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臨床口腔照護介入對失智症患者口腔機能、唾液抗菌肽及生活品質之成效 = The Effects of Clinical-based Oral Care Intervention on Oral Function, Salivary Antimicrobial Peptide Levels and Quality of Life for Patients with Dementia

Record Type:	Language materials, printed : monographic
Paralel Title:	The Effects of Clinical-based Oral Care Intervention on Oral Function, Salivary Antimicrobial Peptide Levels and Quality of Life for Patients with Dementia
Author:	陳明安,
Place of Publication:	[高雄市]
Published:	[撰者];
Year of Publication:	2023[民112]
Description:	183葉圖 : 30公分;
Subject:	失智症
Subject:	dementia
Online resource:	https://handle.ncl.edu.tw/11296/b2t3mj
Summary:	認知障礙者有較差的口腔衛生，因此高齡者如罹患失智症，可能使口腔疾病急速惡化，增加吸入性肺炎的發生，影響他們的健康及生活品質。本研究目的在評價高齡失智症患者口腔照護介入之成效。以隨機對照試驗設計將罹患輕度失智症高齡患者隨機分派到實驗組與對照組。於高雄醫學大學附設醫院體系進行，由神經內科失智症門診主治醫師推薦適合參與研究之患者，最後共有實驗組32人及對照組31人完成前測、三個月後測、六個月後測。衛教介入方式，實驗組給予參加者與照護者診間口腔照護與口腔機能促進的衛生教育課程，內容包括口腔清潔技能指導、咀嚼吞嚥練習的方法、口腔功能重建訓練。此外，每兩週固定給予實驗組電話提醒與諮詢。使用結構式問卷訪談收集口腔健康相關生活品質、自覺口乾狀況、自覺吞嚥狀況、口腔保健行為。使用簡易智能狀態測驗(Mini-Mental Status Examination, MMSE)測量認知功能。由口腔衛生師測量患者的口腔機能(咀嚼機能測試、反覆吞嚥測試、口腔輪替運動次數與口腔濕度)、口腔衛生(牙菌斑指數與舌苔指數)。本研究也進行唾液相關指標收集，收集參加者之唾液回到實驗室以分析其唾液流速、唾液抗菌肽等級，包含乳鐵蛋白、防禦素、組氨素，以上唾液中蛋白濃度以酵素免疫分析法 (Enzyme- linked immunosorbent assay; ELISA)來加以定量。統計分析使用廣義估計方程式(Generalized Estimating Equations, GEE)來分析，介入的成效以Cohen's d之效果量(effect size)呈現。研究結果發現，實驗組相較於對照組的口腔輪替運動/pa/於六個月後測上升，β為4.8、效果量為0.58；/ta/於六個月後測上升，β為4.4、效果量為0.61；/ka/於六個月後測上升，β為3.6、效果量為0.45；反覆吞嚥測試於六個月後測上升，β為1.2、效果量為0.67；咀嚼表現於六個月後測上升，β為0.5、效果量為0.59。口腔衛生方面，實驗組相較於對照組的牙菌斑指數於六個月後測下降，β為－0.4、效果量為0.53；舌苔指數於六個月後測下降，β為－1.8、效果量為0.49；實驗組相較於對照組的唾液流速於六個月後測上升，β為0.7、效果量為0.83；口腔濕度於六個月後測上升，β為2.5、效果量為0.75；口腔健康相關生活品質於六個月後測上升，β為6.1、效果量為0.71；唾液抗菌肽方面，實驗組相較於對照組的乳鐵蛋白(Lactoferrin)於六個月後測上升，β為2.0、效果量為0.82；組氨素-5 (Histatin-5)於三個月後測下降，β為－1.1、效果量為0.82。口腔保健行為方面，實驗組相較於對照組的定期牙科就診於六個月後測增加，aOR為4.1；上次牙科就診目的檢查或洗牙於六個月後測增加，aOR為5.9；三餐後清潔活動假牙於六個月後測增加，aOR為7.4。此外，本研究發現以下變項的三個月後測改變可以預測六個月後測的口腔健康相關生活品質改變：乳鐵蛋白(β=1.7, p=0.009)、口腔輪替運動/ta/(β=0.4, p=0.021)、口腔輪替運動/ka/(β=0.5, p=0.006)、咀嚼表現(β=4.6, p=0.023)、牙菌斑指數(β=－8.5, p<0.001)、舌苔指數(β=－1.9, p=0.002)、「定期牙科就診」(β=13.5, p<0.001)、「上次牙科就診目的檢查或洗牙」(β=12.7, p<0.001)。然而，在認知功能方面，實驗組於所有追蹤時間點的MMSE分數改變皆與對照組沒有差異(p>0.05)。結論針對高齡失智症患者的口腔照護介入，可以有效改善口腔機能、口腔衛生、口腔健康相關生活品質、唾液中乳鐵蛋白及組氨素-5。
Content Note:	第一章緒論 1

臨床口腔照護介入對失智症患者口腔機能、唾液抗菌肽及生活品質之成效 = The Effects of Clinical-based Oral Care Intervention on Oral Function, Salivary Antimicrobial Peptide Levels and Quality of Life for Patients with Dementia
陳, 明安

臨床口腔照護介入對失智症患者口腔機能、唾液抗菌肽及生活品質之成效 = The Effects of Clinical-based Oral Care Intervention on Oral Function, Salivary Antimicrobial Peptide Levels and Quality of Life for Patients with Dementia / 陳明安 - [高雄市] : [撰者], 2023[民112]. - 183葉 ; 圖 ; 30公分.
