Development of dysphagia risk assessment for the community-dwelling elderly

尚未阐明受损社区居住老年人吞咽困难的详细状况。本研究旨在编制一个新的量表--社区老年人吞咽困难风险评估量表（Dysphagia Risk Assessment for the Community-dwelling Elderly，DRACE）。首先，使用顺序量表评估与吞咽困难相关的18种症状。采用因子分析法对结果进行分析，提取出4个因子。从因子1中选择6个项目，从因子2中选择3个项目，从因子3中选择1个项目，从因子4中提取1个项目。将这11个与吞咽困难相关的项目确定为DRACE的评价项目，DRACE的Cronbach 'salpha值为0.84，具有足够的信度。此外，DRACE评分与吞咽困难的两种典型临床评估方法（改良吞咽水试验和重复吞咽唾液试验）显著相关，并且由DRACE确定的吞咽困难风险与呼出气体中硫化氢浓度显著相关，硫化氢是口臭的主要原因。口腔保健频率与DRACE评分无显著相关性，提示本研究开发的DRACE量表对社区老年人吞咽困难的危险性有足够的检测能力。

It has been not elucidated the detailed status of dysphagia among the impaired community-dwelling elderly persons. The purpose of the present study was to develop a new scale, Dysphagia Risk Assessment for the Community-dwelling Elderly (DRACE).The subjects of the present study were 85 community-dwelling elderly persons with physical or mental impairment. First, 18 symptoms related to dysphagia were evaluated using ordinal scale. The results were analyzed using factor analysis, thus four factors were extracted. Six items were selected from factor 1, three items were selected from factor 2, an item was selected from factor 3, and an item was extracted from factor 4. These 11 items related to dysphagia were determined as evaluation items of DRACE.Cronbach's alpha of DRACE was 0.84, thus DRACE had enough reliability. Also, DRACE has sufficient construct validity because the score of DRACE was significantly related to two representative clinical assessment of dysphagia such as modified water swallow test and repetitive saliva swallowing test.Furthermore, dysphagia risk determined from DRACE was significantly related to the concentration of hydrogen sulfide of expired gas, which was a major cause of halitosis. However, frequencies of oral health care were not significantly related to the score of DRACE.These results suggest that DRACE, which is developed in the present study, will have a sufficient detective power to evaluate the risks of dysphagia in the community-dwelling elderly persons.