社区老年人吞咽障碍现状及其影响因素研究
Current Status and Influencing Factors of Dysphagia among the Elderly in Communities
背景 吞咽障碍是一种常见的老年综合征，其发病率逐年升高，易导致吸入性肺炎、窒息等并发症，而目前社区老年人群吞咽障碍现状及其影响因素相关研究较为缺乏。目的 了解上海市社区老年人吞咽障碍的现状，探究吞咽障碍的影响因素，并进一步分析各年龄层吞咽障碍的发生率和影响因素。方法 本研究采用横断面调查方法。于 2022 年 7 月—2023 年 5 月，采用便利抽样的方法在上海市黄浦区、宝山区及奉贤区 5 个社区卫生服务中心的门诊、家庭病床的≥ 60 岁老年人共 358 例为研究对象。记录人口学资料，并测量患者四肢骨骼肌质量指数（ASMI）、握力和步速。采用进食评估问卷调查（EAT-10）筛查老年人吞咽障碍风险。结果 358 例社区老年人中，存在吞咽障碍者（EAT-10 ≥ 3 分）80 例（22.35%）。多因素 Logistic 回归分析结果显示，年龄（≥ 80 岁）（OR=18.484，95%CI=3.571~95.679）、抑郁状态（OR=4.135，95%CI=1.280~13.364）、呛咳史（OR=13.650，95%CI=4.345~42.877）是社区老年人吞咽障碍的危险因素（P<0.05），高 Barthel 指数（OR=0.891，95%CI=0.832~0.953）、高 ASMI（OR=0.330，95%CI=0.199~0.547）是社区老年人吞咽障碍的保护因素（P<0.05）。将受试者按年龄分为 60~69 岁、70~79 岁、≥ 80 岁，吞咽障碍发生率分别为 5.0%（6/119）、11.1%（16/144）、61.1%（58/95），三者吞咽障碍发生率比较，差异有统计学意义（P<0.05）。60~69 岁老年人吞咽障碍组和非吞咽障碍组 BMI、ASMI、抑郁状态比较，差异有统计学意义（P<0.05）；70~79 岁老年人两组握力、小腿围、抑郁状态、Barthel 指数、呛咳史比较，差异有统计学意义（P<0.05）；≥ 80 岁老年人两组 ASMI、握力、步速、Barthel 指数、MMSE 得分、呛咳史比较，差异有统计学意义（P<0.05）。吞咽障碍组中，70~79 岁和≥ 80 岁老年人 ASMI、握力均低于 60~69 岁；≥ 70 岁老年人步速低于 60~69 岁老年人；≥ 80 岁老年人呛咳史发生率高于 60~79 岁，Barthel 指数、MMSE 得分均低于 60~69 岁、70~79 岁（P<0.05）。结论 上海市社区老年人群吞咽障碍患病率高，并且随着年龄的增加，发生率逐渐增高，影响因素明显增多，因此应加强在高龄、抑郁状态及有呛咳史老年人中进行吞咽障碍的筛查。提高肌肉质量及自理能力，并且在不同年龄层进行较为针对性的预防可以有效减轻疾病负担，改善预后。
医药卫生理论医学研究方法预防医学
吞咽障碍老年人患病率社区影响因素分析
王光辉,徐苏,蔡文玮,李晨奕,许又端.社区老年人吞咽障碍现状及其影响因素研究[EB/OL].(2024-02-20)[2025-10-24].https://chinaxiv.org/abs/202402.00200.点此复制
Background Dysphagiaa prevalent geriatric syndromehas been witnessing an upward trend in incidence ratespotentially leading to severe complications like aspiration pneumonia and asphyxia. Despite its significance research on the prevalence and determinants of dysphagia among community-dwelling elderly remains scarce. Objective This study aims to ascertain the prevalence of dysphagia among Shanghai's elderly community by identifying influencing factors and analyzing occurrence rates and determinants across different age brackets. Methods Employing a cross-sectional survey approachthe study was conducted from July 2022 to May 2023. Using convenience samplingthe study involved 358 individuals aged 60 and aboveselected from the outpatient and home care services of five community health service centers in Huangpu Baoshan and Fengxian Districts of Shanghai. Demographic data were collectedand measurements of the Appendicular Skeletal Muscle IndexASMIgrip strengthand walking speed were taken. The Eating Assessment Tool-10EAT-10was utilized to assess the risk of dysphagia among the elderly. Results Out of the 358 community-dwelling elderly individuals surveyed 8022.35%exhibited symptoms of dysphagiaEAT-10 3. Multivariate Logistic regression analysis identified advanced age 80 yearsOR=18.48495%CI=3.571-95.679depressive stateOR=4.13595%CI=1.280-13.364and a history of chokingOR=13.65095%CI=4.345-42.877 as significant risk factors for dysphagiaP<0.05. Conversely a high Barthel IndexOR=0.89195%CI=0.832-0.953and a robust ASMIOR=0.33095%CI=0.199-0.547emerged as protective factorsP<0.05. When stratified by agethe prevalence rates of dysphagia were 5.0%6/11911.1%16/144 and 61.1%58/95for the age groups 60~6970~79and 80 respectivelywith statistically significant differencesP<0.05. Significant disparities were noted between dysphagia and non-dysphagia groups in terms of BMIASMIand depression status for ages 60~69P<0.05grip strengthcalf circumferencedepressionBarthel Indexand choking history for ages 70-79 P<0.05and ASMIgrip strengthwalking speedBarthel IndexMMSE scoresand choking history for ages 80 P<0.05. Within the dysphagia cohortASMI and grip strength in the 70~79 and 80 age groups were lower compared to the 60~69 age groupP<0.05. The walking speed of individuals aged 70 was reduced relative to those aged 60~69P<0.05. Additionallyindividuals aged 80 showed a higher choking incidence and scored lower on the Barthel Index and MMSE than those aged 60~79P<0.05. Conclusion The prevalence of dysphagia among community-dwelling elderly in Shanghai is notably high and progressively increases with agewith a corresponding rise in influencing factors. It is imperative to intensify dysphagia screeningparticularly among the elderly with depressive symptoms or a history of choking. Enhancing muscle mass and self-care capabilitiescoupled with age-specific preventive measurescan substantially alleviate the disease burden and improve prognoses.
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