川上 勝

We developed a wearable swallowing assessment device using a hetero-core fiber-optic pressure sensor for the detection of laryngeal movement during swallowing. The proposed pressure sensor (comfortably attached to the skin of the neck) demonstrated a high sensitivity of 0.592 dB/kPa and a linearity of R2 = 0.995 within a 14 kPa pressure band, which is a suitable pressure for the detection of laryngeal movement. In addition, since the fabricated hetero-core fiber-optic pressure sensor maintains appreciable sensitivity over the surface of the sensor, the proposed wearable swallowing assessment device can accurately track the subtle pressure changes induced by laryngeal movements during the swallowing process. Sixteen male subjects and one female subject were evaluated in a variety of age groups ranging from 30 to 60 years old. For all subjects, characteristic swallowing waveforms (with two valleys based on laryngeal movements consisting of upward, forward, backward, and downward displacements) were acquired using the proposed wearable swallowing assessment device. Since the denoted time of the first valley in the acquired waveform determines the "aging effect", significant differences in swallowing functions among the different age groups were ultimately determined based on the time of the first valley. Additionally, by analyzing each age group using the proposed device, due to p-values being consistently less than 0.05, swallowing times were found to exhibit statistically significant differences within the same groups.

目的 急性期病院から自宅に退院した認知症高齢者の特徴を明らかにする。方法 関東圏内にある急性期病院A病院を2019年度内に退院した70歳以上の認知症高齢者1,349人のうち,(1)認知症の診断を受けた患者,または発現したBPSDの症状に投薬がなされた患者(2)認知症高齢者日常生活自立度判定がIIIa以上と判断されている退院患者どちらかの条件を満たす者延べ551人のうち,入院前後の居場所が不明であった7名を除く544名を分析対象とした。電子カルテ及び退院支援部門の情報からデータを収集した。分析は,544名を調査項目ごとに単純集計し,さらに自宅から入院した303名を,自宅に退院した群(自宅群)137名と,自宅外に退院した群(自宅外群)146名に二分し,調査項目ごとにχ2検定により比較した。調査は,A病院の倫理審査委員会の承認を得て実施した。結果 患者の平均年齢は,85.9歳,男女比は約4:6と女性の方が多かった。緊急入院患者は,約91%を占めていた。退院先は,死亡退院が34名(6.3%),自宅退院者は138名(25.4%)自宅外退院者(特別養護老人ホーム,介護老人保健施設,有料老人ホーム,病院等)は,372名(68.4%)であった。診療科は,内科,脳外科,整形外科,外科,眼科の順に多かった。自宅退院群と自宅外退院群を比較した結果,自宅退院群の特徴として,平均在院日数が短い,退院時の認知症高齢者の日常生活自立度が高く,入院時BI値が移乗・整容・歩行・階段昇降・着替え・排便・排尿コントロールの項目において有意に高かった。また,医療行為の有無においては,膀胱留置カテーテル,吸引,経管栄養の項目において,自宅外退院群の処置有が有意に多かった。考察 研究結果よりA病院の認知症高齢患者の特徴が明らかになった。その特徴を踏まえて,自宅から入院する認知症高齢者が,自宅に退院できるための看護支援を考えていくことができると考える。そのためには,緊急入院を回避する支援の必要性,急性期病院への入院によるADLや認知機能の低下に配慮する必要性,膀胱留置カテーテル・吸引・経管栄養の医療行為を必要としない生活を可能にするための支援が求められているのではないかということが示唆された。本研究結果を踏まえて,急性期病院から認知症高齢者の自宅退院をサポートするために,病院看護師がどのような役割を担い,支援していくことが有効かということについて具体的に明らかにしていくことが,今後の課題と考える。(著者抄録)

A decreasing swallowing function with natural aging may cause a pneumonia. It is important for elderly person to measure a swallowing function to prevent swallowing disorder. To examine the swallowing function in a daily living environment, the swallowing examination device was required to be simple and non-invasive for human body. In this paper, we propose the non-invasive swallowing examination device using a hetero-core fiber optic pressure sensor, which can monitor the movement of the laryngeal prominence (LP) during swallowing by the pressure change to the outside of the skin. As a result of the swallowing test, the proposed fiber optic swallowing test device has been indicated to detect the movement of the LP during swallowing.

Dysphagia is one of the most common diseases seen in the elderly. When older adults have difficulty swallowing, as well as a decreased quality of life, the risk of developing life-threatening diseases increases such as aspiration pneumonia. Therefore, it is important to detect the decline in swallowing function in advance and to provide rehabilitation and treatment. It is desirable that swallowing function tests can be used without medical personnel, do not require the selection of a location such as a nursing home or home, and are non-invasive. In this paper, we propose a swallowing test device using a hetero-core fiber optic pressure sensor that can detect the movement of the laryngeal prominence during swallowing from the external surface of the skin so as to avoid the risk of skin tear. Five subjects were tested for swallowing function measurement, and the results experimentally confirmed the gender and body size differences in the accuracy of the proposed test device. As a result, the swallowing test device is expected to be effective for measuring swallowing function in male subjects who can see the laryngeal prominence.