Yaşlı popülasyonunun yüzeysel elektromyografi yöntemi ile asemptomatik disfaji sıklığının saptanması ve çiğneme egzersizinin tedavideki yeri
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Dosyalar
Tarih
2017
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Yayıncı
Ege Üniversitesi, Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Yutma yaşamsal bir eylemdir. Yutma zorluğu disfaji olarak adlandırılır. Yaşlılarda disfaji, aspirasyon pnömonisi ve malnutrisyon gibi ciddi sağlık sorunları ile kuvvetli bir şekilde ilişkili olup, morbidite ve mortalitenin artmasına, yaşlının hastanede kalış süresinin uzamasına ve sağlık giderlerinde ciddi artışa neden olur. Yaşlılar arasında disfaji prevalansı yüksektir ancak az tanı almaktadır. Bu çalışmada amacımız yaşlıda bilinen bir neden olmaksızın gelişen, semptom vermeyen ancak ciddi komplikasyonlara yol açabilen disfajiyi ortaya çıkarmak ve çiğneme egzersizinin etkinliğini değerlendirmektir.Araştırmamız İzmir ili Karabağlar ilçesi Bozyaka semtinde yeralan Sağlık Bilimleri Üniversitesi ( SBÜ) Bozyaka Eğitim ve Araştırma Hastanesine başvuran 65 yaş ve üstü gönüllülerin katılımıyla Haziran 2016 ile Mayıs 2017 (11 aylık sürede) tarihleri arasında yapılmıştır. %5 hata payı ile %95 güvenlik aralığında (GA) ulaşılması gereken en küçük örnek büyüklüğü 320 olarak hesaplanmıştır (G-power). Semptomatik disfajisi olanların dışlanması için Türkçe validasyonu da olan "EAT-10 anketi" kullanıldı. Bu anketten ≥3 puan alanlar semptomatik kabul edilerek çalışmaya alınmadı. EAT-10 skoru<3 olan (asemptomatik) 320 olgu çalışmaya alındı. Toplam 320 kişiden 7 kişi ulaşılamadığı için çalışmaya alınamadı. Böylece toplam 313 kişi ile çalışmaya devam edildi.. Bu olgular "65-75 yaş", "75-85 yaş" ve "≥85 yaş" olmak üzere üç gruba ayrıldı.238'ini ( %76) 65-75 yaş grubu,62'sini (%10.6), 75-85 yaş grubu ve 13'ünü (%13.4 ) ≥85 yaş grubu oluşturmaktaydı.151'i (%48.2) kadın 162'si (%51.8) erkekti. Hedeflenen örnek büyüklüğüne (313/320) %97,8 oranında ulaşıldı. 3,5,10,15,20 ml sıralı su yutma testi s EMG cihazı ile kaydedildi. Disfaji tanısı gönüllünün yutmayı birden fazla parçada yapması ile kondu. Disfajinin görüldüğü su hacmi ise "disfaji limiti (DL)" olarak kaydedildi. Toplam 39 olguda (%12.7) disfaji saptandı. . 32'si (%13.4) 65-75 yaş grubu, 6'sı (%9.7) 75-85 yaş grubu ve 1'i (%12.5) ≥85 yaş grubu idi. Daha sonra disfaji saptanan 39 kişi 2 gruba randomize edildi.Çalışma grubuna (n=22) sakız çiğneme egzersizi verilirken kontrol grubuna (n=17) herhangi bir egzersiz verilmedi. Egzersiz grubundan 8 hafta boyunca sakız çiğnemeleri istendi (günde 1 saat şekersiz sert sakız). 8 haftanın sonucunda gruplar karşılaştırıldığında egzersiz grubundan 13 kişide (%59.1) kontrol grubunda ise 2 kişide (%11.8) disfajinin kaybolduğu ve gruplar arasında anlamlı fark ortaya çıktığı saptandı (p<0.005). Özetle yaşlı popülasyonda semptom vermeyen disfaji sıktır. Bu olguların saptanmasında s EMG test taraması faydalıdır. Sakız çiğneme egzersizinin yaşam tarzı değişikliği olarak yaşlıda asemptomatik disfajide iyileşme sağladığı gösterilmiştir.
