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Rodd BG, Tas AA, Taylor KDA. Dysphagia, texture modification, the elderly and micronutrient deficiency: a review. Crit Rev Food Sci Nutr 2021; 62:7354-7369. [PMID: 33905267 DOI: 10.1080/10408398.2021.1913571] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Dysphagia is an underlying symptom of many health issues affecting a person's ability to swallow. Being unable to swallow correctly may limit food intake and subsequently micronutrient status. The elderly may be the most at risk group of suffering dysphagia as well as most likely to be deficient in micronutrients. The use of texture-modified meals is a common approach to increasing dysphagia sufferer's food intake. The modification of food may affect the micronutrient content and currently there is a limited number of studies focusing on micronutrient content of texture-modified meals. This review considers the prevalence of dysphagia within the elderly UK community whilst assessing selected micronutrients. Vitamin B12, C, D, folate, zinc and iron, which are suggested to be most likely deficient in the general elderly UK population, were reviewed. Each micronutrient is considered in terms of prevalence of deficiency, metabolic function, food source and processing stability to provide an overview with respect to elderly dysphagia sufferers.
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Affiliation(s)
- B G Rodd
- National Centre for Food Manufacturing, College of Science, University of Lincoln, Lincoln, UK
| | - A A Tas
- National Centre for Food Manufacturing, College of Science, University of Lincoln, Lincoln, UK
| | - K D A Taylor
- National Centre for Food Manufacturing, College of Science, University of Lincoln, Lincoln, UK
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Agarwal V, Joshi I. Need for Nutritious Convenience Foods for the Elderly Population: A Review. CURRENT NUTRITION & FOOD SCIENCE 2021. [DOI: 10.2174/1573401316999201009144719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Worldwide, the population of elderly persons is rising at a very fast rate. Elderly people
have difficulties in performing day to day activities as the aging process deteriorates the normal
functioning of their body. There is risk of inadequate nutrition because of difficulties in shopping
for food, cooking a meal, chewing and putting food in mouth. Vision loss makes cooking, and even
eating, more difficult. Some elderly people live alone or with their spouses. Cooking for one or two
persons/s is not very stimulating. These changes have a great role to play in changing the eating
habits of the elderly which may affect their nutrient intake. All these factors may cause nutritional
deficiencies, malnutrition and other health problems among them. There are major opportunities to
develop convenience food products in order to meet the changing needs of aging population. In order
to get maximum product acceptance, it is important to combine the elements of convenience
and affordability. While designing products for elderly, it is desirable to modify the food consistency
to assist in swallowing, make it nutrient-dense and design it in a way that it can be easily handled
and eaten. The packaging can be easy to open, information written in large fonts and contrasting
colours to help in easy reading. The availability of nutritious ‘ready-meals’ can serve as an opportunity
for elderly people who do not want to cook or have low interest in cooking. This can provide
a variety of healthier food choices to them and help to reduce malnutrition. Access to nutritious
convenience food products can facilitate a positive intervention to the aging consumers.
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Affiliation(s)
- Vyoma Agarwal
- Department of Home Science, IIS (Deemed to be University), Jaipur 302020, India
| | - Ila Joshi
- Department of Home Science, IIS (Deemed to be University), Jaipur 302020, India
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Bushuven S, Niebel I, Huber J, Diesener P. Emotional and Psychological Effects of Dysphagia: Validation of the Jugendwerk Dysphagia Emotion and Family Assessment (JDEFA). Dysphagia 2021; 37:375-391. [PMID: 33817751 PMCID: PMC8019588 DOI: 10.1007/s00455-021-10289-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 03/16/2021] [Indexed: 01/10/2023]
Abstract
Introduction Patients suffering from swallowing disorders are experiencing emotional effects like anger, anxiety, and sadness. This may be affecting patient–therapist relation and family functioning. To assess emotional reaction and their influence on family systems, we developed a 55-item questionnaire based on the Atlas of Emotion and the Calgary Family Intervention Model. Methods We recruited more than 160 participants to validate an online survey, namely the Jugendwerk Dysphagia Emotion and Family Assessment Score (JDEFA). Forty-Nine health care workers, patients, and family members completed the survey and provided additional comments regarding interactions of emotions and dysphagia. Analysis was accomplished by non-parametric tests and principal component analyses with Varimax rotation. Additionally, we accomplished a qualitative content analysis taking a phenomenological single-coder approach. Results Analysis revealed a Cronbach’s Alpha of 0.93. Using primary component analyses, justified by a Kaiser–Meyer–Olkin value of 0.81, we identified two main factors (emotion and family). Patients experienced sadness and anger more often than health care providers, whereas family members felt anxiety even more often. Our qualitative analysis revealed 20 themes (7 for anger, 2 enjoyment, 4 sadness, 3 anxiety, 2 disgust, 1 shame, and 1 punishment). Predominantly, the fear of choking was mentioned by patients, whereas professionals reported about the fear of making mistakes. Conclusion The JDEFA is a valid and reliable testing tool for the assessment of swallowing disorders concerning emotional aspects and family functioning. Both factors have a significant role in dysphagia and evaluations should go along with functional assessments and psychological scores for a holistic understanding of swallowing disorders.
