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Miranda D, Breda J, Cardoso R, Gonçalves N, Caldas AC, Ferreira JJ. Should the Energy Contribution of Commercial Thickeners Be Considered in the Nutrition Plan of Patients With Dysphagia? Nutr Clin Pract 2019; 35:649-654. [PMID: 31489690 DOI: 10.1002/ncp.10408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Clinical management options for dysphagia include the use of thickeners to increase the consistency of liquids. Health professionals may not be aware of the nutrition value of these products, since there are no such recommendation in clinical guidelines. Our aim was to estimate the added nutrition value of the 2 types of commercial thickeners (starch and xanthan gum) to daily nutrition intake and compare their nutrition value for nectar, honey, and pudding consistencies. Additionally, we compared the nutrition value of both thickeners with a high-energy powder, since they share the same main ingredients. METHODS We collected recommended dosages for obtaining the 3 different consistencies and nutrition content from the technical food labels. Daily intake of fluids was estimated from the Portuguese National Food, Nutrition and Physical Activity Survey. Total daily amount of thickener needed was estimated, as well as their correspondent nutrition contributions. RESULTS Estimated daily fluid intake was 2439 mL. Starch thickeners provide significantly more energy at all consistencies than xanthan gum provides (423-846 kcal, P < 0.05, and 103-308 kcal, P < 0.05, respectively). Significantly more fiber is provided by xanthan gum thickeners (9 g in nectar and 27 g in pudding consistencies, P < 0.05). Median energy and carbohydrate values per 100 g of high-energy powder modules and starch thickeners are similar. CONCLUSION The nutrition value of thickeners should be routinely considered in the nutrition assessment and planning of patients with dysphagia for liquids, since they contribute significantly with energy, carbohydrate, and fiber.
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Affiliation(s)
- Diana Miranda
- CNS- Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Joana Breda
- CNS- Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Rita Cardoso
- CNS- Campus Neurológico Sénior, Torres Vedras, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Nilza Gonçalves
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Castro Caldas
- CNS- Campus Neurológico Sénior, Torres Vedras, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joaquim J Ferreira
- CNS- Campus Neurológico Sénior, Torres Vedras, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Namasivayam-MacDonald AM, Steele CM, Keller HH. Perception Versus Performance of Swallow Function in Residents of Long-Term Care. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1198-1205. [PMID: 31194919 DOI: 10.1044/2019_ajslp-18-0186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The purpose of this study was to determine if older adults residing in long-term care were able to accurately self-report their swallowing status by comparing subjective complaints of dysphagia and objective methods of swallowing screening. Method Data were collected from 397 residents of long-term care (M age = 86.8 years ± 7.8; 263 female). Cognitive impairment scores were collected, and each resident was asked (a) if they thought they had a swallowing problem, (b) if they coughed/choked when they ate, and (c) if they coughed/choked when they drank. These responses were compared to results of a swallowing screening tool and mealtime observations of coughing and choking. Results Residents who reported swallowing difficulties (10%, n = 41) were 8 times more likely to fail the swallowing screening (p < .001); however, 80% of residents who failed the swallowing screening did not previously report that swallowing was an issue. There was no significant association between self-reports of coughing and choking at meals and observations. There was no difference in level of cognition between residents who accurately reported swallowing status and those who were inaccurate. Conclusions Residents are largely unable to accurately self-report swallowing difficulties and also have difficulty accurately reporting incidences of coughing and choking. These findings suggest that concerted efforts are required to implement regular, formal swallowing screening protocols in long-term care to objectively identify those at risk.
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Affiliation(s)
| | - Catriona M Steele
- Toronto Rehabilitation Institute, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Heather H Keller
- University of Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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Özsürekci C, Arslan SS, Demir N, Çalışkan H, Şengül Ayçiçek G, Kılınç HE, Yaşaroğlu ÖF, Kızılarslanoğlu C, Tuna Doğrul R, Balcı C, Sümer F, Karaduman A, Yavuz BB, Cankurtaran M, Halil MG. Timing of Dysphagia Screening in Alzheimer's Dementia. JPEN J Parenter Enteral Nutr 2019; 44:516-524. [PMID: 31172554 DOI: 10.1002/jpen.1664] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/18/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dysphagia is an important and frequent symptom in Alzheimer's dementia (AD). We hypothesized that dysphagia could be seen in the early stages of AD and sarcopenia presence rather than the severity of the AD affecting dysphagia. The main aim of this study was to investigate swallowing functions in AD patients according to stages. The second aim was to investigate the correlation between sarcopenia and dysphagia in AD. METHODS This study involved 76 probable AD patients. For all participants, diagnosis of sarcopenia was based on definitions from the revised version of European Working Group on Sarcopenia in Older People at 2018. Dysphagia symptom severity was evaluated by the Turkish version of the Eating Assessment Tool, a videofluoroscopic swallowing study (VFSS) was performed for instrumental evaluation of swallowing. The patients were divided into 3 groups according to the clinical dementia rating (CDR) scale as CDR 1 (mild dementia), CDR 2 (moderate dementia), and CDR 3 (severe dementia). Swallowing evaluation parameters were analyzed between these groups. RESULTS Mean age was 78.9 ± 6.4 years, and 56.4% were female. Twenty-six patients had mild dementia, 31 patients had moderate dementia, 19 patients had severe dementia (CDR 3). We found that sarcopenia rates were similar between AD stages according to CDR in our study population and dysphagia could be seen in every stage of AD. In a multivariate analysis, polypharmacy and sarcopenia were found to be independently associated factors for dysphagia, irrespective of stage of AD (OR: 6.1, CI: 1.57-23.9, P = 0.009; OR: 4.9, CI: 1.24-19.6, P = 0.023, respectively). CONCLUSION Aspirations may be subtle so that AD patients and caregivers may not be aware of swallowing difficulties. Therefore, all AD patients, especially those who have polypharmacy and/or sarcopenia (probable-sarcopenia-severe sarcopenia), should be screened for dysphagia in every stage.
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Affiliation(s)
- Cemile Özsürekci
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Selen Serel Arslan
- Department of Physiotherapy and Rehabilitation, Division of Swallowing Disorders, Hacettepe University Medical Science Faculty, Ankara, Turkey
| | - Numan Demir
- Department of Physiotherapy and Rehabilitation, Division of Swallowing Disorders, Hacettepe University Medical Science Faculty, Ankara, Turkey
| | - Hatice Çalışkan
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Gözde Şengül Ayçiçek
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Hasan Erkan Kılınç
- Department of Physiotherapy and Rehabilitation, Division of Swallowing Disorders, Hacettepe University Medical Science Faculty, Ankara, Turkey
| | - Ömer Faruk Yaşaroğlu
- Department of Physiotherapy and Rehabilitation, Division of Swallowing Disorders, Hacettepe University Medical Science Faculty, Ankara, Turkey
| | - Cemal Kızılarslanoğlu
- Internal Medicine Department, Division of Geriatrics, Gazi University Medical Faculty, Ankara, Turkey
| | - Rana Tuna Doğrul
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Cafer Balcı
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Fatih Sümer
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Ayşe Karaduman
- Department of Physiotherapy and Rehabilitation, Division of Swallowing Disorders, Hacettepe University Medical Science Faculty, Ankara, Turkey
| | - Burcu Balam Yavuz
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Mustafa Cankurtaran
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Meltem Gülhan Halil
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
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Abstract
The global population is aging, and with this demographic shift, the incidence and prevalence of dementia are expected to increase. According to the World Health Organization, an estimated 50 million people are living with dementia worldwide, and this number is expected to triple to 150 million by 2050. Dementia initially affects the brain, eventually affecting the entire body culminating in death, commonly from the complications and comorbidities. People with dementia often experience eating difficulties in addition to a severe decline in cognitive, verbal, and functional abilities secondary to gradual neurodegenerative process, leading to weight loss, malnutrition, and dehydration. When eating difficulties and weight loss occur, health care providers and families often feel obligated to decide to either continue the oral feeding or opt for feeding tube placement. Primary care clinicians, both nurse practitioners and physicians, are presented with challenges when facilitating the decision regarding the feeding options in patients with advanced dementia. This narrative review aims at evaluating the impact of enteral nutrition versus oral feeding by comparing the rates of survival and adverse events in older adults with advanced dementia. It also highlights the best approaches to optimizing nutrition for this frail population.
