なぜ高齢者は誤嚥性肺炎になりやすいのでしょうか?
なぜ高齢者は、誤嚥性肺炎になりやすいのでしょうか。また、誤嚥性肺炎とはどのようなものなのでしょうか。高齢者家族が、「誤嚥性肺炎(ごえんせいはいえん)」と診断されたことがある人も少なくないはずです。この記事では、高齢者と誤嚥性肺炎の関係についてまとめています。
目次
【誤嚥性肺炎】の「誤嚥(ごえん)」とは？
そもそも、誤嚥性肺炎と呼ばれる病気の、誤嚥(ごえん)とはどんな現象なのでしょうか。みなさんも、食事を急いで掻き込んで食べた際に、ムセてしまったことがあるはずです。これが、まさに誤嚥です。
食べ物や唾液は、口⇒咽頭(いんとう)⇒食道を通り、胃へ送られていきます。この口から⇒咽頭を通り、飲み込む段階のことを、嚥下(えんげ)と医療用語では呼んでいます。食べ物が、なんらかの原因で、誤って喉頭(こうとう)と気管に入ってしまう状態のことを医療用語で誤嚥（ごえん）と呼びます。この誤嚥が頻繁に起こる場合、嚥下障害を起こしていると言えます。
高齢者が誤嚥するリスクが高い原因・誤嚥性肺炎に繋がるワケ
高齢者は誤嚥をするリスクが高いと言われています。老化に伴う身体変化に伴い、どのような点に誤嚥のリスクが潜んでおり、肺炎につながるかをご紹介します。高齢者の誤嚥リスクが高い理由には次のようなものが挙げられます。
１・認知症を抱えている
２・脳卒中やパーキンソンなどを抱えている
３・加齢により唾液量が少なくなる
４・年齢によるのど周囲の筋力の低下
①認知症を抱えている
⇒認知症の度合にもよりますが、認知症を抱えている方の場合、食事を食事として認識できないことで、食物を口腔内に入れても、咀しゃくをしたり、飲み込みむといった嚥下の機能が上手く行えないことがあります。
②脳卒中やパーキンソンなど疾患を抱えている
⇒脳卒中やパーキンソンなどの疾患を抱えており、疾患による後遺症や症状のために、飲み込みが上手くできない嚥下障害を抱えることがあります。若年者と比較し、これらの疾患を抱えているのは高齢者が多いと言えます。(*1)(*2)
③加齢により唾液量が少なくなる
⇒若年者と比較し、唾液を分泌させる唾液腺の働きの低下や、身体が保てる水分量が少なく脱水傾向に身体が傾きやすいために、唾液の分泌される量が、加齢とともに少なくなると考えられています。
④加齢によるのど周囲の筋力の低下
⇒のど周囲の筋力が低下することで、飲み込みが悪くなってしまうからです。また、加齢により、食事をかみ砕く(咀しゃく・そしゃく)力や唾液が少なくなることも、食べ物を飲み込みづらくする原因と言えます。
誤嚥により、食物や唾液といった異物が気管～肺に流れ込んでしまうことで、肺に炎症が起こる肺炎を起こします。通常であれば、食物や唾液が誤って気管に入った場合、咳をして身体の外に異物を出そうとする「咳反射」が起こります。この反射の力も、加齢により、低下します。
高齢者や寝たきりの方は、歯磨きなどの口腔ケアが十分に行えず、口の中の清潔が維持できていない場合があります。すると、口の中では、細菌が増え、繁殖していきます。その細菌が、気管から肺へと流れ込み、肺炎になるのです。
また、高齢者は食事量が少なく、栄養状態が悪い方もいらっしゃいます。
栄養状態がわるいことで、免疫機能の低下が起こり、肺炎にり患しやすくなります。
参考ページ
(*1)わが国の脳卒中医療の実像を世界に紹介― 疫学、再開通療法、国産薬最新治療、対策基本法など,国立循環器病研究センター
(*2)臨床神経学雑誌第48巻第2号,厚生労働省特定疾患治療研究事業臨床調査個人票の 集計結果からみたパーキンソン病患者の現況
誤嚥性肺炎を起こしてしまったら…
誤嚥性肺炎と診断された場合、一般的にどのような治療が行われるのでしょうか。
肺炎と呼ばれる疾患名の通り、肺が炎症を起こしている状態です。炎症を沈下させるために、医師の診断のもと、抗菌薬を使用することが基本となります。また、場合によっては経口での飲食をやめ絶食の指示がでることもあります。体内に酸素を充分に取り込むことができていない場合や、呼吸状態が悪いケースでは、人工呼吸器を使用して呼吸を補助したり、酸素の投与をおこなうこともあります。また歯磨きなどの口腔ケアを充分に行うことや、嚥下の機能を低下させないことも大切な治療の一つです。
誤嚥性肺炎を起こさないために、今日からできること
誤嚥性肺炎へのリスクを下げるために、日々行える予防法を、ここではご紹介致します。
１・口腔ケアを充分に行う
２・嚥下体操を行い、嚥下機能を維持、向上させる
３・食事の形態を工夫する
４・食事の姿勢を意識する
５・肺炎球菌ワクチン・インフルエンザワクチンの摂取
①口腔ケアを充分に行う
⇒歯磨きなどの口腔ケアをしっかり行いましょう。口腔内の細菌を減らすことで、唾液が気管に流れた際に、肺炎を起こすリスクを減らすことができると言われています。
②嚥下体操を行い、嚥下機能を維持、向上させる
⇒食事を食べる前に、嚥下体操を行う週間をつけることをおすすめします。嚥下体操を行うと、食事を食べるために必要な筋肉を動かし、感覚を促進することができるため、誤嚥を予防することができます。
参考サイト公益財団法人長寿科学振興財団 健康長寿ネット 嚥下障害のリハビリテーション（基礎訓練）
③食事形態を工夫する
⇒常食ではムセてしまうため、とろみをつける、おかずを細かく刻むことで嚥下をしやすくするなど、食事の形態を工夫をします。形態の工夫により、食べやすくなることで、飲み込みが良くなったり、栄養を充分にとることができる可能性があります。
④食事の姿勢を意識する
⇒食事の介助が必要な方の場合、ベット上で介助を行う場合があります。その際、上向きになってしまうと、食事を飲み込づらく、食物が気管へ滑り落ち、誤嚥するリスクがあります。座ってご自身で摂取する場合でも同様です。椅子に深く座り、前かがみの姿勢をとりましょう。
⑤肺炎球菌ワクチン・インフルエンザワクチンの摂取
⇒ウイルスや細菌が肺に感染することで起きる病気が肺炎です。肺炎球菌ワクチンやインフルエンザワクチンを摂取しておくことで、感染を予防し、万が一かかっても、重症化を防ぐことができると言われています。
まとめ
誤嚥性肺炎の最大の原因は加齢であると言われています。その理由として、高齢者が認知症や脳の疾患を患うことや、加齢に伴う身体変化が挙げられます。万が一誤嚥性肺炎にり患した場合は、抗生剤や、絶食をする、口腔ケアの強化と言ったことが治療として行われる場合があります。誤嚥性肺炎は予防できる病気だと言われています。食事の工夫や、嚥下体操などを行い、日頃から注意していきましょう。
「今後の生活環境が変わる事への不安」や「介護を使って生活をどうデザインをしていったら良いか」など介護は協力体制で成り立っております。 ちょっとでも解決できる、ストレス軽減できる記事を目指し、一つの相談場所のメディアを目指しております。
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