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Affiliation(s)
- Stefan Bushuven
- Department of Neurorehabilitation, Hegau-Jugendwerk Gailingen, Healthcare Association Constance (GLKN), Gailingen, Germany. .,Institute for Infection Control and Infection Prevention, Healthcare Association Constance (GLKN), Hegau-Bodensee-Hospital, 78315, Radolfzell, Germany. .,Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany.
| | - Isabell Niebel
- Department of Neurorehabilitation, Hegau-Jugendwerk Gailingen, Healthcare Association Constance (GLKN), Gailingen, Germany
| | - Johanna Huber
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Paul Diesener
- Department of Neurorehabilitation, Hegau-Jugendwerk Gailingen, Healthcare Association Constance (GLKN), Gailingen, Germany
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Madhavan A. Preclinical Dysphagia in Community Dwelling Older Adults: What Should We Look For? AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:833-843. [PMID: 33684295 DOI: 10.1044/2020_ajslp-20-00014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Purpose Traditionally, etiology of dysphagia is thought to be related to multiple medical diagnoses including stroke, head and neck cancer, degenerative neurological conditions, and so forth. However, community dwelling older adults (CDOA) can present with dysphagia in the absence of any specific etiology. The purpose of this research was to develop a multidimensional framework to help identify those CDOA at risk for dysphagia of nonspecific etiology. Method Pertinent literature was examined to identify support for the proposed framework and to explain how the various elements support the model. Results Several factors that are not traditionally thought to be associated with dysphagia can both initiate and exacerbate symptoms of swallowing difficulties. Swallowing difficulties may be subtle and underreported. Monitoring for symptoms related to preclinical dysphagia may be helpful for early identification. Conclusions Dysphagia in CDOA is complex and multidimensional. Clinicians working with older adults will benefit from considering elements described in this multidimensional framework to better understand the etiology of swallowing deficits and improve management. Supplemental Material https://doi.org/10.23641/asha.14150078.
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Affiliation(s)
- Aarthi Madhavan
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
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55
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Diaz JG, Lombardi I. Prevalence of swallowing difficulties in older people without neurological disorders: Swallowing profile of older people in the city of Santos, Brazil. J Oral Rehabil 2021; 48:614-620. [PMID: 33586260 DOI: 10.1111/joor.13157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/27/2022]
Abstract
Several studies report that 40% to 60% of older people have some difficulty chewing and/or swallowing, which can lead to malnutrition, dehydration, weight loss, a lack of eating desire, etc. Identify older adults with swallowing difficulties in the city of Santos, Brazil, among users of the public healthcare system. A cross-sectional study was conducted with 100 individuals aged 60 to 90 years with no neurological disorders. Patient histories were taken, and stomatognathic evaluations were performed. The Mini Mental Health Examination (MMHE) and swallowing-related quality-of-life questionnaire (SWAL-QOL) were administered. The clinical swallowing assessment was performed with liquid, pasty and solid foods using two assessment protocols (Dysphagia Risk Evaluation Protocol and the Protocol for the Introduction and Transition of Foods)'. We found complaints of poorly adapted dentures among 49.3% of denture wearers and a high prevalence of hypofunction of oro-facial muscles. Sixty-five per cent of the respondents had facial muscle hypofunction, 51% exhibited lip hypofunction, and 49% exhibited tongue hypofunction. Moreover, 54% reported difficulty swallowing. On the SWAL-QOL questionnaire, 37% reported choking when eating food, 44% reported choking when drinking liquids, 29% reported coughing during meals, and 77% reported difficulty chewing. The present study revealed an important prevalence of complaints related to swallowing difficulties among older people in the city of Santos with structural and physiological changes characteristic of presbyphagia. The most prevalent conditions were poorly adapted dentures and hypofunction of oro-facial muscles, underscoring the importance of stomatognathic interventions in primary care.