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Lee JY, Hyun YS, Kim HS. Nutritional status of Korean elderly with dementia in a long-term care facility in Hongseong. Nutr Res Pract 2019; 13:32-40. [PMID: 30788054 PMCID: PMC6369111 DOI: 10.4162/nrp.2019.13.1.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study investigated nutritional status of the elderly with dementia in a care facility with the aim of improving the meal quality of the facility. SUBJECTS/METHODS Data were collected from 30 dementia patients aged more than 65 years in a long-term care facility in Hongseong. The data were obtained from questionnaires and medical records. The food intake data was obtained using food photographs and the nutrient intakes were calculated using the CAN-Pro 5.0. The data were compared with the dietary reference intakes for Koreans (KDRIs). The nutrient density, diet quality such as nutrient adequacy ratio (NAR), mean adequacy ratio (MAR), and index of nutritional quality (INQ), as well as dietary diversity score (DDS) were evaluated. The data were analyzed using SPSS statistical programs. RESULTS The average daily energy intakes for men and women were much lower than the estimated energy requirements of the KDRIs. The average intakes of energy and most nutrients in the general diet group were significantly higher than those of the other two groups. Significant differences in diet quality and diet diversity were observed according to the meal type groups. The NARs of some minerals (calcium, iron, and zinc) and vitamins (vitamin B6 and folic acid) were less than 0.5 in all study groups. The NARs of protein, iron and MAR of the general diet group were significantly higher than those of the liquid diet group. The DDS scores of meats, fruits and diary food group were very low in all meal type groups, meaning that the diet qualities of the study subjects were not appropriate in all meal type groups. CONCLUSIONS The food intakes of the study groups showed some limitations by a direct comparison with KDRIs because of the very low physical activities of the study subjects. The diet quality and diet diversity indices suggest the need for improvements in the nutritional quality in all types of diet. Overall, new intervention strategies targeting facility residents with dementia in Korea are needed as soon as possible.
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Affiliation(s)
- Ji-Yeon Lee
- Department of Food Science and Nutrition, Soonchunhyang University, 22 Soonchunhyang-ro, Shinchang-myun, Asan, Chungnam 31538, Korea
| | - Yeong-Soon Hyun
- Samsung Yeonhap Clinic, 662-2, Hongnam-ro, Gwangcheon-eup, Hongseong-gun, Chungnam 31538, Korea
| | - Hee-Seon Kim
- Department of Food Science and Nutrition, Soonchunhyang University, 22 Soonchunhyang-ro, Shinchang-myun, Asan, Chungnam 31538, Korea
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Ji EK, Wang HH, Jung SJ, Lee KB, Kim JS, Hong BY, Kim TW, Lim SH. The Changes for Strength of Oropharyngeal Muscles in Patients with Dementia and Dysphagia. BRAIN & NEUROREHABILITATION 2019. [DOI: 10.12786/bn.2019.12.e12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Eun Kyu Ji
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae Hyun Wang
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung June Jung
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung Bo Lee
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Sung Kim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Woo Kim
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Sestili M, Logrippo S, Cespi M, Bonacucina G, Ferrara L, Busco S, Grappasonni I, Palmieri GF, Ganzetti R, Blasi P. Potentially Inappropriate Prescribing of Oral Solid Medications in Elderly Dysphagic Patients. Pharmaceutics 2018; 10:pharmaceutics10040280. [PMID: 30558366 PMCID: PMC6321461 DOI: 10.3390/pharmaceutics10040280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 12/10/2018] [Indexed: 11/16/2022] Open
Abstract
Pharmaceutical formulations suitable for dysphagic patients are not always commercially available, motivating caregivers to crush tablets or open capsules to facilitate swallowing. Since this action may modify the characteristics of the medicine, it should be considered potentially inappropriate. This paper is the first to focus on how hospitalization affected the rate of potentially inappropriate prescriptions (PIPs) and the incidence of dosage form-related PIPs in elderly patients with dysphagia. Data was collected by reviewing patient medical records in the Italian National Research Center on Aging of Ancona. The therapy at admission and discharge was analysed in terms of: inappropriate drug associations, inappropriate drugs for dysphagic patients, inappropriate dosage forms and inappropriate dosage form modifications. Forty-one dysphagic patients with an average age of 88.3 years were included in the study and 451 prescriptions were analysed. PIPs were widespread at admission, and hospitalization did not improve the situation in a statistically significant manner. The most common PIPs identified (>80%) were related to dosage form selection and modification. This study highlights a clear need for continuing medical education about prescription appropriateness and modification of solid dosage forms in patients with dysphagia.
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Affiliation(s)
- Matteo Sestili
- Hospital Pharmacy, Italian National Research Center on Aging (INRCA), via della Montagnola 81, 60127 Ancona, Italy.
| | - Serena Logrippo
- School of Pharmacy, University of Camerino, via Gentile III da Varano, 62032 Camerino, Italy.
- International School of Advanced Studies (ISAS), University of Camerino, Via Camillo Lili 55, 62032 Camerino, Italy.
| | - Marco Cespi
- School of Pharmacy, University of Camerino, via Gentile III da Varano, 62032 Camerino, Italy.
| | - Giulia Bonacucina
- School of Pharmacy, University of Camerino, via Gentile III da Varano, 62032 Camerino, Italy.
| | - Letizia Ferrara
- Medical Direction, Italian National Research Center on Aging (INRCA), via della Montagnola 81, 60127 Ancona, Italy.
| | - Silvia Busco
- School of Pharmacy, University of Camerino, via Gentile III da Varano, 62032 Camerino, Italy.
| | - Iolanda Grappasonni
- School of Pharmacy, University of Camerino, via Gentile III da Varano, 62032 Camerino, Italy.
| | | | - Roberta Ganzetti
- Hospital Pharmacy, Italian National Research Center on Aging (INRCA), via della Montagnola 81, 60127 Ancona, Italy.
| | - Paolo Blasi
- School of Pharmacy, University of Camerino, via Gentile III da Varano, 62032 Camerino, Italy.
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Miarons M, Rofes L. Systematic review of case reports of oropharyngeal dysphagia following the use of antipsychotics. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 42:209-227. [PMID: 30470564 DOI: 10.1016/j.gastrohep.2018.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/23/2018] [Accepted: 09/07/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this systematic review was to examine the effect of antipsychotic medication on dysphagia based on clinical case reports. PATIENTS AND METHODS Literature searches were performed using the electronic databases PubMed and Embase. In PubMed, we used the MeSH terms "antipsychotic agents" OR "tranquilizing agents" combined with "deglutition disorders" OR "deglutition". In Embase, we used the Emtree terms "neuroleptic agents" combined with "swallowing" OR "dysphagia". Two reviewers assessed the eligibility of each case independently. RESULTS A total of 1043 abstracts were retrieved, of which 36 cases met the inclusion criteria; 14 cases were related to typical antipsychotics and 22 to atypical antipsychotics. Dysphagia occurred together with extrapyramidal symptoms in half of the cases and was the only prominent symptom in the other half. The most common strategy against dysphagia was changing to another antipsychotic (n=13, 36.1%). CONCLUSIONS The data from this review indicate that antipsychotics can increase the prevalence of dysphagia.
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Affiliation(s)
- Marta Miarons
- Pharmacy department, Mataró Hospital, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain.
| | - Laia Rofes
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
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De Pralormo S, Brunet M, Marquis A, Bruneau C, Le Roux G, Deguigne M. Ingestion of bar soap may produce serious injury: clinical effects and risk factors. Clin Toxicol (Phila) 2018; 57:356-361. [PMID: 30307335 DOI: 10.1080/15563650.2018.1517880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Most household and body soaps have an alkaline pH (9-12). In addition to their foaming effect, they irritate the skin. This study aims to review soap exposure reported to the Angers Poison Control Centre. METHOD A retrospective study of accidental or deliberate oral exposure to solid soaps reported to the Angers Poison Control Centre between 1 January 2000 and 1 April 2015. Poisoning severity was reassessed for each case according to the Poisoning Severity Score (PSS). RESULTS 553 cases of exposure were recorded. In more than 40% of cases (n = 226), exposure occurred in community settings (retirement homes, nursing homes). Patients had a history of dementia in 220 cases (40%). The most common symptoms were labial oedema (28%, n = 153), oropharyngeal irritation (10%, n = 56), salivation (10%, n = 53), vomiting (9%, n = 48) and cough (8%, n = 45). Among symptomatic patients (n = 276), one patient died from aspiration pneumonia and one patient died from a cardiogenic shock following oropharyngeal oedema, vomiting, cough and bronchial obstruction. Patients with dementia were more often symptomatic (75% vs 34%, p < .001) and more frequently hospitalised (22% vs 0.8%, p < .001). They experienced more moderate to severe symptoms (8% vs 0%, p < .001). Mildly severe (PSS2, n = 14), highly severe (PSS3, n = 1) and fatal (PSS4, n = 2) poisoning were observed only in patients with dementia. CONCLUSION Ingestion of soap bars is potentially serious, especially in patients with dementia. This type of soap should not be available to them in community settings and close monitoring should be considered in the event of oral exposure.
