养老机构老年人吞咽障碍影响因素的meta分析

夏燕; 夏杰琼; 郭洪花; 赵子冉; 李文; 张彩虹

doi:10.16766/j.cnki.issn.1674-4152.003618

养老机构老年人吞咽障碍影响因素的meta分析

doi: 10.16766/j.cnki.issn.1674-4152.003618

1.
海南医学院国际护理学院，海南海口 571199
2.
海南省托老院养护区，海南海口 570311

基金项目:

海南省基础与应用基础研究计划(省自然科学基金)项目 820RC779

海南省卫生健康行业科研项目 21A200061

海南医学院研究生创新课题 HYYS2021B05

详细信息

通讯作者:
张彩虹，E-mail: 404669792@qq.com

中图分类号: R592 R197.7
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出版历程
- 收稿日期: 2023-12-15
- 网络出版日期: 2024-11-19

Influencing factors of dysphagia in the elderly in nursing home: a meta-analysis

1.
International School of Nursing, Hainan Medical University, Haikou, Hainan 571199, China

摘要

摘要: 目的系统评价养老机构老年人发生吞咽障碍的影响因素，为实施针对性干预提供参考。方法计算机检索PubMed、Web of Science、The Cochrane Library、Ovid、Embase、CNKI、CBM、WanFang Data以及维普网(VIP)数据库关于养老机构老年人吞咽障碍影响因素的研究，检索时限为建库至2023年3月。2名研究者按照纳入排除标准独立完成文献筛选、数据提取及质量评价，结局指标为养老机构老年人发生吞咽障碍的影响因素(包括其OR值及95% CI)。使用RevMan 5.3软件进行meta分析。结果共纳入12篇文献，包括32 890例研究对象。Meta分析结果显示：高龄(P=0.010)、进食时间长(P < 0.001)、进食量少(P=0.007)、协助进食(P < 0.001)、中重度认知障碍(P < 0.001)、脑血管疾病(P=0.040)、心血管疾病(P < 0.001)、肺炎病史(P < 0.001)、牙齿缺失(P < 0.001)、咀嚼困难(P=0.020)和重度依赖(P < 0.001)共11个因素为养老机构老年人吞咽障碍的危险因素。结论养老机构老年人发生吞咽障碍的危险因素较多，养老机构工作人员应全面评估老年人的吞咽障碍风险。
- 老年人 /
- 养老机构 /
- 吞咽障碍 /
- 影响因素 /
- Meta分析
Abstract: Objective To systematically evaluate the influencing factors of dysphagia in the elderly in nursing home and provide reference for targeted interventions. Methods Studies on influencing factors of dysphagia among the elderly in nursing home were searched from PubMed, Web of Science, the Cochrane Library, Ovid, Embase, CBM, CNKI, VIP and WanFang Database. The retrieval time was from inception to March 2023. Two researchers screened literature by following the inclusion and exclusion criteria independently, extracted data and evaluated the quality of literature. The influencing factors (including OR value and 95% CI) of dysphagia in the elderly in nursing home were outcome indicators. RevMan 5.3 software was used to conduct meta-analysis. Results The results included a total of 12 studies, including 32890 study subjects. The meta-analysis results showed that advanced age (P=0.010), eating time (long, P < 0.001), food take (less, P=0.007), assisted eating (P < 0.001), moderate to severe cognitive dysfunction (P < 0.001), cerebrovascular disease (P=0.040), cardiovascular disease (P < 0.001), history of pneumonia (P < 0.001), tooth loss (P < 0.001), chewing difficulties (P=0.020), and severe dependence (P < 0.001) were all risk factors for dysphagia in the elderly in nursing homes. Conclusion There are many risk factors for dysphagia among the elderly in nursing homes, and the staff of nursing homes should comprehensively assess the risk of dysphagia among the elderly.
- The aged /
- Nursing home /
- Dysphagia /
- Influencing factors /
- Meta-analysis

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图 1 文献筛选流程及结果

Figure 1. Literature selection process and results

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图 2 高龄对养老机构老年人吞咽障碍发生的影响

Figure 2. Influence of advanced age on dysphagia in the elderly in nursing home

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图 3 脑血管疾病对养老机构老年人吞咽障碍发生的影响

Figure 3. Influence of cerebrovascular disease on dysphagia in the elderly in nursing home