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Affiliation(s)
- Juliana Gonzalez Diaz
- Intedisciplinary postgraduate program at the Federal University of São Paulo, Federal University of São Paulo, Santos, SP, Brazil
| | - Império Lombardi
- Human Movement Sciences, Department of Federal University of São Paul, Santos, SP, Brazil
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Tae WS, Lee S, Choi S, Pyun SB. Effects of aging on brain networks during swallowing: general linear model and independent component analyses. Sci Rep 2021; 11:1069. [PMID: 33441738 PMCID: PMC7806781 DOI: 10.1038/s41598-020-79782-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/14/2020] [Indexed: 01/29/2023] Open
Abstract
Swallowing disorders occur more frequently in older adults. However, the effects of the aging process on neural activation when swallowing are unclear. We aimed to identify neural regions activated during swallowing and evaluate changes in neural activation and neural networks with aging. Using a general linear model (GLM) and independent component (IC) analyses, blood oxygen level-dependent (BOLD) signals were observed in the lateral precentral gyrus, postcentral gyrus, anterior insular cortices, supramarginal gyri, and medial frontal gyrus during swallowing. The right thalamus and anterior cingulate gyri were found to be active areas by GLM and IC analyses, respectively. In the correlational analyses, age was negatively correlated with BOLD signals of the lateral precentral gyri, postcentral gyri, and insular cortices in swallowing tasks. Additionally, correlation analyses between ICs of all participants and age revealed negative correlations in the right supramarginal gyrus, both anterior cingulate cortices, putamen, and cerebellum. In the network analysis, the BOLD signal positively correlated with age in the default mode network (DMN), and was negatively correlated in the lateral precentral gyri, postcentral gyri, and insular cortices. The amplitude of low-frequency fluctuations was significantly decreased in the DMN and increased in swallowing-related areas during swallowing tasks. These results suggest that aging has negative effects on the activation of swallowing-related regions and task-induced deactivation of the DMN. These changes may be used to detect early functional decline during swallowing.
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Affiliation(s)
- Woo-Suk Tae
- grid.222754.40000 0001 0840 2678Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sekwang Lee
- grid.222754.40000 0001 0840 2678Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sunyoung Choi
- grid.418980.c0000 0000 8749 5149Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sung-Bom Pyun
- grid.222754.40000 0001 0840 2678Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea ,grid.222754.40000 0001 0840 2678Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea ,Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Kurosu A, Osman F, Daggett S, Peña-Chávez R, Thompson A, Myers SM, VanKampen P, Koenig SS, Ciucci M, Mahoney J, Rogus-Pulia N. Factors Associated with Self-Reported Dysphagia in Older Adults Receiving Meal Support. J Nutr Health Aging 2021; 25:1145-1153. [PMID: 34866141 PMCID: PMC8653989 DOI: 10.1007/s12603-021-1700-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Dysphagia is common in older adults. However, there are no current estimates of dysphagia in community-dwelling older adults those receiving meal support. It is unknown whether dysphagia is associated with other measures of physical function (activities of daily living [ADL] ability or nutrition status). The study purposes were to determine the prevalence of self-reported dysphagia and to identify factors associated with self-reported dysphagia in community-dwelling older adults receiving meal support. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS 476 community-dwelling older adults (78.5±0.51 years) across five Elder Nutrition Program meal services in Wisconsin participated in the study. MEASUREMENTS Data were collected through administration of validated ADL and nutrition questionnaires (nutritional status, functional status with ADLs, chewing ability, dental conditions, and prior diagnoses of dysphagia, pneumonia, and dementia). For self-reported dysphagia, the validated 10-item eating assessment tool (EAT-10) was used. RESULTS The prevalence of self-reported dysphagia (EAT-10 score of ≥ 3) was 20.4%. Multivariate logistic regression results indicated that poor nutritional status (OR=3.1, p=0.04), difficulty chewing (OR=2.2, p=0.03), prior dysphagia diagnosis (OR=34.8, p<0.001), prior pneumonia diagnosis (OR=2.1, p=0.04), and meal service site (OR=2.68, p=0.02) were associated with self-reported dysphagia. CONCLUSION Approximately one in five community-dwelling older adults receiving meal support had self-reported dysphagia. Increased risk for poor nutrition, reduced chewing ability, prior dysphagia and pneumonia diagnosis, and meal service site were identified as factors associated with dysphagia on the EAT-10. Results highlight the need for further studies across more sites to identify dysphagia risk indicators in community-dwelling older adults receiving meal support state-wide.
