吉田 光由

肺炎は日本人の死因の第3位と言われており、死亡者の9割以上が高齢者であることから、超高齢社会のなか、肺炎対策は喫緊の課題といえる。高齢者の肺炎の多くは誤嚥性肺炎であり、誤嚥は、脳卒中患者においてよく見られるのはもちろんのこと、最近は、加齢や疾患に伴うサルコペニアによる嚥下障害にも注目が集まっている。したがって、嚥下障害の診断には、舌などの嚥下関連筋の筋力低下の評価が重要と考えられることから、本研究では、脳卒中関連肺炎の発症予測に舌圧測定が有効となりえるかを明らかにするとともに、医療介護関連肺炎予防に向けて要介護高齢者に対する舌圧測定などの口腔機能の評価法の有用性を検討することとした。さらに、医療介護関連肺炎の発症と栄養状態との関係についても明らかにすることとした。(著者抄録)

OBJECTIVE: This study aimed to assess the relationship between oral hygiene/stomatognathic function and residual intraoral medication in older adults and to identify the oral factors associated with residual oral medication. METHODS: The study included 309 older adults (77 men, 232 women, mean age: 74.1 ± 7.4 years) who were prescribed medications at regular intervals. The following survey items were assessed: overall physical condition, intraoral condition and oral function. Participants prescribed oral medication were classified into groups with and without residual medication in the oral cavity. Statistical analysis was performed using univariate analysis for each of the factors contributing to the presence of residual medication. RESULTS: Only 1.9% of all patients had residual medication, which suggests that older adults in this survey had a low risk of residual intraoral medication. However, greater attention should be given to residual intraoral medication in older adults receiving long-term care. Powdered-form oral medications were more likely to remain in the oral cavity. Older adults with residual medication had a tendency to have less occlusal support, poor tongue hygiene and poor tongue movement. Oral function, particularly functions that are closely related to swallowing, was significantly lower in the residual intraoral medication group when compared to those of the group without residual intraoral medication. CONCLUSIONS: Reduced oral function and powered medication were associated with greater residual intraoral medication in this sample of older Japanese adults.