Development of Dysphagia Nursing System for the Elderly Living at Home

本研究的目的是为居家老人建立吞咽困难筛检系统，并探讨自我控制吞咽训练计划的有效性。本研究经爱知县护理卫生学院伦理委员会批准。作为第一次筛选试验，采用改进的吞咽困难风险自评量表进行问卷调查。志愿者是759名老年人。作为第二次筛选试验，对71名了解本研究目的并表示同意的居家老人进行重复唾液吞咽试验、改良水吞咽试验和食物测试。同时记录吞咽过程中舌骨上肌的表面肌电图和呼吸图。以显像法作为金标准。结果如下：修正后的吞咽困难风险评估的Cronbach’s α和重测相关系数（test-retest）分别为0.90和0.62。各因子的Cronbach’s α为0.70 ~ 0.88。与改进前相比，有效度和信度均有所提高。当第一次和所有第二次筛选试验的分界点为6点时，敏感性为0.619，特异性为0.569。调查吞咽困难风险家庭评估量表。家庭评定量表总分的Cronbach′s α和重测相关系数分别为0.89和0.78。自评量表与家庭评定量表的符合率为0.85 ~ 0.952，相关系数为0.60 ~ 0.79。上述结果表明，采用改进的吞咽困难风险自评量表或家庭评估量表进行筛查和二次筛查，可以发现老年人存在吞咽困难，70岁及以上老年人重复吞咽频率增加，安全呼吸方式减少。对4名年轻人和1名老年人进行声门上吞咽训练。在深吸气后，在呼吸循环的适当时间产生一种声音来触发吞咽。训练的有效性是基于两个年轻人和一个老年人成功的声门上吞咽的数量增加这一事实提出的。少

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