第一章緒論 1.
參考書目: 葉.
失智症dementia

臨床口腔照護介入對失智症患者口腔機能、唾液抗菌肽及生活品質之成效 = The Effects of Clinical-based Oral Care Intervention on Oral Function, Salivary Antimicrobial Peptide Levels and Quality of Life for Patients with Dementia
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200 1 $a 臨床口腔照護介入對失智症患者口腔機能、唾液抗菌肽及生活品質之成效 $d The Effects of Clinical-based Oral Care Intervention on Oral Function, Salivary Antimicrobial Peptide Levels and Quality of Life for Patients with Dementia $z eng $f 陳明安
210 $a [高雄市] $c [撰者] $d 2023[民112]
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327 1 $a 第一章緒論 1
328 $a 博士論文--高雄醫學大學牙醫學系博士班
330 $a 認知障礙者有較差的口腔衛生，因此高齡者如罹患失智症，可能使口腔疾病急速惡化，增加吸入性肺炎的發生，影響他們的健康及生活品質。本研究目的在評價高齡失智症患者口腔照護介入之成效。以隨機對照試驗設計將罹患輕度失智症高齡患者隨機分派到實驗組與對照組。於高雄醫學大學附設醫院體系進行，由神經內科失智症門診主治醫師推薦適合參與研究之患者，最後共有實驗組32人及對照組31人完成前測、三個月後測、六個月後測。衛教介入方式，實驗組給予參加者與照護者診間口腔照護與口腔機能促進的衛生教育課程，內容包括口腔清潔技能指導、咀嚼吞嚥練習的方法、口腔功能重建訓練。此外，每兩週固定給予實驗組電話提醒與諮詢。使用結構式問卷訪談收集口腔健康相關生活品質、自覺口乾狀況、自覺吞嚥狀況、口腔保健行為。使用簡易智能狀態測驗(Mini-Mental Status Examination, MMSE)測量認知功能。由口腔衛生師測量患者的口腔機能(咀嚼機能測試、反覆吞嚥測試、口腔輪替運動次數與口腔濕度)、口腔衛生(牙菌斑指數與舌苔指數)。本研究也進行唾液相關指標收集，收集參加者之唾液回到實驗室以分析其唾液流速、唾液抗菌肽等級，包含乳鐵蛋白、防禦素、組氨素，以上唾液中蛋白濃度以酵素免疫分析法 (Enzyme- linked immunosorbent assay; ELISA)來加以定量。統計分析使用廣義估計方程式(Generalized Estimating Equations, GEE)來分析，介入的成效以Cohen's d之效果量(effect size)呈現。研究結果發現，實驗組相較於對照組的口腔輪替運動/pa/於六個月後測上升，β為4.8、效果量為0.58；/ta/於六個月後測上升，β為4.4、效果量為0.61；/ka/於六個月後測上升，β為3.6、效果量為0.45；反覆吞嚥測試於六個月後測上升，β為1.2、效果量為0.67；咀嚼表現於六個月後測上升，β為0.5、效果量為0.59。口腔衛生方面，實驗組相較於對照組的牙菌斑指數於六個月後測下降，β為－0.4、效果量為0.53；舌苔指數於六個月後測下降，β為－1.8、效果量為0.49；實驗組相較於對照組的唾液流速於六個月後測上升，β為0.7、效果量為0.83；口腔濕度於六個月後測上升，β為2.5、效果量為0.75；口腔健康相關生活品質於六個月後測上升，β為6.1、效果量為0.71；唾液抗菌肽方面，實驗組相較於對照組的乳鐵蛋白(Lactoferrin)於六個月後測上升，β為2.0、效果量為0.82；組氨素-5 (Histatin-5)於三個月後測下降，β為－1.1、效果量為0.82。口腔保健行為方面，實驗組相較於對照組的定期牙科就診於六個月後測增加，aOR為4.1；上次牙科就診目的檢查或洗牙於六個月後測增加，aOR為5.9；三餐後清潔活動假牙於六個月後測增加，aOR為7.4。此外，本研究發現以下變項的三個月後測改變可以預測六個月後測的口腔健康相關生活品質改變：乳鐵蛋白(β=1.7, p=0.009)、口腔輪替運動/ta/(β=0.4, p=0.021)、口腔輪替運動/ka/(β=0.5, p=0.006)、咀嚼表現(β=4.6, p=0.023)、牙菌斑指數(β=－8.5, p<0.001)、舌苔指數(β=－1.9, p=0.002)、「定期牙科就診」(β=13.5, p<0.001)、「上次牙科就診目的檢查或洗牙」(β=12.7, p<0.001)。然而，在認知功能方面，實驗組於所有追蹤時間點的MMSE分數改變皆與對照組沒有差異(p>0.05)。結論針對高齡失智症患者的口腔照護介入，可以有效改善口腔機能、口腔衛生、口腔健康相關生活品質、唾液中乳鐵蛋白及組氨素-5。 $u Cognitive function is related with oral health. People with mild cognitive impairment have worse oral health than healthy people. If the elderly suffers from dementia, it may cause the rapid deterioration of oral diseases and the incidence of aspiration pneumonia, further impact their health and quality of life. This study aims to evaluate the effects of the intervention of a new-designed method of oral care on oral function and oral hygiene for the elderly. A randomized controlled trial was used. The elderly patients with mild dementia and their caregivers recruited from Kaohsiung Medical University Hospital. All patients were recommended by the physicians of Neurology Dementia outpatient clinic. In total, there were 32 participants in the experimental group (EG) and 31 participants in control group (CG) completed baseline, 3-month and 6-month follow-ups. A brief one-on-one oral health education teaching module including oral hygiene skill, chewing and swallowing practices, and oral function rehabilitation training were conducted on EG patients and their caregivers by a well-trained dental hygienist. The participants were encouraged to do it themselves at home. Moreover, the EG participants received one reminder phone call