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Affiliation(s)
| | - Marion Brunet
- a Centre Antipoison - Toxicovigilance, CHU Angers , Angers , France
| | - Armelle Marquis
- a Centre Antipoison - Toxicovigilance, CHU Angers , Angers , France
| | - Chloé Bruneau
- a Centre Antipoison - Toxicovigilance, CHU Angers , Angers , France
| | - Gaël Le Roux
- a Centre Antipoison - Toxicovigilance, CHU Angers , Angers , France
| | - Marie Deguigne
- a Centre Antipoison - Toxicovigilance, CHU Angers , Angers , France
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Oral Modified Release Multiple-Unit Particulate Systems: Compressed Pellets, Microparticles and Nanoparticles. Pharmaceutics 2018; 10:pharmaceutics10040176. [PMID: 30287798 PMCID: PMC6321440 DOI: 10.3390/pharmaceutics10040176] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/07/2018] [Accepted: 09/16/2018] [Indexed: 01/06/2023] Open
Abstract
Oral modified-release multiparticulate dosage forms, which are also referred to as oral multiple-unit particulate systems, are becoming increasingly popular for oral drug delivery applications. The compaction of polymer-coated multiparticulates into tablets to produce a sustained-release dosage form is preferred over hard gelatin capsules. Moreover, multiparticulate tablets are a promising solution to chronic conditions, patients’ adherence, and swallowing difficulties if incorporated into orodispersible matrices. Nonetheless, the compaction of multiparticulates often damages the functional polymer coat, which results in a rapid release of the drug substance and the subsequent loss of sustained-release properties. This review brings to the forefront key formulation variables that are likely to influence the compaction of coated multiparticulates into sustained-release tablets. It focusses on the tabletting of coated drug-loaded pellets, microparticles, and nanoparticles with a designated section on each. Furthermore, it explores the various approaches that are used to evaluate the compaction behaviour of particulate systems.
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Flynn E, Smith CH, Walsh CD, Walshe M. Modifying the consistency of food and fluids for swallowing difficulties in dementia. Cochrane Database Syst Rev 2018; 9:CD011077. [PMID: 30251253 PMCID: PMC6513397 DOI: 10.1002/14651858.cd011077.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with dementia can have feeding and swallowing difficulties (dysphagia). Modification of the consistency of food or fluids, or both, is a common management strategy. However, diet modification can affect quality of life and may lead to dehydration and malnutrition. Evidence on the benefits and risks of modifying food and fluids is mandatory to improve the care of people with dementia and dysphagia. OBJECTIVES To determine the effectiveness and adverse effects associated with modifying the consistency of food and fluids in improving oral intake and eliminating aspiration in adults with dysphagia and dementia. SEARCH METHODS We searched ALOIS (the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group), the Cochrane Library, MEDLINE via Ovid SP, Embase via Ovid SP, PsycINFO via Ovid SP, CINAHL via EBSCOhost, LILACS via BIREME, ClinicalTrials.gov and the World Health Organization (WHO) Portal on 9 May 2018. We also checked the reference lists of relevant articles to identify any additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs and cluster-RCTs published in any language that measured any of the outcomes of interest. We included trials with adults with a clinical diagnosis of dementia with symptoms and signs of dysphagia confirmed on instrumental assessment. We included participants with all types, stages and severities of dementia. Control groups received either no intervention or interventions not involving diet modification or modification to sensory properties of food. DATA COLLECTION AND ANALYSIS Two review authors independently assessed for inclusion all potential studies identified. Data were extracted independently along with assessment of methodological quality using standard Cochrane methods. We contacted study authors for additional unpublished information. MAIN RESULTS No trials on modification of food met the inclusion criteria. We included two studies that examined modification to fluids. Both were part of the same large multicentre trial and included people with dementia and people with or without dementia and Parkinson's disease. Participation in the second trial was determined by results from the first trial. With unpublished data supplied by study authors, we examined data from participants with dementia only. The first study, a cross-over trial, investigated the immediate effects on aspiration of two viscosities of liquids (nectar thick and honey thick) compared to regular liquids in 351 participants with dementia using videofluoroscopy. Regular liquids with a chin down head posture, as well as regular liquids without any intervention were also compared. The sequence of interventions during videofluoroscopy may have influenced response to intervention. The second study, a parallel designed RCT, compared the effect of nectar and honey thick liquids with a chin down head posture over a three-month period in a subgroup of 260 participants with dementia. Outcomes were pneumonia and adverse intervention effects. Honey thick liquids, which are more consistent with descriptors for 'spoon thick' or 'extremely thick' liquids, showed a more positive impact on immediate elimination of aspiration during videofluoroscopy, but this consistency showed more adverse effects in the second follow-up study. During the second three-month follow-up trial, there were a greater number of incidents of pneumonia in participants receiving honey thick liquids than those receiving nectar thick liquids or taking regular liquids with a chin down posture. There were no deaths classified as 'definitely related' to the type of fluids prescribed. Neither trial addressed quality of life. Risk of bias for both studies is high. The overall quality of evidence for outcomes in this review is low. AUTHORS' CONCLUSIONS We are uncertain about the immediate and long-term effects of modifying the consistency of fluid for swallowing difficulties in dementia as too few studies have been completed. There may be differences in outcomes depending on the grade of thickness of fluids and the sequence of interventions trialled in videofluoroscopy for people with dementia. Clinicians should be aware that while thickening fluids may have an immediate positive effect on swallowing, the long-term impact of thickened fluids on the health of the person with dementia should be considered. Further high-quality clinical trials are required.
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Affiliation(s)
- Eadaoin Flynn
- Trinity College DublinClinical Speech and Language Studies7‐9 South Leinster Street2 DublinIreland
| | | | - Cathal D Walsh
- Department of Mathematics and StatisticsHealth Research Institute (HRI) and MACSIUniversity of LimerickIreland
| | - Margaret Walshe
- Trinity College DublinClinical Speech and Language Studies7‐9 South Leinster Street2 DublinIreland
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Clarke G, Fistein E, Holland A, Tobin J, Barclay S, Barclay S. Planning for an uncertain future in progressive neurological disease: a qualitative study of patient and family decision-making with a focus on eating and drinking. BMC Neurol 2018; 18:115. [PMID: 30115018 PMCID: PMC6094897 DOI: 10.1186/s12883-018-1112-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/30/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Dysphagia and other eating and drinking difficulties are common in progressive neurological diseases. Mealtimes can become a major source of difficulty and anxiety for patients and their families. Decisions about eating, drinking and care can become challenging as disease progresses, and the person in question loses the capacity to participate in decisions about their own care. We sought to investigate how patients and their family members make decisions about their future care as their condition deteriorates, with a particular focus on mealtimes, eating and drinking. METHODS Longitudinal qualitative in-depth interviews were undertaken with patients and their family members (N = 29) across a range of disease groups, including: dementia, Parkinson's Disease, Huntington's Disease, Progressive Supranuclear Palsy, Motor Neurone Disease, Multiple Sclerosis. Patients had varying degrees of eating and drinking difficulties, and levels of decision-making capacity. Interviews were 'participant led' and undertaken in the patients' own homes or a place of their choosing. Follow-up interviews were three months to one year later depending upon disease trajectory. Interviews were audio recorded and analysed in NVivo using a Thematic Analysis approach. RESULTS Twenty-nine participants were interviewed between 2015 and 2017. Two key themes emerged from the analysis: 1) Health Literacy: the extent to which patients and relatives appeared to know about the condition and its treatment. Patients and their family members varied in their ability to speak and communicate about their condition and prognosis. 2) Planning style: the extent to which participants appeared to value involvement in advance care-planning. Patients and their family members varied in the way in which they made decisions: some preferred to 'take each day as it comes', while others wished to plan extensively for the future. CONCLUSIONS Issues with eating and drinking are often overlooked. Clinicians need to understand both the patient's level of health literacy and their style of planning before communicating with patients and their families about these sensitive issues.
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Affiliation(s)
- Gemma Clarke
- Primary Care Unit, Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK.
| | - Elizabeth Fistein
- Primary Care Unit, Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Anthony Holland
- The Health Foundration, Chair in Learning Disabilities, Cambridge Intellectual and Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Sam Barclay
- Primary Care Unit, Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
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Jablonski RA, Kolanowski AM, Azuero A, Winstead V, Jones-Townsend C, Geisinger ML. Randomised clinical trial: Efficacy of strategies to provide oral hygiene activities to nursing home residents with dementia who resist mouth care. Gerodontology 2018; 35:365-375. [PMID: 30004139 DOI: 10.1111/ger.12357] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The purpose of this study was to test the efficacy of MOUTh (Managing Oral Hygiene Using Threat Reduction), a nonpharmacologic, relationship-based intervention vs. control on 2 primary outcomes for nursing home (NH) residents with dementia who resisted mouth care: (i) reduction in the occurrence and intensity of care-resistant behaviours (CRBs) and (ii) improvement in oral health. Two secondary outcomes were also examined: (i) the duration of mouth care and (ii) the completion of oral hygiene activities. BACKGROUND Persons with dementia who exhibit CRBs are at risk for inadequate mouth care and subsequent systemic illnesses. MATERIALS AND METHODS The study used a randomised repeated measures design. Recruitment occurred in 9 nursing homes that varied in size, ownership, reimbursement patterns and location. One hundred and one nursing home residents with dementia were randomised at the individual level to experimental (n = 55) or control groups (n = 46). One hundred participants provided data for the analyses. RESULTS Compared to the control group, persons in the experimental group had twice the odds of allowing mouth care and completing oral hygiene activities; they also allowed longer duration of mouth care (d = 0.56), but showed only small reductions in the intensity of CRBs (d = 0.16) and small differential improvements in oral health (d = 0.18). CONCLUSION The data suggest that this intervention facilitates mouth care among persons with dementia. The management of refusal behaviour may be a clinically more realistic approach than reducing or eradicating refusals.