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Affiliation(s)
- A Kurosu
- Nicole Rogus-Pulia, Division of Otolaryngology- Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA,
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58
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Groher ME. Aging and Dysphagia. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Utility of the EAT-10 in the detection of dysphagia in high-risk hospitalisation units at a university hospital: a cross-sectional study. NUTR HOSP 2020; 37:1197-1200. [PMID: 33155478 DOI: 10.20960/nh.03233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: the objective was to assess the utility of the Eating Assessment Tool (EAT-10) in hospitalisation units with patients at high risk of dysphagia. Patients and methods: a cross-sectional study was conducted in the Neurology and Internal Medicine wards; patients with admission < 24 hours and in a terminal stage of disease were excluded. In the first 24-48 hours of admission the presence of dysphagia as assessed with the EAT-10, the risk of malnutrition as assessed with the Malnutrition Universal Screening Tools (MUST), and comorbidities using the Charlson index were screened. Results: a total of 169 patients were recruited (76.0 years, 52 % women); 19.5 % were at risk of malnutrition. The EAT-10 instrument could be administered in 80.6 % of the patients, and was positive in 26.6 % (women 34.1 % vs. men 18.4 %; p = 0.025). When comparing patients with higher comorbidity with those with a lower Charlson index, a lower response rate to EAT-10 was observed (78.4 % vs. 93.9 %; p = 0.038), without differences in screening positivity (28.3 % vs. 19.4 %; p = 0.310). The prevalence of dysphagia risk was higher in the Internal Medicine unit than in the Neurology unit (30.4 % vs. 19.6 %; p = 0.133), as was the percentage of cases in which screening could not be performed (21.1 % vs. 11.1 %; p = 0.011). There were no significant differences in risk of malnutrition, mortality, hospital stay, or readmission according to the EAT-10. Conclusions: The EAT-10 has limited utility in the studied hospitalisation units due to a high rate of unfeasible tests, especially among patients at higher risk of dysphagia.
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Kletzien H, Kelm-Nelson CA, Wang S, Suzuki M, Connor NP. Myogenic marker expression as a function of age and exercise-based therapy in the tongue. Exp Gerontol 2020; 142:111104. [PMID: 33017670 PMCID: PMC7748063 DOI: 10.1016/j.exger.2020.111104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/29/2020] [Accepted: 09/24/2020] [Indexed: 12/30/2022]
Abstract
Degeneration of tongue muscles with aging may contribute to swallowing deficits observed in elderly people. However, the capacity for tongue muscle stem cells (SCs) to regenerate and repair the aged tongue and improve tongue strength following tongue exercise (a current clinical treatment) has never been examined. We found that the expression of regenerative, myogenic markers were impaired with age and may be related to increased expression of senescent marker p16INK4a. Tongue strength increased in young adult and old rats following exercise and was related to the expression of Pax7, MyoD, myogenin, and p16INK4a. Our study also suggests that strengthening of tongue muscles via clinical rehabilitation strategies also increased the expression of SC regenerative markers in the tongue throughout the exercise duration.