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图 4 中重度认知障碍对养老机构老年人吞咽障碍发生的影响

Figure 4. Influence of moderate to severe cognitive dysfunction on dysphagia in the elderly in nursing home

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图 5 重度依赖对养老机构老年人吞咽障碍发生的影响

Figure 5. Influence of severe dependence on dysphagia in the elderly in nursing home

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表 1 纳入研究的基本特征及质量评价

Table 1. Basic information and quality assessment about the included study

作者	年份	地区	样本量	诊断标准	影响因素	质量评价(分)
PARK Y H^[7]	2013	韩国	395	吞咽功能评估量表	①②③④⑦⑪⑫⑭	8
MONCAYO-HERNANDEZ B A^[8]	2021	美国	100	容积-粘度测试	③	10
XAVIER J S^[9]	2022	巴西	73	容积-粘度测试	①⑤	10
OKABE Y^[10]	2017	日本	238	改良饮水试验	⑧	10
HAGGLUND P^[11]	2022	瑞典	4 751	询问照护人员	⑤	9
CHEN S^[12]	2020	中国	775	进食评估问卷	③⑨⑩	8
PU D^[13]	2017	香港	865	容积-粘度测试+进食评估问卷	②⑥⑩⑪⑬	10
刘金枚^[14]	2023	中国	475	标准吞咽功能评估量表	⑧⑪	10
高薇薇^[15]	2019	中国	997	饮水试验	①②⑧⑨	10
陈丽丽^[16]	2014	中国	400	临床护理用吞咽功能评估工具	①④⑥⑦⑧⑬	10
STREICHER M^[17]	2017	欧洲和北美	23 549	查阅医疗档案	⑦⑪⑭⑭	10
NOGUEIRA D^[18]	2023	葡萄牙	272	3盎司水吞咽试验+吞咽困难自评问卷	①	8
注：①高龄；②性别；③巴塞尔指数；④进食时间(长)；⑤进食量(少)；⑥协助进食；⑦中重度认知障碍；⑧脑血管疾病；⑨心血管疾病；⑩肺炎病史；⑪重度依赖；⑫ BMI低；⑬牙齿缺失；⑭咀嚼困难。

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表 2 养老机构老年人吞咽障碍影响因素的meta分析

Table 2. Meta-analysis of influencing factors of dysphagia in the elderly in nursing home

影响因素	纳入研究	纳入样本量	异质性检验		效应模型	效应量
影响因素	纳入研究	纳入样本量	I²(%)	P值	效应模型	OR(95% CI)	P值
高龄	5^{[7, 9, 15-16, 18]}	2 137	92	< 0.001	随机	1.27(1.06~1.53)	0.010
性别(男性)	3^{[7, 13, 15]}	2 257	88	< 0.001	随机	1.11(0.54~2.31)	0.770
进食时间(长)	2^{[7, 16]}	795	0	0.390	固定	3.31(1.94~5.65)	< 0.001
进食量(少)	2^{[9, 11]}	4 824	23	0.260	固定	1.88(1.52~2.31)	< 0.001
协助进食	2^{[13, 16]}	1 265	0	0.900	固定	3.15(2.19~4.54)	< 0.001
中重度认知障碍	3^{[7, 16-17]}	24 344	0	0.400	固定	1.98(1.67~2.36)	< 0.001
脑血管疾病	4^{[10, 14-16]}	2 110	97	< 0.001	随机	8.16(1.10~60.26)	0.040
心血管疾病	2^{[12, 15]}	1 772	0	0.840	固定	4.08(2.41~6.89)	< 0.001
肺炎病史	2^{[12, 13]}	1 640	0	0.630	固定	4.08(2.18~7.66)	< 0.001
BMI(低)	2^{[7, 17]}	23 944	90	0.002	随机	1.74(0.80~3.75)	0.160
咀嚼困难	2^{[7, 17]}	23 944	96	< 0.001	随机	5.33(1.36~20.86)	0.020
牙齿缺失	2^{[13, 16]}	1 265	2	0.310	固定	4.74(2.71~8.30)	< 0.001
重度依赖	4^{[7, 13-14, 17]}	25 284	44	0.150	固定	4.89(4.15~5.75)	< 0.001
BI指数	3^{[7-8, 12]}	1 270	95	< 0.001	随机	1.68(0.98~2.88)	0.060
注：BI为巴塞尔指数(Bethel index)。