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Affiliation(s)
- Rita A Jablonski
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.,Memory Disorders Clinic, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ann M Kolanowski
- College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vicki Winstead
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Maria L Geisinger
- School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
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64
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Heuberger R, Wong H. Knowledge, Attitudes, and Beliefs of Physicians and Other Health Care Providers Regarding Artificial Nutrition and Hydration at the End of Life. J Aging Health 2018. [PMID: 29519177 DOI: 10.1177/0898264318762850] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: Despite the growing evidence against artificial nutrition and hydration (ANH) use among patients with advanced dementia, little is known about the perspectives of the health care team. This study examined the knowledge, attitudes, and beliefs of physicians and other health care providers regarding the use of ANH at the end of life (EOL). Methods: A cross-sectional survey explored the provision of EOL care using a hypothetical case scenario of a patient with advanced dementia and dysphagia. Questionnaire items were analyzed using parametric and nonparametric approaches. Results: In this sample of 323 respondents, statistical significance was found between physicians and other health care providers' views on ANH and its related beneficial effects or health outcomes in EOL care. Discussion: Results indicate knowledge deficits in physicians and other health care professionals and highlight the need for comprehensive continuing education programs on EOL topics. Conclusion: Differences in knowledge, attitudes and beliefs regarding ANH in EOL among healthcare providers were observed and education regarding evidence based clinical guidelines are necessary.
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Affiliation(s)
| | - Helen Wong
- 1 Central Michigan University, Mount Pleasant
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65
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Affiliation(s)
- M Payne
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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66
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Namasivayam-MacDonald AM, Burnett L, Nagy A, Waito AA, Steele CM. Effects of Tongue Strength Training on Mealtime Function in Long-Term Care. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:1213-1224. [PMID: 29084315 PMCID: PMC6194927 DOI: 10.1044/2017_ajslp-16-0186] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 08/03/2017] [Indexed: 05/07/2023]
Abstract
PURPOSE The primary aim of this study was to determine the feasibility and effectiveness of an 8-week tongue-strengthening intervention protocol for seniors with mild to moderately severe cognitive impairment in the long-term care setting. Outcome measures of interest included tongue strength, mealtime duration, and food intake. METHOD In this pre-post group study of treatment outcomes, data were collected from 7 adults (aged 84-99 years). Participants were observed across a series of mealtimes to determine mealtime duration and intake before and after 16 treatment sessions. During therapy, participants performed isometric strength exercises and tongue pressure accuracy tasks using the Iowa Oral Performance Instrument (model number 2.1, IOPI Medical). Differences in tongue strength as a function of treatment were explored between the first 3 and final 3 sessions using univariate repeated-measures analysis of variance. Single-subject methods were used to explore baseline and posttreatment data for measures of mealtime function. RESULTS Anterior and posterior tongue strength increased significantly with therapy. There were no changes in mealtime function. CONCLUSIONS This study shows proof of concept that some older adults with cognitive impairment are able to participate in a tongue-strengthening intervention and achieve improvements in tongue strength. Failure to find evidence of associated changes of mealtime function suggests that mealtime measures may not be directly sensitive to changes in tongue strength.
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Affiliation(s)
- Ashwini M. Namasivayam-MacDonald
- Rehabilitation Sciences Institute, University of Toronto, Canada
- Toronto Rehabilitation Institute, University Health Network, Canada
- Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY
| | - Lynsey Burnett
- Toronto Rehabilitation Institute, University Health Network, Canada
| | - Ahmed Nagy
- Toronto Rehabilitation Institute, University Health Network, Canada
- Fayoum University, Egypt
| | - Ashley A. Waito
- Rehabilitation Sciences Institute, University of Toronto, Canada
- Toronto Rehabilitation Institute, University Health Network, Canada
| | - Catriona M. Steele
- Rehabilitation Sciences Institute, University of Toronto, Canada
- Toronto Rehabilitation Institute, University Health Network, Canada
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67
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Franx BAA, Arnoldussen IAC, Kiliaan AJ, Gustafson DR. Weight Loss in Patients with Dementia: Considering the Potential Impact of Pharmacotherapy. Drugs Aging 2017; 34:425-436. [PMID: 28478593 DOI: 10.1007/s40266-017-0462-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Unintentional body weight loss is common in patients with dementia and is linked to cognitive impairment and poorer disease outcomes. It is proposed that some dementia medications with market approval, while aiming to improve cognitive and functional outcomes of a patient with dementia, are associated with reported body weight or body mass index loss. This review presents evidence in the published literature on body weight loss in dementia, describes selected theories behind body weight loss, evaluates the potential impact of approved dementia pharmacotherapies on body weight, considers the potential role for medical foods, understands the potential influence of treatments for neuropsychiatric symptoms and signs, and finally, summarizes this important area.
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Affiliation(s)
- Bart A A Franx
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilse A C Arnoldussen
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Amanda J Kiliaan
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Deborah R Gustafson
- Department of Neurology, Section for NeuroEpidemiology, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 1213, Brooklyn, NY, 11203, USA. .,Neuropsychiatric Epidemiology Unit (EPINEP), Institute for Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. .,Department of Health and Education, University of Skövde, Skövde, Sweden.
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68
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Hattrem MN, Dille MJ, Seternes T, Ege T, Draget KI. The Relative Bioavailability of Ibuprofen After Administration With a Novel Soft Chewable Drug Formulation. Clin Pharmacol Drug Dev 2017; 7:168-176. [PMID: 28444716 PMCID: PMC5811835 DOI: 10.1002/cpdd.357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/06/2017] [Indexed: 01/16/2023]
Abstract
The first aim of the present study was to evaluate the bioavailability of ibuprofen dispersed in a novel soft chewable formulation compared with a traditional ibuprofen tablet; its second was to map the quality of taste masking and patient product satisfaction. In a phase 1, single‐center, open‐label, randomized, crossover study, healthy subjects received a soft‐chew formulation or a hard tablet (reference), both containing 100 mg ibuprofen. Serial blood samples were collected over 24 hours to assess ibuprofen bioavailability. Taste and satisfaction after chewing the novel formulation 3 or 8 times were evaluated with a questionnaire. The soft‐chew formulation showed comparable bioavailability to the reference tablet. The highest peak plasma concentration was observed after 3 chews, and the relative bioavailability was approximately 8% higher compared to 8 chews. The overall flavor was well appreciated, and chewing 3 times was significantly preferred (P = .043) over chewing 8 times. Soft chewable drug formulations may improve compliance and potentially benefit several subpopulations who experience dysphagia.
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Affiliation(s)
| | - Morten J Dille
- Department of Biotechnology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tore Seternes
- Norwegian College of Fishery Science, University of Tromsø, 9037 Tromsø, Norway
| | | | - Kurt I Draget
- Department of Biotechnology, Norwegian University of Science and Technology, Trondheim, Norway.,Vitux Pharma AS, Oslo, Norway
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69
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Mori T, Yoshikawa M, Maruyama M, Hiraoka A, Nakamori M, Yoshida M, Tsuga K. Development of a candy-sucking test for evaluating oral function in elderly patients with dementia: A pilot study. Geriatr Gerontol Int 2017; 17:1977-1981. [DOI: 10.1111/ggi.13003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/05/2016] [Accepted: 12/19/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Takahiro Mori
- Department of Advanced Prosthodontics; Hiroshima University Graduate School of Biomedical and Health Sciences; Hiroshima Japan
| | - Mineka Yoshikawa
- Department of Advanced Prosthodontics; Hiroshima University Graduate School of Biomedical and Health Sciences; Hiroshima Japan
| | - Mariko Maruyama
- Department of Advanced Prosthodontics; Hiroshima University Graduate School of Biomedical and Health Sciences; Hiroshima Japan
| | - Aya Hiraoka
- Department of Advanced Prosthodontics; Hiroshima University Graduate School of Biomedical and Health Sciences; Hiroshima Japan
| | - Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics; Hiroshima University Graduate School of Biomedical and Health Sciences; Hiroshima Japan
| | - Mitsuyoshi Yoshida
- Department of Advanced Prosthodontics; Hiroshima University Graduate School of Biomedical and Health Sciences; Hiroshima Japan
| | - Kazuhiro Tsuga
- Department of Advanced Prosthodontics; Hiroshima University Graduate School of Biomedical and Health Sciences; Hiroshima Japan
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Rignell L, Mikati M, Wertsén M, Hägglin C. Sedation with orally administered midazolam in elderly dental patients with major neurocognitive disorder. Gerodontology 2017; 34:299-305. [DOI: 10.1111/ger.12262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Lena Rignell
- Clinic of Pedodontics and Special Dental Care; Sahlgrenska University Hospital; Mölndal Sweden
| | - Mona Mikati
- Clinic of Pedodontics and Special Dental Care; Sahlgrenska University Hospital; Mölndal Sweden
| | - Madeleine Wertsén
- Clinic of Pedodontics and Special Dental Care; Sahlgrenska University Hospital; Mölndal Sweden
- Department of Gerodontology; Public Dental Service; Region Västra Götaland Sweden
| | - Catharina Hägglin
- Department of Gerodontology; Public Dental Service; Region Västra Götaland Sweden
- Department of Behavioural & Community Dentistry; Institute of Odontology; Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
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71
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Abstract
Breathing is vital for survival but also interesting from the perspective of rhythm generation. This rhythmic behavior is generated within the brainstem and is thought to emerge through the interaction between independent oscillatory neuronal networks. In mammals, breathing is composed of three phases - inspiration, post-inspiration, and active expiration - and this article discusses the concept that each phase is generated by anatomically distinct rhythm-generating networks: the preBötzinger complex (preBötC), the post-inspiratory complex (PiCo), and the lateral parafacial nucleus (pF L), respectively. The preBötC was first discovered 25 years ago and was shown to be both necessary and sufficient for the generation of inspiration. More recently, networks have been described that are responsible for post-inspiration and active expiration. Here, we attempt to collate the current knowledge and hypotheses regarding how respiratory rhythms are generated, the role that inhibition plays, and the interactions between the medullary networks. Our considerations may have implications for rhythm generation in general.
