酸味冷触刺激が要介護高齢者の唾液嚥下に与える影響

The effects of sour-cold tactile stimulation on saliva swallowing in the elderly requiring long-term care

　唾液嚥下惹起促進を目的に酸味冷触刺激を行い，嚥下機能に与える影響を検討した．対象は要介護高齢者59名．日常生活自立度のJ，A，B，Cはそれぞれ1名，22名，22名，14名で，主疾患は脳血管疾患42.4％，認知症疾患37.3％，呼吸器疾患6.8％，神経筋疾患3.4％，循環器系疾患1.7％，内分泌・代謝性疾患1.7％，消化器系疾患1.7％，その他5.1％であった．方法は，無刺激，無味冷触刺激，酸味冷触刺激後の初回嚥下潜時，10分間の唾液嚥下頻度および唾液量の測定をした．酸味冷触刺激後は，無刺激・無味冷触刺激後に比して，初回嚥下潜時が有意に短縮し，10分間の唾液嚥下頻度が有意に増加した．酸味冷触刺激は，嚥下に関与する神経活動を継続的に高め，その結果，初回嚥下潜時が短縮し，持続的に嚥下頻度が増加したと考えられる．酸味冷触刺激は，飲食物を用いない間接訓練で安全・簡便に行え，急性期の経口摂取を行っていない段階での間接訓練や，食事場面で追加嚥下が惹起しない場合の嚥下惹起促進など，広範囲に適用可能であると考えられる．

　The aim of this study was to clarify the effects of sour cold tactile stimulation for saliva swallowing among the elderly who require long-term care.

　59 residents of a long-term care welfare facility for the elderly participated in this study. Their levels of ADL were full independence: 1 subject, independence indoors only: 22 subjects, wheelchair life: 22 subjects, bed ridden: 14 subjects. 42.4%(25 subjects) of them were stroke survivors, and 37.3%(22 subjects) were the patients of dementing illness. We measured their latency of the first saliva swallow, the frequency of saliva swallowing and the amount of saliva for a 10 minute-period under the condition: without stimulation, with cold tactile stimulation or sour cold tactile stimulation. The latency was shortened and the frequency increased with sour cold tactile stimulation significantly in both the stroke and dementia group. We therefore consider that sour cold tactile stimulation could activate the swallowing nerve system sustainably. Sour cold tactile stimulation can be easily, safely and widely applicable for indirect therapy technique because it does not need oral intake of real foods or liquids. It could be very effective for the elderly requiring long-term care to prevent saliva pooling and aspiration pneumonia due to overflowed saliva and/or residual bolus.