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Affiliation(s)
- Heidi Kletzien
- Department of Biomedical Engineering, University of Wisconsin-Madison, United States of America; Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America; Department of Stem Cell and Regenerative Biology, Harvard University, United States of America.
| | - Cynthia A Kelm-Nelson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America
| | - Sabrina Wang
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America
| | - Masatoshi Suzuki
- Department of Biomedical Engineering, University of Wisconsin-Madison, United States of America; Department of Comparative Biosciences, University of Wisconsin-Madison, United States of America
| | - Nadine P Connor
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, United States of America; Department of Communication Sciences and Disorders, University of Wisconsin-Madison, United States of America
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Schwarz M, Ward EC, Cornwell P, Coccetti A, D'Netto P, Smith A, Morley-Davies K. Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1944-1955. [PMID: 32780593 DOI: 10.1044/2020_ajslp-19-00060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs (n = 7) and SLPs (n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase (n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.
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Affiliation(s)
- Maria Schwarz
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Meadowbrook, Queensland, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
| | - Petrea Cornwell
- Menzies Health Institute, School of Allied Health Sciences, Griffith University, Mount Gravatt, Queensland, Australia
| | - Anne Coccetti
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Meadowbrook, Queensland, Australia
| | - Pamela D'Netto
- Speech Pathology Department, Wide Bay Hospital and Health Service, Queensland, Australia
| | - Aimee Smith
- Speech Pathology Department, Wide Bay Hospital and Health Service, Queensland, Australia
| | - Katharine Morley-Davies
- Speech Pathology Department, QEII Hospital, Metro South Hospital and Health Service, Coopers Plains, Queensland, Australia
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Sendzischew Shane MA, Moshiree B. Esophageal and Gastric Motility Disorders in the Elderly. Clin Geriatr Med 2020; 37:1-16. [PMID: 33213764 DOI: 10.1016/j.cger.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The elderly are particularly prone to developing upper gastrointestinal disturbances. Changes are due to the aging process, diabetes, cardiovascular risk factors, and neurologic issues. Medications used to treat these underlying conditions can cause gastrointestinal symptoms. Dysphagia is common and can be oropharyngeal and/or esophageal. Gastroparesis is due to either medications such opiates, or due to neurologic sequala of diabetes, cerebrovascular accidents, or neurologic diseases such as Parkinson's disease. Given limitations in many commonly used prokinetics with a wide range of side effect profiles including neurologic and cardiac, the focus of treatment should be on symptom management with dietary changes.
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Affiliation(s)
- Morgan A Sendzischew Shane
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, CRB 1184, Miami, FL 33136, USA.
| | - Baharak Moshiree
- Atrium Health-Charlotte, UNC School of Medicine, Charlotte Campus, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
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63
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Etter NM, Madhavan A. Changes in Motor Skills, Sensory Profiles, and Cognition Drive Food Selection in Older Adults With Preclinical Dysphagia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2723-2730. [PMID: 32692607 DOI: 10.1044/2020_jslhr-20-00098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Self-selection and self-avoidance of certain foods is one possible indicator of preclinical (prior to any clinical intervention) dysphagia in healthy older adults. Self-selection of food choices is influenced by changes in a combination of factors, including neuromuscular, sensory, and individual patient characteristics. Changes to these factors occur both centrally or peripherally and can be part of typical, healthy aging. Alterations in motor, sensory, or cognitive skills may lead to self-imposed modifications to food choices and, therefore, highlight potential risk for dysphagia. Conclusions For effective screening and assessments procedures in healthy aging adults, the diagnosis of preclinical dysphagia will likely require a multifaceted assessment. A combination of assessment methods using objective and subjective measurements of neuromuscular, sensory, and individual patient factors, as well as knowledge of food avoidance, may provide insight for identifying community-dwelling older adults at risk for dysphagia and allow for earlier monitoring and intervention.
