Development of dysphagia risk assessment for the community-dwelling elderly

吞咽困难的详细状况尚未在社区居住的受损老年人中得到阐明。本研究的目的是开发一个新的量表，吞咽困难风险评估为社区居住的老年人（DRACE）。本研究的对象为85名有身体或精神障碍的社区长者。首先，采用顺序量表对18种与吞咽困难相关的症状进行评估。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中选取6个条目，从因子2中选取3个条目，从因子3中选取1个条目，从因子4中提取1个条目。这11个与吞咽困难相关的项目被确定为DRACE的评估项目。DRACE的Cronbach’s alpha为0.84，具有足够的信度。此外，DRACE的得分与两项具有代表性的吞咽困难临床评估（改良水吞试验和重复唾液吞试验）显著相关，具有足够的建构效度。此外，从DRACE中确定的吞咽困难风险与过期气体中硫化氢的浓度显著相关，这是导致口臭的主要原因。然而，口腔保健频率与DRACE评分无显著相关。这些结果表明，本研究开发的DRACE将具有足够的检测能力来评估社区居住老年人吞咽困难的风险。

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.