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Affiliation(s)
- Tatiana M. Anderson
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA, USA
- Graduate Program for Neuroscience, University of Washington School of Medicine, Seattle, WA, USA
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Neurological Surgery and Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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72
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Paranji S, Paranji N, Wright S, Chandra S. A Nationwide Study of the Impact of Dysphagia on Hospital Outcomes Among Patients With Dementia. Am J Alzheimers Dis Other Demen 2017; 32:5-11. [PMID: 27821563 PMCID: PMC10852859 DOI: 10.1177/1533317516673464] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
OBJECTIVES To assess the impact of dysphagia on clinical and operational outcomes in hospitalized patients with dementia. DESIGN Retrospective cohort study. SETTING 2012 Nationwide Inpatient Sample. PARTICIPANTS All patients discharged with a diagnosis of dementia (N = 234,006) from US hospitals in 2012. MEASUREMENTS Univariate and multivariate regression models, adjusting for stroke and patient characteristics, to assess the impact of dysphagia on the prevalence of comorbidities, including pneumonia, sepsis, and malnutrition; complications, including mechanical ventilation and death; and operational outcomes, including length of stay (LOS) and total charges for patients with dementia. RESULTS Patients having dementia with dysphagia (DWD) had significantly higher odds of having percutaneous endoscopic gastrostomy placement during the admission (odds ratio [OR]: 13.68, 95% confidence interval [CI]: 12.53-14.95, P < .001), aspiration pneumonia (OR: 6.27, 95% CI: 5.87-6.72, P < .001), pneumonia (OR: 2.84, 95% CI: 2.67-3.02, P < .001), malnutrition (OR: 2.5, 95% CI: 2.27-2.75, P < .001), mechanical ventilation (OR: 1.69, 95% CI: 1.51-1.9, P < .001), sepsis (OR: 1.52, 95% CI: 1.39-1.67, P < .001), and anorexia (OR: 1.29, 95% CI: 1.01-1.65, P = .04). Mean LOS was 2.16 days longer (95% CI: 1.98-2.35, P < .001), mean charge per case was US$10,703 higher (95% CI: US$9396-US$12,010, P < .001), and the odds of being discharged to a skilled nursing, rehabilitation, or long-term facility was 1.59 times higher (95% CI: 1.49-1.69, P < .001) in the DWD cohort compared to patients having dementia without dysphagia. CONCLUSION Dysphagia is a significant predictor of worse clinical and operational outcomes including a 38% longer LOS and a 30% increase in charge per case among hospitalized patients with dementia. Although these findings may not be surprising, this new evidence might bring heightened awareness for the need to more thoughtfully support patients with dementia and dysphagia who are hospitalized.
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Affiliation(s)
- Suchitra Paranji
- Divisions of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, MD, USA
| | - Neethi Paranji
- Divisions of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, MD, USA
| | - Scott Wright
- General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, MD, USA
| | - Shalini Chandra
- Divisions of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, MD, USA
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73
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Boccardi V, Ruggiero C, Patriti A, Marano L. Diagnostic Assessment and Management of Dysphagia in Patients with Alzheimer's Disease. J Alzheimers Dis 2016; 50:947-55. [PMID: 26836016 DOI: 10.3233/jad-150931] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A growing concern in patients affected by Alzheimer's disease (AD) is dysphagia, or swallowing impairment, which leads to malnutrition, dehydration, weight loss, functional decline and fear of eating and drinking, as well as a decrease in the quality of life. Thus the diagnostic assessment of dysphagia in patients with AD is imperative to ensure that they receive effective management, avoiding complications, and reducing comorbidity and mortality in such a growing population. Dysphagia management requires a multidisciplinary approach considering that no single strategy is appropriate for all patients. However, evidence for clinical diagnostic assessment, interventions, and medical management of dysphagia in these patients are still limited: few studies are reporting the evaluation and the management among this group of patients. Here we analyzed the most recent findings in diagnostic assessment and management of swallowing impairment in patients affected by AD.
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Affiliation(s)
- Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Carmelinda Ruggiero
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Alberto Patriti
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, "San Matteo degli Infermi" Hospital, ASL Umbria 2, Spoleto, Italy
| | - Luigi Marano
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, "San Matteo degli Infermi" Hospital, ASL Umbria 2, Spoleto, Italy
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74
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Dionyssiotis Y, Papachristos A, Petropoulou K, Papathanasiou J, Papagelopoulos P. Nutritional Alterations Associated with Neurological and Neurosurgical Diseases. Open Neurol J 2016; 10:32-41. [PMID: 27563361 PMCID: PMC4962432 DOI: 10.2174/1874205x01610010032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 05/15/2016] [Accepted: 05/25/2016] [Indexed: 02/08/2023] Open
Abstract
Neurological and neurosurgical diseases lead to complications producing malnutrition increasing pathology and mortality. In order to avoid complications because of malnutrition or overcome deficiencies in nutrients supplements are often used for these subjects. The physiopathological mechanisms of malnutrition, methods of nutritional assessment and the supplemental support are reviewed in this paper based on the assumption that patients need to receive adequate nutrition to promote optimal recovery, placing nutrition as a first line treatment and not an afterthought in the rehabilitation.
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Affiliation(s)
- Yannis Dionyssiotis
- Physical Medicine & Rehabilitation Department, European Interbalkan Medical Center "DIABALKANIKO", Thessaloniki, Greece
| | | | - Konstantina Petropoulou
- 2 Physical Medicine & Rehabilitation Department, National Rehabilitation Center "EKA-KAT", Ilion, Athens, Greece
| | - Jannis Papathanasiou
- Section of Kinesiotherapy & Physiotherapy Department of Preventive Medicine, Medical University of Sofia, Sofia, Bulgaria
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75
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Ilott I, Gerrish K, Eltringham SA, Taylor C, Pownall S. Exploring factors that influence the spread and sustainability of a dysphagia innovation: an instrumental case study. BMC Health Serv Res 2016; 16:406. [PMID: 27538983 PMCID: PMC4991017 DOI: 10.1186/s12913-016-1653-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/10/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Swallowing difficulties challenge patient safety due to the increased risk of malnutrition, dehydration and aspiration pneumonia. A theoretically driven study was undertaken to examine the spread and sustainability of a locally developed innovation that involved using the Inter-Professional Dysphagia Framework to structure education for the workforce. A conceptual framework with 3 spread strategies (hierarchical control, participatory adaptation and facilitated evolution) was blended with a processual approach to sustaining organisational change. The aim was to understand the processes, mechanism and outcomes associated with the spread and sustainability of this safety initiative. METHODS An instrumental case study, prospectively tracked a dysphagia innovation for 34 months (April 2011 to January 2014) in a large health care organisation in England. A train-the-trainer intervention (as participatory adaptation) was deployed on care pathways for stroke and fractured neck of femur. Data were collected at the organisational and clinical level through interviews (n = 30) and document review. The coding frame combined the processual approach with the spread mechanisms. Pre-determined outcomes included the number of staff trained about dysphagia and impact related to changes in practice. RESULTS The features and processes associated with hierarchical control and participatory adaptation were identified. Leadership, critical junctures, temporality and making the innovation routine were aspects of hierarchical control. Participatory adaptation was evident on the care pathways through stakeholder responses, workload and resource pressures. Six of the 25 ward based trainers cascaded the dysphagia training. The expected outcomes were achieved when the top-down mandate (hierarchical control) was supplemented by local engagement and support (participatory adaptation). CONCLUSIONS Frameworks for spread and sustainability were combined to create a 'small theory' that described the interventions, the processes and desired outcomes a priori. This novel methodological approach confirmed what is known about spread and sustainability, highlighted the particularity of change and offered new insights into the factors associated with hierarchical control and participatory adaptation. The findings illustrate the dualities of organisational change as universal and context specific; as particular and amendable to theoretical generalisation. Appreciating these dualities may contribute to understanding why many innovations fail to become routine.