every 2 weeks. The structured questionnaire was used to collect data regarding oral health-related quality of life (OHRQoL), oral health care behaviors, perceived dry mouth conditions and perceived swallowing conditions. Cognitive function was measured by the Mini-Mental Status Examination (MMSE). The data related to plaque index (PI), Winkel tongue coating index (WTCI) masticatory efficiency test, repetitive saliva swallowing test (RSST), the diadochokinetic (DDK) rate and humidity test was measured by a dental hygienist. For salivary indicators, collected saliva from participants took back to the laboratory to analyze their saliva flow rate, salivary antimicrobial peptide level, including lactoferrin, defensin, and histatin. These protein concentrations in saliva were analyzed by enzyme-linked immunosorbent assay (ELISA). Generalized Estimating Equations (GEE) were used to analyze, and Cohen's d was used to indicate effect sizes. The results of the study found that compared with the control group, oral DDK /pa/ increased after six months, with a β of 4.8 and an effect size of 0.58; /ta/ increased after six months, with a β of 4.4 , the effect size was 0.61; /ka/ increased after six months, β was 3.6, and the effect size was 0.45; the repeated swallowing test increased after six months, β was 1.2, and the effect size was 0.67; After one month, the test increased, β was 0.5, and the effect size was 0.59. In terms of oral hygiene, compared with the control group, the plaque index of the experimental group decreased after six months, with a β of -0.4 and an effect size of 0.53; the tongue coating index decreased after six months, with a β of -1.8 and an effect of Compared with the control group, the saliva flow rate of the experimental group increased after six months, β was 0.7, and the effect size was 0.83; the oral humidity increased after six months, β was 2.5, and the effect size was 0.75; Oral health-related quality of life increased after six months, with a β of 6.1 and an effect size of 0.71; in terms of salivary antimicrobial peptides, Lactoferrin in the experimental group increased after six months compared with the control group, with a β of 2.0 and an effect size of 0.71. was 0.82; Hisatin-5 decreased after three months, β was -1.1, and the effect size was 0.82. In terms of oral health behaviors, compared with the control group, the regular dental visits of the experimental group increased after six months, with an OR of 4.1; the last dental check-up or cleaning of teeth increased after six months, with an OR of 5.9; Cleaning dentures after meals increased at six months, with an aOR of 7.4. In addition, the study found that 3-month follow-up changes in the following variables could predict 6-month follow-up changes in OHRQoL: lactoferrin (β=1.7, p=0.009), oral DDK /ta/ (β=0.4, p=0.021), oral DDK/ka/(β=0.5, p=0.006), masticatory performance (β=4.6, p=0.023), PI (β=-8.5, p<0.001), WTCI (β=-1.9, p=0.002), "regular dental visits" (β=13.5, p<0.001), "dental visit for examination or scaling" (β=12.7, p<0.001). However, there were no difference between the EG and the CG in the change of MMSE scores in cognitive function at all follow-up points (p>0.05). In conclusion, oral care intervention for elderly patients with dementia can effectively improve oral function, oral hygiene, OHRQoL, salivary lactoferrin and histatin-5.
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