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表 3 各影响因素敏感性分析

Table 3. Sensitivity analysis of each influencing factor

影响因素	固定效应模型		随机效应模型
影响因素	OR(95% CI)	P值	OR(95% CI)	P值
高龄	1.24(1.19~1.29)	< 0.001	1.27(1.06~1.53)	0.010
性别(男)	1.21(0.94~1.55)	0.130	1.11(0.54~2.31)	0.770
进食时间(长)	3.31(1.94~5.65)	< 0.001	3.31(1.94~5.65)	< 0.001
进食量(少)	1.88(1.52~2.31)	< 0.001	2.04(1.22~3.41)	0.007
协助进食	3.15(2.19~4.54)	< 0.001	3.15(2.19~4.54)	< 0.001
中重度认知障碍	1.98(1.67~2.36)	< 0.001	1.98(1.67~2.36)	< 0.001
脑血管疾病	6.04(4.31~8.46)	< 0.001	8.16(1.10~60.26)	0.040
心血管疾病	4.08(2.41~6.89)	< 0.001	4.08(2.41~6.89)	< 0.001
肺炎病史	4.08(2.18~7.66)	< 0.001	4.08(2.18~7.66)	< 0.001
BMI(低)	1.28(1.13~1.46)	< 0.001	1.74(0.80~3.75)	0.160
咀嚼困难	9.25(7.98~10.72)	< 0.001	5.33(1.36~20.86)	0.020
牙齿缺失	4.74(2.71~8.30)	< 0.001	4.77(2.67~8.49)	< 0.001
重度依赖	4.89(4.15~5.75)	< 0.001	4.67(3.34~6.52)	< 0.001
BI指数	0.98(0.97~0.99)	< 0.001	1.68(0.98~2.88)	0.060

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参考文献(35)

