were 0.85〜0.952 and 0.60〜0.79, respectively.These results showed that screening by the modified dysphagia risk self-assessment scale or the family-assessment scale and second screening test will detect elderly people with dysphagiaThen, the frequency of repetitive swallowing increased and the safe respiratory pattern decreased in elderly 70 years and over.Supraglottic swallow training was conducted on four young persons and one elderly. After inhaling deeply, a sound was generated to trigger the swallowing at the appropriate time in the respiratory cycle. The effectiveness of the training was suggested based on the fact that the numbers of successful supraglottic swallows increased in two young persons and one elderly person. Less