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Affiliation(s)
- Nicole Michele Etter
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Aarthi Madhavan
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
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64
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Bhattacharya D, Ali SJV, Cheng LK, Xu W. RoSE: A Robotic Soft Esophagus for Endoprosthetic Stent Testing. Soft Robot 2020; 8:397-415. [PMID: 32758017 DOI: 10.1089/soro.2019.0205] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Soft robotic systems are well suited for developing devices for biomedical applications. A bio-mimicking robotic soft esophagus (RoSE) is developed as an in vitro testing device of endoprosthetic stents for dysphagia management. Endoprosthetic stent placement is an immediate and cost-effective therapy for dysphagia caused by malignant esophageal strictures from esophageal cancer. However, later stage complications, such as stent migration, could weaken the swallow efficacy in the esophagus. The stent radial force (RF) on the esophageal wall is pivotal in avoiding stent migration. Due to limited randomized controlled trials in patients, the stent design and stenting guidelines are still unconstructive. To address the knowledge deficit, we have investigated the capabilities of the RoSE by implanting two stents (stent A and B) of different radial stiffness characteristics, to measure the stent RF and its effect on the stent migration. Also, endoscopic manometry on the RoSE under peristalsis has been performed to study the impact of stenting and stent dysfunctionality on the intrabolus pressure signatures (IBPSs) in the RoSE, and further its effects on the swallowing efficacy. Each implanted stent in the RoSE underwent a set of experiments with various test variables (peristalsis velocity and wavelength, and bolus concentrations). In this study, the conducted tests are representative of the application of RoSE to perform a wide-ranging assessment of the stent behavior. The usability of RoSE has been discussed by comparing the results of stent A and B, for various combinations of the test variables mentioned earlier. The results have demonstrated that the stiffer stent B has a higher RF, whereas stent A maintained its RF at a low profile due to its lesser stiffness. The results have also implicated that a high RF is necessary to minimize the stent migration under prolonged peristaltic contractions in the RoSE. For the manometry experiments, stent A slightly increased the IBPS, but the stiffer stent B significantly decreased the IBPS, especially for the higher concentration boluses. It was found that if a stiffer stent buckles, it can reduce the swallow efficacy and cause recurrent dysphagia. Therefore, RoSE is an innovative soft robotic platform that is capable of testing various endoprosthetic stents, thereby offering a solution to many existing clinical challenges in the area of stent testing.
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Affiliation(s)
- Dipankar Bhattacharya
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand.,Riddet Institute, Palmerston North, New Zealand
| | - Sherine J V Ali
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand.,Riddet Institute, Palmerston North, New Zealand
| | - Leo K Cheng
- Riddet Institute, Palmerston North, New Zealand.,Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Medical Technologies Centre of Research Excellence, Auckland, New Zealand
| | - Weiliang Xu
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand.,Riddet Institute, Palmerston North, New Zealand.,Medical Technologies Centre of Research Excellence, Auckland, New Zealand
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Applebaum J, Lee E, Harun A, Davis A, Hillel AT, Best SR, Akst LM. Characterization of Geriatric Dysphagia Diagnoses in Age-Based Cohorts. OTO Open 2020; 4:2473974X20939543. [PMID: 32685871 PMCID: PMC7346702 DOI: 10.1177/2473974x20939543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/15/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE An aging population requires increased focus on geriatric otolaryngology. Patients aged ≥65 years are not a homogenous population, and important physiologic differences have been documented among the young-old (65-74 years), middle-old (75-84), and old-old (≥85). We aim to analyze differences in dysphagia diagnoses and swallowing-related quality-of-life among these age subgroups. STUDY DESIGN Retrospective chart review. SETTING Tertiary care laryngology clinic. SUBJECTS AND METHODS We identified chief complaint, diagnosis, and self-reported swallowing handicap (Eating Assessment Tool [EAT-10] score) of all new patients aged ≥65 years presenting to the Johns Hopkins Voice Center between April 2015 and March 2017. Dysphagia diagnoses were classified by physiologic etiology and anatomic source. Diagnostic categories and EAT-10 score were evaluated as functions of patient age and sex. RESULTS Of 839 new patients aged ≥65 years, 109 (13.0%) reported a chief complaint of dysphagia and were included in this study. The most common dysphagia etiologies were neurologic and esophageal. Most common diagnoses were diverticula (15.6%), reflux (13.8%), and radiation induced (8.3%). Diverticula, cricopharyngeal hypertonicity, and radiation-induced changes were associated with higher EAT-10 score (P < .001). Significant differences by sex were found in anatomic source of dysphagia, as men and women were more likely to present with oropharyngeal and esophageal disease, respectively (P = .023). Dysphagia etiology and EAT-10 score were similar across age subgroups. CONCLUSION Important differences among dysphagia diagnosis and EAT-10 score exist among patients aged ≥65 years. Knowledge of these differences may inform diagnostic workup, management, and further investigations in geriatric otolaryngology.