[1]	THIYAGALINGAM S, KULINSKI A E, THORSTEINSDOTTIR B, et al. Dysphagia in older adults[J]. Mayo Clin Proc, 2021, 96(2): 488-497. doi: 10.1016/j.mayocp.2020.08.001
[2]	DOAN T N, HO W C, WANG L H, et al. Prevalence and methods for assessment of oropharyngeal dysphagia in older adults: a systematic review and meta-analysis[J]. J Clin Med, 2022, 11(9): 2605. DOI: 10.3390/jcm11092605.
[3]	BOSCH G, COMAS M, DOMINGO L, et al. Dysphagia in hospitalized patients: prevalence, related factors and impact on aspiration pneumonia and mortality[J]. Eur J Clin Invest, 2023, 53(4): e13930. DOI: 10.1111/eci.13930.
[4]	KO D, OH J, JOO S, et al. Dietary habits, food product selection attributes, nutritional status, and depression in middle-aged and older adults with dysphagia[J]. Nutrients, 2022, 14(19): 4045. DOI: 10.3390/nu14194045.
[5]	YANG R Y, YANG A Y, CHEN Y C, et al. Association between dysphagia and frailty in older adults: a systematic review and meta-analysis[J]. Nutrients, 2022, 14(9): 1812. DOI: 10.3390/nu14091812.
[6]	曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具[J]. 中国循证心血管医学杂志, 2012, 4(4): 297-299. doi: 10.3969/j.1674-4055.2012.04.004 ZENG X T, LIU H, CHEN X, et al. Meta-analysis series 4: quality assessment tools for observational studies[J]. Chinese Journal of Evidence-Based Cardiovascular Medicine, 2012, 4(4): 297-299. doi: 10.3969/j.1674-4055.2012.04.004
[7]	PARK Y H, HAN H R, OH B M, et al. Prevalence and associated factors of dysphagia in nursing home residents[J]. Geriatr Nurs, 2013, 34(3): 212-217. doi: 10.1016/j.gerinurse.2013.02.014
[8]	MONCAYO-HERNANDEZ B A, HERRERA-GUERRERO J A, VINAZCO S, et al. Sarcopenic dysphagia in institutionalised older adults[J]. Endocrinol Diabetes Nutr (Engl Ed), 2021, 68(9): 602-611.
[9]	XAVIER J S, GOIS A C B, COSTA LIMA K, et al. Swallowing disorders and associated factors in older adults living in nursing homes[J]. Eur Arch Otorhinolaryngol, 2022, 279(7): 3733-3740. doi: 10.1007/s00405-022-07355-1
[10]	OKABE Y, TAKEUCHI K, IZUMI M, et al. Posterior teeth occlusion and dysphagia risk in older nursing home residents: a cross-sectional observational study[J]. J Oral Rehabil, 2017, 44(2): 89-95. doi: 10.1111/joor.12472
[11]	HAGGLUND P, GUSTAFSSON M, LOVHEIM H. Oropharyngeal dysphagia and associated factors among individuals living in nursing homes in northern Sweden in 2007 and 2013[J]. BMC Geriatr, 2022, 22(1): 421. DOI: 10.1186/s12877-022-03114-3.
[12]	CHEN S, CUI Y, DING Y, et al. Prevalence and risk factors of dysphagia among nursing home residents in eastern China: a cross-sectional study[J]. BMC Geriatr, 2020, 20(1): 352. doi: 10.1186/s12877-020-01752-z
[13]	PU D, MURRY T, WONG M, et al. Indicators of dysphagia in aged care facilities[J]. J Speech Lang Hear Res, 2017, 60(9): 2416-2426. doi: 10.1044/2017_JSLHR-S-17-0028
[14]	刘金枚, 李航, 彭杨, 等. 医养结合型养老机构老年人吞咽障碍发生现状及影响因素分析[J]. 中华现代护理杂志, 2023, 29(2): 227-232. doi: 10.3760/cma.j.cn115682-20220420-01954 LIU J M, LI H, PENG Y, et al. Status quo and influencing factors of dysphagia in elderly people in integrated medical and nursing service institution for the aged[J]. Chinese Journal of Modern Nursing, 2023, 29(2): 227-232. doi: 10.3760/cma.j.cn115682-20220420-01954
[15]	高薇薇, 张晓晓, 白银婷. 宁波市养老院老年人吞咽功能障碍调查[J]. 中国康复理论与实践, 2019, 25(7): 761-765. GAO W W, ZHANG X X, BAI Y T. Swallowing dysfunction for old people in nursing homes in Ningbo[J]. Chinese Journal of Rehabilitation Theory and Practice, 2019, 25(7): 761-765.
[16]	陈丽丽, 李红, 林榕, 等. 老年痴呆患者吞咽困难状况及危险因素分析[J]. 护理学杂志, 2014, 29(21): 24-26. doi: 10.3870/hlxzz.2014.21.024 CHEN L L, LI H, LIN R, et al. Prevalence and associated factors of dysphagia in elderly patients with dementia[J]. Journal of Nursing Science, 2014, 29(21): 24-26. doi: 10.3870/hlxzz.2014.21.024
[17]	STREICHER M, WIRTH R, SCHINDLER K, et al. Dysphagia in nursing homes-results from the NutritionDay Project[J]. J Am Med Dir Assoc, 2018, 19(2): 141-147. doi: 10.1016/j.jamda.2017.08.015
[18]	NOGUEIRA D, REIS E. Swallowing disorders in nursing home residents: how can the problem be explained?[J]. Clin Interv Aging, 2013, 8: 221-227.