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Affiliation(s)
- Irene Ilott
- Formerly Knowledge Translation Project Lead with the NIHR CLAHRC SY, Sheffield, UK
| | - Kate Gerrish
- School of Nursing and Midwifery University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, NIHR CLAHRC Yorkshire and Humber, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, D Floor Research, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
| | | | - Carolyn Taylor
- Dietetic Department, Sheffield Teaching Hospital NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU UK
| | - Sue Pownall
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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76
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Jiang JL, Fu SY, Wang WH, Ma YC. Validity and reliability of swallowing screening tools used by nurses for dysphagia: A systematic review. Tzu Chi Med J 2016; 28:41-48. [PMID: 28757720 PMCID: PMC5442897 DOI: 10.1016/j.tcmj.2016.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/22/2016] [Accepted: 04/29/2016] [Indexed: 12/13/2022] Open
Abstract
Dysphagia following neurological impairment increases the risk of dehydration, malnutrition, aspiration pneumonia, and even death. Screening for dysphagia has been reported to change negative outcomes. This review evaluated the validity and reliability of measurement tools for screening dysphagia in patients with neurological disorders to identify a feasible tool that can be used by nurses. Electronic databases were searched for studies from 1992 to 2015 related to dysphagia screening measurements. The search was applied to the Pubmed, CINAHL, Cochrane, Medline, EBSCO host, and CEPS + CETD databases. A checklist was used to evaluate the psychometric quality. The tools were evaluated for their feasibility for incorporation into routine care by nurses in hospitals. A total of 104 papers were retrieved, and eight articles finally met the inclusion criteria. The sensitivity and specificity of the screening tools ranged from 29% to 100% and from 65% to 100%, respectively. The interrater reliability ranged from good to excellent agreement. On the basis of quality evaluations, all the included studies had a risk of bias because of inadequate methodological characteristics. The Standardized Swallowing Assessment is the most suitable tool for detecting dysphagia because its psychometric properties and feasibility are higher than those of other screening tools that can be administered by nurses.
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Affiliation(s)
- Jiin-Ling Jiang
- Department of Nursing, Tzu Chi University, Hualien, Taiwan.,Department of Nursing, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Shu-Ying Fu
- Department of Nursing, Tzu Chi University, Hualien, Taiwan
| | - Wan-Hsiang Wang
- Department of Nursing, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Taiwanese Centre for Evidence-based Health Care, Hualien, Taiwan
| | - Yu-Chin Ma
- Department of Nursing, Tzu Chi University, Hualien, Taiwan
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77
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Li CM, Lee HY, Hsieh SH, Wang TG, Wang HP, Chen JJJ. Development of Innovative Feedback Device for Swallowing Therapy. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0146-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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78
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Seçil Y, Arıcı Ş, İncesu TK, Gürgör N, Beckmann Y, Ertekin C. Dysphagia in Alzheimer's disease. Neurophysiol Clin 2016; 46:171-8. [PMID: 26924307 DOI: 10.1016/j.neucli.2015.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 12/29/2015] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate electrophysiological parameters of swallowing in all stages of Alzheimer's disease. METHODS Forty Alzheimer's disease patients, 20 age-matched normal controls and 20 young normal controls were included. Dysphagia limit (DL) and sequential water swallowing (SWS) tests were performed. Cardiac rhythm, respiration and sympathetic skin responses were concomitantly recorded. RESULTS Dysphagia was found in 30/40 (75%) of Alzheimer's disease patients. Mean volume at the DL test was significantly reduced (16.5±1.0mL) in the Alzheimer's disease group. Swallowing and apnea times in the SWS test were significantly prolonged in elderly controls, but even longer in Alzheimer's disease patients. CONCLUSIONS Alzheimer's disease patients had electrophysiological features of dysphagia, even in the early period of disease. The cortical involvement and severity of cognitive disorder can increase swallowing problems, but subclinical signs of dysphagia may be observed even in patients with mild or moderate Alzheimer's disease.
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Affiliation(s)
- Yaprak Seçil
- Neurology Department, Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi, 35360 Izmir, Turkey.
| | - Şehnaz Arıcı
- Neurology Department, Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi, 35360 Izmir, Turkey
| | - Tülay Kurt İncesu
- Neurology Department, Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi, 35360 Izmir, Turkey
| | - Nevin Gürgör
- Neurology Department, Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi, 35360 Izmir, Turkey
| | - Yeşim Beckmann
- Neurology Department, Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi, 35360 Izmir, Turkey
| | - Cumhur Ertekin
- Department of Clinical Neurophysiology, Ege University Medical School Hospital, Izmir, Turkey
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79
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Sarabia-Cobo CM, Pérez V, de Lorena P, Domínguez E, Hermosilla C, Nuñez MJ, Vigueiro M, Rodríguez L. The incidence and prognostic implications of dysphagia in elderly patients institutionalized: A multicenter study in Spain. Appl Nurs Res 2016; 30:e6-9. [DOI: 10.1016/j.apnr.2015.07.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 06/28/2015] [Accepted: 07/02/2015] [Indexed: 11/29/2022]
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80
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Tsukamoto M, Manabe N, Kamada T, Hirai T, Hata J, Haruma K, Inoue K. Number of Gastrointestinal Symptoms is a Useful Means of Identifying Patients with Cancer for Dysphagia. Dysphagia 2016; 31:547-54. [DOI: 10.1007/s00455-016-9712-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 04/15/2016] [Indexed: 12/17/2022]
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81
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Crary MA. Adult Neurologic Disorders. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00003-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Dysphagia impacts on the health and quality of life of individuals and contributes to the cost of health care. This paper summarises current literature regarding the nature, assessment and management of acquired oro-pharyngeal dysphagia in older adults. It examines the aetiology, prevalence and consequences of dysphagia, as well as issues regarding medication administration. Assessment of dysphagia is explored in terms of multidisciplinary screening, speech and language therapist clinical swallowing evaluation and instrumental assessment.
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Affiliation(s)
- John Lancaster
- Senior Lecturer in Speech Pathology and Therapy, Manchester Metropolitan University
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Papaioannou A, Santesso N, Morin SN, Feldman S, Adachi JD, Crilly R, Giangregorio LM, Jaglal S, Josse RG, Kaasalainen S, Katz P, Moser A, Pickard L, Weiler H, Whiting S, Skidmore CJ, Cheung AM. Recommendations for preventing fracture in long-term care. CMAJ 2015; 187:1135-1144. [PMID: 26370055 PMCID: PMC4610837 DOI: 10.1503/cmaj.141331] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Alexandra Papaioannou
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont.
| | - Nancy Santesso
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Suzanne N Morin
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Sidney Feldman
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Jonathan D Adachi
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Richard Crilly
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Lora M Giangregorio
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Susan Jaglal
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Robert G Josse
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Sharon Kaasalainen
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Paul Katz
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Andrea Moser
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Laura Pickard
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Hope Weiler
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Susan Whiting
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Carly J Skidmore
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
| | - Angela M Cheung
- Department of Medicine (Papaioannou, Adachi, Pickard), Department of Clinical Epidemiology and Biostatistics (Papaioannou, Santesso) and School of Nursing (Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Geriatric Education and Research in Aging Sciences Centre (Papaioannou, Pickard, Skidmore), St. Peter's Hospital, Hamilton, Ont.; Department of Medicine (Morin), McGill University Health Centre, Montréal, Que.; Montreal General Hospital (Morin), Montréal, Que.; Department of Medicine (Feldman, Josse, Moser, Cheung) and Department of Physical Therapy (Jaglal), University of Toronto, Toronto, Ont.; Baycrest Geriatric Health Care System (Feldman, Katz, Moser), Toronto, Ont.; St. Joseph's Healthcare (Adachi), Hamilton, Ont.; Division of Geriatric Medicine, Department of Medicine (Crilly), University of Western Ontario, London, Ont.; Department of Kinesiology (Giangregorio), University of Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (Jaglal), Toronto, Ont.; Li Ka Shing Knowledge Institute (Josse), St Michael's Hospital, Toronto, Ont.; School of Dietetics and Human Nutrition (Weiler), McGill University, Montréal. Que.; Department of Nutrition and Dietetics (Whiting), University of Saskatchewan, Saskatoon, Sask.; Toronto General Hospital (Cheung), Toronto, Ont
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84
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Patient-centred pharmaceutical design to improve acceptability of medicines: similarities and differences in paediatric and geriatric populations. Drugs 2015; 74:1871-1889. [PMID: 25274536 PMCID: PMC4210646 DOI: 10.1007/s40265-014-0297-2] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient acceptability of a medicinal product is a key aspect in the development and prescribing of medicines. Children and older adults differ in many aspects from the other age subsets of population and require particular considerations in medication acceptability. This review highlights the similarities and differences in these two age groups in relation to factors affecting acceptability of medicines. New and conventional formulations of medicines are considered regarding their appropriateness for use in children and older people. Aspects of a formulation that impact acceptability in these patient groups are discussed, including, for example, taste/smell/viscosity of a liquid and size/shape of a tablet. A better understanding of the acceptability of existing formulations highlights opportunities for the development of new and more acceptable medicines and facilitates safe and effective prescribing for the young and older populations.