Swallowing is a vital action. The difficulty of swallowing is called dysphagia. Dysphagia in the elderly is strongly associated with serious health problems such as malnutrition, and aspiration pneumonia in the elderly, leading to prolonged hospital stay, increased morbidity and mortality. Among the elderly, the prevalence of dysphagia is high but it is underdiagnosed. In this study, our aim was to reveal dysphagia without a known cause in the elderly and without symptoms, which could lead to serious complications. Our research was conducted with the participation of volunteers aged 65 years and over who applied to Bozyaka Education and Research Hospital of Health Sciences University (SBU) located in Izmir province, Karabağlar and Bozyaka district. The study was conducted between June 2016 and May 2017 within an 11-month period. The minimum sample size that should be reached at the 95% safety margin (GA) with a 5% error margin is 320 (G-Power). A validated EAT-10 survey was conducted among healthy elderly people aged 65 years and older who meet the exclusion criteria in order to eliminate elderly people with symptomatic dysphagia and a total of 320 people have been reached with the score is less than 3. These individuals were those who did not have symptomatic dysphagia and normal on the questionnaire. A total of 313 people participated in the study and 7 people were not reached and were excluded from the study. Volunteers were divided into 3 groups of 65-75, 75-85, 85 years and over. 238 (76%) of the 313 volunteers studied were composed of 65-75 age group, 62 (10.6%), 75-85 age group, 13 (13.4%) 85 and over age group. 151 of the 313 participants (48.2%) were female, and 162 (51.8%) were male. The targeted number (313/320) reached 97.8%. The 3,5,10,15,20 ml sequential water swallowing test was recorded with the EMG device. Dysphagia was detected in 39 elderly patients. The diagnosis of dysphagia was made by observing multiple (partly) swallowing. The minimum water volume detected in the dysphagia was recorded as the dysphagia limit (DL). We found asymptomatic dysphagia rate in the elderly population as 12.74%. 39 asymptomatic dysphagia were found in 32 patients (13.4%) in the age group of 65-75, 6 patients (9.7%) in the age group of 75-85, 1 patient (12.5%) in the over age group that is, hidden dysphagia without any obvious symptoms. A total of 39 dysphagia patients were randomly divided into 2 groups. While the group of 22 persons constituted the gum chewing group, the remaining 17 persons constituted the non-exercise group. For the exercise group, they requested to chew hard-chewing gum without sugar for 1 hour a day for 8 weeks. The other group (non-exercise) did not chew gum and formed the control group. The Mann-Whitney test was used to determine whether there was a difference in the distribution of swallowing time and apnea durations in the water swallowing test before taking them to the study in the 2 groups. There was no difference in apnea durations (except apnea period in 15 ml water test) and swallowing time between two groups (p <0.05). Exercise group and control group were compared at the end of 8 weeks. Dysphagia disappeared in 13 of the 22 exercising individuals, while dysphagia persisted in 9 individuals. In the control group of 17 people who did not exercise, 2 persons showed disappearance of dysphagia while 15 people showed dysphagia. There was a significant difference between exercise and control groups in terms of improvement in favor of exercise (p <0.005). Asymptomatic dysphagia is common in the elderly population. Surface EMG scanning may be useful to reveal asymptomatic dysphagia, and gum chewing exercise may lead to asymptomatic dysphagia improvement in elderly individuals.
Swallowing is a vital action. The difficulty of swallowing is called dysphagia. Dysphagia in the elderly is strongly associated with serious health problems such as malnutrition, and aspiration pneumonia in the elderly, leading to prolonged hospital stay, increased morbidity and mortality. Among the elderly, the prevalence of dysphagia is high but it is underdiagnosed. In this study, our aim was to reveal dysphagia without a known cause in the elderly and without symptoms, which could lead to serious complications. Our research was conducted with the participation of volunteers aged 65 years and over who applied to Bozyaka Education and Research Hospital of Health Sciences University (SBU) located in Izmir province, Karabağlar and Bozyaka district. The study was conducted between June 2016 and May 2017 within an 11-month period. The minimum sample size that should be reached at the 95% safety margin (GA) with a 5% error margin is 320 (G-Power). A validated EAT-10 survey was conducted among healthy elderly people aged 65 years and older who meet the exclusion criteria in order to eliminate elderly people with symptomatic dysphagia and a total of 320 people have been reached with the score is less than 3. These individuals were those who did not have symptomatic dysphagia and normal on the questionnaire. A total of 313 people participated in the study and 7 people were not reached and were excluded from the study. Volunteers were divided into 3 groups of 65-75, 75-85, 85 years and over. 238 (76%) of the 313 volunteers studied were composed of 65-75 age group, 62 (10.6%), 75-85 age group, 13 (13.4%) 85 and over age group. 151 of the 313 participants (48.2%) were female, and 162 (51.8%) were male. The targeted number (313/320) reached 97.8%. The 3,5,10,15,20 ml sequential water swallowing test was recorded with the EMG device. Dysphagia was detected in 39 elderly patients. The diagnosis of dysphagia was made by observing multiple (partly) swallowing. The minimum water volume detected in the dysphagia was recorded as the dysphagia limit (DL). We found asymptomatic dysphagia rate in the elderly population as 12.74%. 39 asymptomatic dysphagia were found in 32 patients (13.4%) in the age group of 65-75, 6 patients (9.7%) in the age group of 75-85, 1 patient (12.5%) in the over age group that is, hidden dysphagia without any obvious symptoms. A total of 39 dysphagia patients were randomly divided into 2 groups. While the group of 22 persons constituted the gum chewing group, the remaining 17 persons constituted the non-exercise group. For the exercise group, they requested to chew hard-chewing gum without sugar for 1 hour a day for 8 weeks. The other group (non-exercise) did not chew gum and formed the control group. The Mann-Whitney test was used to determine whether there was a difference in the distribution of swallowing time and apnea durations in the water swallowing test before taking them to the study in the 2 groups. There was no difference in apnea durations (except apnea period in 15 ml water test) and swallowing time between two groups (p <0.05). Exercise group and control group were compared at the end of 8 weeks. Dysphagia disappeared in 13 of the 22 exercising individuals, while dysphagia persisted in 9 individuals. In the control group of 17 people who did not exercise, 2 persons showed disappearance of dysphagia while 15 people showed dysphagia. There was a significant difference between exercise and control groups in terms of improvement in favor of exercise (p <0.005). Asymptomatic dysphagia is common in the elderly population. Surface EMG scanning may be useful to reveal asymptomatic dysphagia, and gum chewing exercise may lead to asymptomatic dysphagia improvement in elderly individuals.
Açıklama
Anahtar Kelimeler
Yaşlı, Asemptomatik Disfaji, Surface EMG, Çiğneme, Egzersiz, Elderly, Asymptomatic Dysphagia, Surface EMG, Chewing, Exercise
