嚥下障害の早期発見とEAT-10

EAT-10日本語版は以下のHPからダウンロード可能です。
www.maff.go.jp/j/shokusan/seizo/kaigo/pdf/eat-10.pdf

嚥下障害患者の早期発見におけるEAT-10と多職種チームの役割に関するレビュー論文（書籍の章）を紹介します。

Kaspar K, Ekberg O. Identifying vulnerable patients: role of the EAT-10 and the multidisciplinary team for early intervention and comprehensive dysphagia care. Nestle Nutr Inst Workshop Ser. 2012;72:19-31. doi: 10.1159/000339977.

ヨーロッパでの話ですので、そのまま日本にあてはまるかどうかはわかりませんが、嚥下障害（特に軽度の）が見過ごされていて適切な対応を受けていないことが少なくありません。EAT-10を含めた妥当性のある嚥下スクリーニングを用いることは有用と思われます。

実際、系統的な嚥下スクリーニングプログラムによって、肺炎発症が55%減少し、入院期間が短縮したという報告があります。

日本では中等度～重度の嚥下障害患者（特に脳卒中）に対する嚥下リハが進んでいます。一方、加齢による軽度の嚥下機能低下（presbyphagia、老嚥）やサルコペニアの嚥下障害の評価と対応はまだ不十分です。日本でのEAT-10の有効性検証が必要です。

Abstract

There is underdiagnosis and low awareness of dysphagia despite that the condition is modifiable and poorly managed symptoms diminish psychological well-being and overall quality of life. Frontline clinicians are in a unique position to be alert to the high prevalence of swallowing difficulty among elderly, evaluate and identify those who need intervention, and assure that individuals receive appropriate care. Proper diagnosis and treatment of oral-pharyngeal dysphagia involves a multidisciplinary healthcare team effort and starts with systematic screening of at-risk patients. The presence of a medical condition such as acute stroke, head and neck cancer, head trauma, Alzheimer's disease, Parkinson's disease, pneumonia or bronchitis is adequate basis for predicting high risk. Systematic screening of dysphagia and resulting malnutrition among at-risk older adults is justified in an effort to avoid pneumonia and is recommended by clinical practice guidelines. Systematic screening with a validated method (e.g. the 10-item Eating Assessment Tool, EAT-10) as part of a comprehensive care protocol enables multidisciplinary teams to more effectively manage the condition, reduce the economic and societal burden, and improve patient quality of life. In fact, care settings with a systematic dysphagia screening program attain significantly better patient outcomes including reduced cases of pneumonia (by 55%) and reduced hospital length of stay.