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85
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Electrophysiological Techniques to Evaluate Swallowing in Central and Peripheral Nervous System Disorders. J Clin Neurophysiol 2015; 32:314-23. [PMID: 26241241 DOI: 10.1097/wnp.0000000000000189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Neurogenic dysphagia is a frequent condition that may result in serious complications. Despite high incidence of neurogenic dysphagia, the neurologist is not really interested in its clinical diagnosis and management. In this review, several neurophysiological methods are described to evaluate the neurogenic dysphagia. These kinds of assessment methods are important for early diagnosis and some management strategies against to progressive swallowing pathology. The longitudinal follow-up of the patients also provides data about the prognosis of dysphagia. In our opinion, the neurophysiological methods presented in this review are reliable, cheap, and easy applicable quantitative tests to detect and follow both clinical and subclinical dysphagia. All these electrophysiological techniques can be applied within the discipline of the EMG laboratory.
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86
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Rösler A, Pfeil S, Lessmann H, Höder J, Befahr A, von Renteln-Kruse W. Dysphagia in Dementia: Influence of Dementia Severity and Food Texture on the Prevalence of Aspiration and Latency to Swallow in Hospitalized Geriatric Patients. J Am Med Dir Assoc 2015; 16:697-701. [DOI: 10.1016/j.jamda.2015.03.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
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87
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Zargaraan A, Saghafi Z, Hasandokht Firouz M, Fadavi G, Ghorbani Gorji S, Mohammadifar MA. Effect of Rheological Properties on Sensory Acceptance of Two-Model Dysphagia-Oriented Food Products. J Texture Stud 2015. [DOI: 10.1111/jtxs.12131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Azizollaah Zargaraan
- Office of the Vice President for Research; National Nutrition and Food Technology Research Institute; Shahid Beheshti University of Medical Science; Tehran Iran
| | - Zahra Saghafi
- Department of Food Science and Technology; National Nutrition and Food Technology Research Institute; Faculty of Nutrition Sciences and Food Technology; Shahid Beheshti University of Medical Sciences; PO Box 19395-4741 Tehran Iran
| | - Mahtab Hasandokht Firouz
- Department of Food Science and Technology; National Nutrition and Food Technology Research Institute; Faculty of Nutrition Sciences and Food Technology; Shahid Beheshti University of Medical Sciences; PO Box 19395-4741 Tehran Iran
| | - Ghasem Fadavi
- Department of Food and Agriculture Research; Institute of Standard and Industrial Research of Iran (ISIRI); Karaj Iran
| | - Sara Ghorbani Gorji
- School of Agriculture and Food Sciences; University of Queensland; St. Lucia Queensland Australia
| | - Mohammad Amin Mohammadifar
- Department of Food Science and Technology; National Nutrition and Food Technology Research Institute; Faculty of Nutrition Sciences and Food Technology; Shahid Beheshti University of Medical Sciences; PO Box 19395-4741 Tehran Iran
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88
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Hedman S, Nydahl M, Faxén-Irving G. Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients. Clin Nutr 2015; 35:692-8. [PMID: 25998583 DOI: 10.1016/j.clnu.2015.04.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/11/2015] [Accepted: 04/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND & AIMS Malnutrition is a well-recognized problem in geriatric patients. Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients. The objective of this study was to investigate routines regarding dietary prescriptions and monitoring of food intake in geriatric patients and to see how well the prescribed diet conforms to the patients' nutritional status and ability to eat. A further aim was to identify the most common reasons and factors interacting with patients not finishing a complete meal. METHODS This study combines two methods using both qualitative and quantitative analysis. Patients (n = 43; 82.5 ± 7.5 yrs; 60% females) at four geriatric wards performed a two-day dietary record, assisted by a dietician. Nurses and assistant nurses at each ward participated in a semi-structured interview regarding prescription of diets and portion size for the patients. RESULTS The prescribed diet differed significantly (P < 0.01) from a diet based upon the patient's nutritional status and ability to eat. Only 30% of the patients were prescribed an energy-enriched diet in contrast to 60% that was in need of it. The most common reason for not finishing the meal was lack of appetite. Diet prescription for the patient was based upon information about eating difficulties identified in the Mini Nutritional Assessment-Short Form (MNA-SF) at admission and the type of diet that was prescribed on a previous ward. Monitoring of the patients' food intake was described as a continuous process discussed daily between the staff. CONCLUSION Patients' nutritional status and to what extent they were able to eat a complete meal was not routinely considered when prescribing food and monitoring food intake in this study. By making use of this information the diet could be tailored to the patients' needs, thereby improving their nutritional treatment.
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Affiliation(s)
- S Hedman
- Department of Clinical Nutrition and Dietetics, Karolinska University Hospital, Stockholm, Sweden.
| | - M Nydahl
- Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - G Faxén-Irving
- Department of Clinical Nutrition and Dietetics, Karolinska University Hospital, Stockholm, Sweden; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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89
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Edahiro A, Hirano H, Yamada R, Chiba Y, Watanabe Y. [Comparative study of eating behavior in elderly patients with Alzheimer's disease and vascular dementia: a first report. - Comparison of disturbed eating behavior - ]. Nihon Ronen Igakkai Zasshi 2015; 50:651-60. [PMID: 24622139 DOI: 10.3143/geriatrics.50.651] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM In elderly patients with dementia, it is known that a loss of independence in eating can cause malnutrition, dehydration, a decrease in food consumption and the immune function and further worsening of the cognitive function, with an increased risk of pneumonia and a shortened life expectancy. The purpose of this study was to investigate the occurrence of a disturbed eating behavior in elderly patients with Alzheimer's disease (AD) and vascular dementia (VaD), who together comprise the majority of elderly patients with dementia. METHODS A total of 233 patients (150 AD patients and 83 VaD patients) who were residents of institutions or group homes were enrolled. The patients underwent an assessment of eating behavior, a cognitive assessment, a neurological examination and measurement of the vital signs. Additionally, statistical analyses were performed to compare eating behavior between the patients with AD and those with VaD at varying severity of dementia. RESULTS A disturbed eating behavior was observed significantly more frequently as the severity of dementia increased. The prevalence of difficulty in rinsing/gargling and dysphagia increased with the severity of dementia. There were differences in the frequency of disturbed eating behavior between the AD and VaD patients. Among the patients with mild dementia, the VaD patients exhibited a higher incidence of a disturbed eating behavior than the AD patients. On the other hand, some behaviors prominent in the patients with severe dementia were related to various types of cognitive impairment in the AD patients, namely difficulty in beginning a meal, difficulty in maintaining attention while eating and difficulty in performing the specific motor skills necessary to open food packages. Marked individual differences were observed in the mild VaD patients, with a high frequency of disturbed eating behavior and dysphagia related to symptoms of neurological deficits. No correlations were found with the severity of dementia. CONCLUSIONS Both AD and VaD are types of dementia; however, the frequency of a disturbed eating behavior differs greatly between these populations. It is necessary to focus on differences in these parameters and also the causes of dementia in order to develop effective care techniques for patients with dementia.
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Affiliation(s)
- Ayako Edahiro
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology
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90
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Bentur N, Sternberg S, Shuldiner J, Dwolatzky T. Feeding tubes for older people with advanced dementia living in the community in Israel. Am J Alzheimers Dis Other Demen 2015; 30:165-72. [PMID: 24963078 PMCID: PMC10852585 DOI: 10.1177/1533317514539726] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND Feeding tubes to address eating problems of older people with advanced dementia (OPAD) has been studied primarily in nursing homes. OBJECTIVES To examine the prevalence of feeding tube use among OPAD living in the community; to evaluate the characteristics, quality of care, and the burden on caregivers. METHODS A cross-sectional survey of 117 caregivers of OPAD living in the community. RESULTS Of 117 patients, 26% had feeding tubes. Compared to nonusers, feeding tube users had more use of restraints, greater problems with swallowing, more emergency room visits, and were more likely to have a legal guardian. In addition, caregivers of feeding tube users were older and reported very heavy burden of care. Half of the caregivers reported that the medical team consulted them before insertion of the feeding tube. CONCLUSION Feeding tube use in OPAD in the community is associated with negative outcomes and increased caregiver burden.
