Study On Appropriacy Evaluation Of Swallowing Function Training To Elderly Patients With Dysphagia In The Community

Objectives 1.To investigate the quality of life and its influence factors of elderly patients with dysphagia in the community.2.To evaluate the effects and appropriacy of swallowing function training to elderly patients with dysphagia in the community.Methods 1.The elderly patients with dysphagia from outpatient departments of the two general hospitals in Fujian Province were selected by convenient sampling method from May 2017 to December 2017.The research tools included the general information questionnaire,Eating Assessment Tool-10,swallowing functional evaluation method and Swallowing Quality-of-Life Questionnaire(SWAL-QOL).Univariate and multiple regression analysis were used to explore the main factors affecting the quality of life.2.A randomized controlled trial was conducted in a sample of 64 elderly stroke patients with dysphagia at the department of speech therapy in a general hospital in Fujian Province which was divided into experimental and control groups.A total of 61 cases completed the study,31 in experimental group and 30 in control group.Patients in both groups received conventional drug therapy.The experimental group received swallowing electrical stimulation treatment within 1-4 weeks and swallowing function training within 1-8 weeks.While the control group received swallowing electrical stimulation treatment within 1-4 weeks and only regular follow-up visits within 5-8 weeks.The Standardized Swallowing Assessment(SSA)and Water Swallow Test(WST)were used to evaluate the swallowing function before intervention,4 weeks and 8 weeks after intervention.Besides,cost-effect analysis,the compliance,adverse reactions and application satisfaction were applied to evaluate appropriacy of swallowing function training.Results 1.The average score of SWAL-QOL in 178 elderly patients with dysphagia was 51.53±17.74.From low to high on each dimension of SWAL-QOL scores were social function,mental health,burden,fatigue,eating duration,food selection,eating desire,sleep,fear,swallowing symptoms and communication.The results of univariate analysis showed that age,marriage status,the way of eating and dysphagia severity were the factors affecting the quality of life of elderly patients with dysphagia.Multiple linear regression analysis showed that age,the way of eating and dysphagia severity were the significant factors which affect the quality of life of elderly patients with dysphagia(P<0.05).2.The baseline data between two groups were similar(P>0.05).After 4 weeks,the SSA score of the two groups were all lower than the baseline level,and the SSA score of the experimental group was lower than that of the control group significantly(P<0.05).However,there was no significant differences between the two groups in the treatment effect of WST(P>0.05).After 8 weeks,the SSA scores in both groups were lower than those of 4 weeks after intervention,and the SSA score in the experimental group was lower than the control group.The treatment effect of WST in the experimental group was better than the control group significantly(P<0.05).During the intervention of swallowing function training,there were no adverse reactions or adverse events,and the safety was 100%.The cost-effectiveness ratio of swallowing function training was 1.99,which was lower than that of swallowing electrical stimulation 3.94 and combined therapy 4.05.The compliance of all patients was over 80%,and 49.1% of the patients adhered to swallowing function training all the time.The questionnaire survey showed 80.6% of the patients stated they had mastered the training methods;80.7% of the patients stated training was easy to grasp.77.4% of the patients stated the requirements of consumptive materials were low.96.8% of the patients were satisfied with the training.Conclusions 1.The quality of life of elderly patients with dysphagia in the community was in the low level,and social function,mental health,burden,fatigue and eating duration were affected mostly.Age,marriage status,the way of eating and dysphagia severity were the influence factors of quality of life of the elderly patients with dysphagia,among which age,the way of eating and dysphagia severity were the main influence factors.2.Swallowing function training could improve the swallowing function of elderly patients with dysphagia which accorded with appropriate technology requirement of validity,safty,economy,participation,maturity,convenience.