歌唱遊戲介入對長期照護單位65歲以上長者吞嚥功能影響之成效

背景及目的：隨著台灣超高齡化的來臨，長者吞嚥議題將是重要的挑戰。歌唱、發聲等動作可促進唇、舌及口腔肌肉活動的協調性，且相較於傳統制式的吞嚥訓練，更具吸引力。因此，本研究透過歌唱遊戲介入，以提升65歲以上長者之吞嚥能力。研究方法：本研究採類實驗、重複測量設計，於2020年11月至2021年7月期間，以中部某長期照護機構65歲以上長者為研究對象，招募實驗組及控制組各15名進行研究。介入時間為期8週，每週2次，每次30分鐘。介入措施為運用歌唱、發聲及懷舊童玩等遊戲式的活動。於介入前、介入後第4週及第8週，以愛荷華口腔功能評量器（Iowa Oral Performance Instrument，IOPI）、結構性問卷（基本資料、進食評估問卷、迷你營養評估量表、中國人幸福感量表-迷你版）等工具進行資料收集。所得資料以SPSS 21.0版進行描述性和推論性統計分析，比較兩組吞嚥功能、營養狀態、幸福感及唇舌肌力變化。研究結果：在吞嚥能力上，歌唱遊戲介入對吞嚥能力有持續改善效果，實驗組於介入後8週發生吞嚥困難的比例顯著低於介入前(p=0.020)，而控制組則無顯著差異(p=0.071)。在唇舌肌力上，歌唱遊戲介入可維持前舌壓、提升後舌壓(24.80±14.32→27.27±12.19 kPa)，於介入後8週實驗組後舌壓明顯優於持續退化之控制組(p=0.033)。兩組在幸福感方面雖無統計上顯著差異，但實驗組幸福感有持續上升(6.00±1.51→6.53±2.03→6.67±1.84)，而控制組有持續下降(6.47±2.72→6.40±3.20→6.13±2.92)的趨勢。在營養狀態方面，實驗組在介入後4週營養不良風險族群增多，營養良好族群減少，兩者相較具顯著差異(p=0.020)，但在介入後8週營養不良風險族群降低，營養良好族群回升後，兩者相較則無顯著差異。以GEE Model分析介入後吞嚥能力、營養狀態、幸福感等變項，隨介入時間組別間的變化皆無顯著差異，而在唇舌肌力方面，發現控制組第三次前舌壓較第一次檢測降低6.33kPa，並具統計上顯著差異(p=0.004)，控制了BMI及疾病數的共變影響後，於第三次檢測時實驗組與控制組之改變幅度差異達顯著水準(β=6.64, p=0.020)。結論與建議：歌唱遊戲介入可改善長期照護單位65歲以上長者吞嚥功能及幸福感狀態，且可維持前舌肌力，並持續性的提升後舌肌力，而控制BMI值與疾病種類後，模式預測介入可增加長者6.64 kPa的前舌壓。故可藉由歌唱遊戲活動改善吞嚥能力與相關生、心理狀態，進而提升高齡者生活品質。

Background and Purpose: With the advent of super-aging in Taiwan, the issue of elderly swallowing will be an important challenge. Actions such as singing and vocalization can promote the coordination of lip, tongue, and oral muscle activities and are more attractive than traditional swallowing training. Therefore, this study intervened through singing games to improve the swallowing ability of the elderly over 65.Methods: This study adopts a quasi-experiment and repeated measurement design. From November 2020 to July 2021, the elderly over 65 years old in a long-term care institution in central Taiwan had recruited for the study. Finally, we recruited 15 people in each experimental and control group. The intervention lasted eight weeks, twice a week, 30 minutes each time. The interventions were game-like activities using singing, vocalization, and nostalgic play. Before the intervention, four weeks and eight weeks after, the Iowa Oral Performance Instrument (IOPI), structured questionnaires (basic information, Eating Assessment Tool, Mini Nutritional Assessment scale, Chinese Happiness Inventor Scale-mini version) and other tools for data collection. The obtained data were analyzed by SPSS version 21.0 for descriptive and inferential statistical analysis.Result: In terms of swallowing ability, the intervention of singing games has a continuous improvement effect on swallowing power. In addition, the proportion of dysphagia in the experimental group after the intervention for eight weeks was significantly lower than before the intervention (p=0.020), while there was no significant difference in the control group (p=0.071). Regarding lip-tongue muscle strength, the singing game intervention could maintain the anterior tongue pressure and increase the posterior tongue pressure (24.80±14.32→27.27±12.19 kPa). After eight weeks of intervention, the experimental group was significantly better than the control group with continuous deterioration (p=0.033). Although there was no statistically significant difference between the two groups in terms of happiness, the happiness of the experimental group continued to increase (6.00±1.51→ 6.53±2.03→6.67±1.84). In contrast, the control group continued to decline (6.47±2.72→6.40±3.20→6.13±2.92) trend. Regarding nutritional status, the groups at risk of malnutrition in the experimental group increased four weeks after the intervention, and those with good nutrition decreased. There was a significant difference between the two (p=0.020). After the population rebounded, there was no significant difference between the two groups. GEE model was used to analyze variables such as swallowing ability, nutritional status, and well-being after the intervention. There was no significant difference between the groups with the intervention time. In terms of lip-tongue muscle strength, in the control group, the tongue pressure before the third time was higher than the first time. The detection decreased by 6.33 kPa, and there was a statistically significant difference (p=0.004). After controlling for the covariation effect of BMI and the number of diseases, the difference between the experimental and control group reached a significant level in the third test (β=6.64, p=0.020). Conclusions and recommendations: Singing game intervention can improve the swallowing function and well-being of the elderly over 65 years old in long-term care units, maintain the strength of the anterior tongue muscle, and continuously improve the muscle strength of the posterior tongue. Furthermore, after controlling the BMI value and the type of disease, the model prediction intervention can Increase the anterior tongue pressure by 6.64 kPa in the elderly. Therefore, it is possible to improve the swallowing ability and related health and psychological state through singing and game activities, thereby improving the quality of life of the elderly.