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Affiliation(s)
- Netta Bentur
- Aging Department, Myers-JDC-Brookdale Institute, Jerusalem, Israel
| | - Shelley Sternberg
- Division of Public Health, Maccabi Healthcare Services, Jerusalem, Israel Aging Department, Shaarei Zedek Medical Center Memory Clinic, Jerusalem, Israel
| | | | - Tzvi Dwolatzky
- Faculty of Health Sciences, Mental Health Center, and Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beersheva, Israel Aging Department, Rambam Health Care Campus, Haifa, Israel
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91
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Rogus-Pulia N, Malandraki GA, Johnson S, Robbins J. Understanding Dysphagia in Dementia: The Present and the Future. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0078-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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92
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Jansen S, Ball L, Desbrow B, Morgan K, Moyle W, Hughes R. Nutrition and dementia care: Informing dietetic practice. Nutr Diet 2014. [DOI: 10.1111/1747-0080.12144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Sarah Jansen
- Centre for Health Practice Innovation Griffith University Australia
| | - Lauren Ball
- Centre for Health Practice Innovation Griffith University Australia
| | - Ben Desbrow
- Centre for Health Practice Innovation Griffith University Australia
| | | | - Wendy Moyle
- Centre for Health Practice Innovation Griffith University Australia
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93
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Abstract
OBJECTIVE To determine the prevalence of dysphagia, reported etiologies, and impact among adults in the United States. STUDY DESIGN Cross-sectional analysis of a national health care survey. SUBJECTS AND METHODS The 2012 National Health Interview Survey was analyzed, identifying adult cases reporting a swallowing problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to health care professionals for swallowing problems, diagnoses given, and severity of the swallowing problem were analyzed. The relationship between swallowing problems and lost workdays was assessed. RESULTS An estimated 9.44 ± 0.33 million adults (raw N = 1554; mean age, 52.1 years; 60.2% ± 1.6% female) reported a swallowing problem (4.0% ± 0.1%). Overall, 22.7% ± 1.7% saw a health care professional for their swallowing problem, and 36.9% ± 0.1.7% were given a diagnosis. Women were more likely than men to report a swallowing problem (4.7% ± 0.2% versus 3.3% ± 0.2%, P < .001). Of the patients, 31.7% and 24.8% reported their swallowing problem to be a moderate or a big/very big problem, respectively. Stroke was the most commonly reported etiology (422,000 ± 77,000; 11.2% ± 1.9%), followed by other neurologic cause (269,000 ± 57,000; 7.2% ± 1.5%) and head and neck cancer (185,000 ± 40,000; 4.9% ± 1.1%). The mean number of days affected by the swallowing problem was 139 ± 7. Respondents with a swallowing problem reported 11.6 ± 2.0 lost workdays in the past year versus 3.4 ± 0.1 lost workdays for those without a swallowing problem (contrast, +8.1 lost workdays, P < .001). CONCLUSION Swallowing problems affect 1 in 25 adults, annually. A relative minority seek health care for their swallowing problem, even though the subjective impact and associated workdays lost with the swallowing problem are significant.
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Affiliation(s)
- Neil Bhattacharyya
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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94
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Herrera C, Quilez R, Castro ME, Canovas C. [Dysphagia in the elderly]. Rev Esp Geriatr Gerontol 2014; 49:243-4. [PMID: 24998640 DOI: 10.1016/j.regg.2014.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 02/03/2014] [Indexed: 11/25/2022]
Affiliation(s)
- C Herrera
- Servicio de Geriatría, Hospital Nuestra Señora de Gracia, Zaragoza, España.
| | - Raquel Quilez
- Servicio de Geriatría, Hospital Nuestra Señora de Gracia, Zaragoza, España
| | - Maria E Castro
- Servicio de Geriatría, Hospital Nuestra Señora de Gracia, Zaragoza, España
| | - Carmen Canovas
- Servicio de Geriatría, Hospital Nuestra Señora de Gracia, Zaragoza, España
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95
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Abstract
This article provides an overview of dementia and how it relates to nutrition. It examines the evidence for food and nutrition preventing, causing and treating dementia. The article highlights how malnutrition can affect the individual with dementia. The remainder of the article provides an in-depth, focused discussion on the difficulties people may experience in the community in relation to food and eating and the impact this has on family caregivers, with recommendations for achieving optimum nutrition.
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Affiliation(s)
- Stephanie Ragdale
- Admiral Nurse, Central Manchester, Manchester Mental Health and Social Care Trust
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96
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Lindroos E, Saarela RKT, Soini H, Muurinen S, Suominen MH, Pitkälä KH. Caregiver-reported swallowing difficulties, malnutrition, and mortality among older people in assisted living facilities. J Nutr Health Aging 2014; 18:718-22. [PMID: 25226112 DOI: 10.1007/s12603-014-0506-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study is to explore the prevalence of swallowing difficulties (SWD) and their associations with nutritional status, eating habits, nutritional care, and mortality among older people in assisted living. DESIGN A cross-sectional study with interviews and nutritional assessments at baseline and 3-year follow-up for mortality. SETTING Assisted living facilities in the Helsinki metropolitan area, Finland. PARTICIPANTS All residents (N=1466) in assisted living facilities. MEASUREMENTS Personal interviews yielded information on demographics, medical history, functional status, SWDs and eating habits. Residents' nutritional status was assessed with the Mini Nutritional Assessment (MNA). Three-year mortality data were retrieved from central registers. RESULTS SWDs were common; 11.8% of subjects suffered from them. Those with SWDs were older, more often female, and more frequently had Parkinson's disease, chronic obstructive pulmonary disease (COPD), and chronic/ recurrent infections than those without SWDs. No differences were present between the groups in prevalence of stroke or dementia, but more severe cognitive decline occurred among those with SWDs. According to the MNA, 30.6% of those with SWDs were malnourished (<17 points), whereas the respective figure for those without SWDs was 11.0% (p < .001). Those with SWDs ate more often fluid or puréed food (27.8% vs. 3.8%, p < .001), ate more often little or quite little of their food portion (32.6% vs. 23.5%, p < .010), and consumed less fluids (< 5 cups/day 51.7% vs. 35.6%, p< .001) than those without SWDs. Of those with SWDs, 55.0% died by the end of follow-up, whereas the respective figure for those without SWDs was 41.5%. In logistic regression analysis using age, sex, comorbidities, and MNA as covariates, SWDs continued to predict mortality (OR=1.49, 95% CI=1.04 -2.12). CONCLUSIONS SWDs are common and associated with poor nutrition and risk of death of patients in assisted living facilities. Nurses should be trained to assess SWDs and nutritional problems in order to take optimal care of these residents.
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Affiliation(s)
- E Lindroos
- Eeva Lindroos, M.Sc, Helsinki Metropolia, University of Applied Sciences, Finland, Mannerheimintie 172, FIN-00300 Helsinki, Finland, tel. +358-50-5695677, E-mail address:
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97
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Pouyet V, Giboreau A, Benattar L, Cuvelier G. Attractiveness and consumption of finger foods in elderly Alzheimer’s disease patients. Food Qual Prefer 2014. [DOI: 10.1016/j.foodqual.2013.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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98
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Goldberg LR, Heiss CJ, Parsons SD, Foley AS, Mefferd AS, Hollinger D, Parham DF, Patterson J. Hydration in older adults: the contribution of bioelectrical impedance analysis. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 16:273-281. [PMID: 24521507 DOI: 10.3109/17549507.2014.882989] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The sensory and gastrointestinal changes that occur with ageing affect older adults' food and liquid intake. Any decreased liquid intake increases the risk for dehydration. This increased dehydration risk is compounded in older adults with dysphagia. The availability of a non-invasive and easily administered way to document hydration levels in older adults is critical, particularly for adults in residential care. This pilot study investigated the contribution of bioelectrical impedance analysis to measure hydration in 19 older women in residential care: 13 who viewed themselves as healthy and six with dysphagia. Mann-Whitney U analyses documented no significant between-group differences for Total Body Water (TBW), Fat Free Mass (FFM), Fat Mass (FM), and percentage Body Fat (%BF). However, when compared to previously published data for age-matched women, the TBW and FFM values of the two participant groups were notably less, and FM and %BF values were notably greater than expected. If results are confirmed through continued investigation, such findings may suggest that long-term care facilities are unique environments in which all older residents can be considered at-risk for dehydration and support the use of BIA as a non-invasive tool to assess and monitor their hydration status.
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99
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Chang E, Brownhill S, Bidewell J, Johnson A, Ratnayake S. Focus on Feeding! Evaluation of a framework for maximizing mealtime in aged care facilities. Int J Nurs Pract 2014; 21:269-77. [PMID: 24754457 DOI: 10.1111/ijn.12260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Unintentional weight loss is a health risk for residents of aged care facilities, a concern for families and places demands on nursing staff. An existing weight loss framework to assess and manage residents' weight developed by a multidisciplinary team was implemented and evaluated with nurses and residents in aged care facilities within an area health service of Sydney, Australia. Thematic analysis generated seven binary concepts relating to relational, procedural, behavioural, physical, psychological, environmental and temporal aspects of feeding assistance provided by nurses to residents. Theoretical sampling was applied to the literature confirming those concepts which were organized as a model of feeding assistance labelled the Focus on Feeding! Decision Model. Nurses can play a pivotal role in the assessment of feeding difficulty and implementation of innovative mealtime programs. The Model aims to promote nurses' critical thinking and decision-making to improve nutritional intake of residents and avoid preventable weight loss.
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Affiliation(s)
- Esther Chang
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Suzanne Brownhill
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - John Bidewell
- School of Science and Health, University of Western Sydney, Sydney, New South Wales, Australia
| | - Amanda Johnson
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Shyama Ratnayake
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
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100
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Flynn EP, Smith CH, Walsh CD, Walshe M. Modifying the consistency of food and fluids for swallowing difficulties in dementia. Hippokratia 2014. [DOI: 10.1002/14651858.cd011077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Eadaoin P Flynn
- Trinity College Dublin; Clinical Speech and Language Studies; 7-9 South leinster Street Dublin 2 Ireland
| | - Christina H Smith
- University College London; Psychology and Language Sciences; London UK
| | - Cathal D Walsh
- Trinity College Dublin; Department of Statistics; Dublin Ireland
| | - Margaret Walshe
- Trinity College Dublin; Clinical Speech and Language Studies; 7-9 South leinster Street Dublin 2 Ireland
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