[19]	HOLLINGHURST J, SMITHARD D G. Identifying dysphagia and demographic associations in older adults using electronic health records: a national longitudinal observational study in Wales (United Kingdom) 2008-2018[J]. Dysphagia, 2022, 37(6): 1612-1622. doi: 10.1007/s00455-022-10425-5
[20]	PICCA A, LOZANOSKA-OCHSER B, CALVANI R, et al. Inflammatory, mitochondrial, and senescence-related markers: underlying biological pathways of muscle aging and new therapeutic targets[J]. Exp Gerontol, 2023, 178: 112204. DOI: 10.1016/j.exger.2023.112204.
[21]	JING X, YANG M, LIU Y, et al. Associations of trunk muscle mass and muscle quality Indicators with self-reported dysphagia in older inpatients[J]. Dysphagia, 2023, 38(1): 415-424. doi: 10.1007/s00455-022-10480-y
[22]	CHRISTMAS C, ROGUS-PULIA N. Swallowing disorders in the older population[J]. J Am Geriatr Soc, 2019, 67(12): 2643-2649. doi: 10.1111/jgs.16137
[23]	林伟权, 孙敏英, 刘览, 等. 广州市社区老年人慢性病共病与营养状况相关性研究[J]. 中华全科医学, 2022, 20(11): 1870-1873. doi: 10.16766/j.cnki.issn.1674-4152.002723 LIN W Q, SUN M Y, LIU L, et al. Study on the relationship between multimorbidity and nutritional status among the community-dwelling elderly people in Guangzhou[J]. Chinese Journal of General Practice, 2022, 20(11): 1870-1873. doi: 10.16766/j.cnki.issn.1674-4152.002723
[24]	WATANABE Y, OKADA K, KONDO M, et al. Oral health for achieving longevity[J]. Geriatr Gerontol Int, 2020, 20(6): 526-538. doi: 10.1111/ggi.13921
[25]	TRAN T P, NGUYEN L T, HIROSE K, et al. Malnutrition is associated with dysphagia in Vietnamese older adult inpatients[J]. Asia Pac J Clin Nutr, 2021, 30(4): 588-594.
[26]	DEHAGHANI S E, DOOSTI A, ZARE M. Association between swallowing disorders and cognitive disorders in adults: a systematic review and meta-analysis[J]. Psychogeriatrics, 2021, 21(4): 668-674. doi: 10.1111/psyg.12704
[27]	ESTARLICH M, TOLSA C, TRAPERO I, et al. Circadian variations and associated factors in patients with ischaemic heart disease[J]. Int J Environ Res Public Health, 2022, 19(23): 15628. DOI: 10.3390/ijerph192315628.
[28]	MATSUO H, YOSHIMURA Y, FUJITA S, et al. Incidence of dysphagia and its association with functional recovery and 1-year mortality in hospitalized older patients with heart failure: a prospective cohort study[J]. JPEN J Parenter Enteral Nutr, 2021, 45(2): 372-380. doi: 10.1002/jpen.1845
[29]	江方辉, 应忠明, 施玲玲. 揿针埋针联合吞咽康复训练治疗脑卒中后吞咽障碍的效果观察[J]. 中华全科医学, 2021, 19(3): 483-485. doi: 10.16766/j.cnki.issn.1674-4152.001841 JIANG F H, YING Z M, SHI L L. Observation on the effect of pressing needle embedding acupuncture point combined with swallowing rehabilitation training on dysphagia after stroke[J]. Chinese Journal of General Practice, 2021, 19(3): 483-485. doi: 10.16766/j.cnki.issn.1674-4152.001841
[30]	YOSHIMATSU Y, MELGAARD D, WESTERGREN A, et al. The diagnosis of aspiration pneumonia in older persons: a systematic review[J]. Eur Geriatr Med, 2022, 13(5): 1071-1080. doi: 10.1007/s41999-022-00689-3
[31]	TEZZE C, SANDRI M, TESSARI P. Anabolic resistance in the pathogenesis of sarcopenia in the elderly: role of nutrition and exercise in young and old people[J]. Nutrients, 2023, 15(18): 4073. DOI: 10.3390/nu15184073.
[32]	ISHII M, NAKAGAWA K, YOSHIMI K, et al. Time spent away from bed to maintain swallowing function in older adults[J]. Gerontology, 2023, 69(1): 37-46. doi: 10.1159/000522499
[33]	余丽丽. 老年患者吞咽障碍风险预测模型的建立[D]. 十堰: 湖北医药学院, 2021. YU L L. Establishment of risk prediction model for dysphagia in elderly patients[D]. Shiyan: Hubei University of Medicine, 2021.
[34]	NISHIDA T, YAMABE K, HONDA S. Dysphagia is associated with oral, physical, cognitive and psychological frailty in Japanese community-dwelling elderly persons[J]. Gerodontology, 2020, 37(2): 185-190. doi: 10.1111/ger.12455
[35]	BANDA K J, CHU H, CHEN R, et al. Prevalence of oropharyngeal dysphagia and risk of pneumonia, malnutrition, and mortality in adults aged 60 years and older: a meta-analysis[J]. Gerontology, 2022, 68(8): 841-853. doi: 10.1159/000520326