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Affiliation(s)
- Jeremy Applebaum
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emerson Lee
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Aisha Harun
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Ashley Davis
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alexander T. Hillel
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Simon R. Best
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lee M. Akst
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Pu D, Yiu EML, Chan KMK. Factors associated with signs of aspiration in older adults: A prospective study. Geriatr Nurs 2020; 41:635-640. [PMID: 32402573 DOI: 10.1016/j.gerinurse.2020.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/25/2022]
Abstract
This was a prospective cohort design study that followed a group of older adults for up to 12 months. Two hundred and ninety-one participants with a mean age of 81.4 ± 9.1 years were recruited. Signs of aspiration were screened by the Yale Swallow Protocol. Variables investigated for risk were oromotor functions, self-perception of swallowing function, cognitive function, and medical history. Seventy participants were revisited for a follow-up aspiration screening 8 to 9 months later. Multivariate logistic regression found that male sex, need for assistance for feeding and mobility, reduced cognitive function, subjective judgement of swallowing function, and oromotor function were major variables that can be used to screen for older adults who may require referrals for swallowing assessment. Those who continue to show signs of aspiration across time exhibit a more frail profile than their counterparts who do not.
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Affiliation(s)
- Dai Pu
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Sassoon Road, Hong Kong; Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, 7/F, Meng Wah Complex, Pokfulam, Hong Kong
| | - Edwin M L Yiu
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, 7/F, Meng Wah Complex, Pokfulam, Hong Kong
| | - Karen M K Chan
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, 7/F, Meng Wah Complex, Pokfulam, Hong Kong.
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67
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Furuya J, Suzuki H, Tamada Y, Onodera S, Nomura T, Hidaka R, Minakuchi S, Kondo H. Food intake and oral health status of inpatients with dysphagia in acute care settings. J Oral Rehabil 2020; 47:736-742. [DOI: 10.1111/joor.12964] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/27/2020] [Accepted: 03/11/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Junichi Furuya
- Oral Health Sciences for Community Welfare Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University (TMDU) Tokyo Japan
- Department of Prosthodontics and Oral Implantology School of Dentistry Iwate Medical University Iwate Japan
| | - Hiroyuki Suzuki
- Gerodontology and Oral Rehabilitation Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University (TMDU) Tokyo Japan
| | - Yasushi Tamada
- Department of Prosthodontics and Oral Implantology School of Dentistry Iwate Medical University Iwate Japan
| | - Shohei Onodera
- Department of Prosthodontics and Oral Implantology School of Dentistry Iwate Medical University Iwate Japan
| | - Taro Nomura
- Department of Prosthodontics and Oral Implantology School of Dentistry Iwate Medical University Iwate Japan
| | - Rena Hidaka
- Oral Health Sciences for Community Welfare Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University (TMDU) Tokyo Japan
| | - Shunsuke Minakuchi
- Gerodontology and Oral Rehabilitation Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University (TMDU) Tokyo Japan
| | - Hisatomo Kondo
- Department of Prosthodontics and Oral Implantology School of Dentistry Iwate Medical University Iwate Japan
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68
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Krekeler BN, Weycker JM, Connor NP. Effects of Tongue Exercise Frequency on Tongue Muscle Biology and Swallowing Physiology in a Rat Model. Dysphagia 2020; 35:918-934. [PMID: 32130514 DOI: 10.1007/s00455-020-10105-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/25/2020] [Indexed: 11/28/2022]
Abstract
Age-related changes in muscle composition and function are often treated using exercise, including muscles of the tongue to treat swallowing impairments (dysphagia). Although tongue exercise is commonly prescribed, optimal tongue exercise doses have not been determined. The purpose of this study was to evaluate effects of varying tongue exercise frequency on tongue force, genioglossus muscle fiber size, composition and metabolism, and swallowing in a rat model. We randomized 41 old and 40 young adult Fischer 344/Brown Norway rats into one of four tongue exercise groups: 5 days/week; 3 days/week; 1 day/week; or sham. Tongue force was higher following all exercise conditions (vs sham); the 5 day/week group had the greatest change in tongue force (p < 0.001). There were no exercise effects on genioglossus (GG) fiber size or MyHC composition (p > 0.05). Significant main effects for age showed a greater proportion of Type I fibers in (p < 0.0001) and increased fiber size of IIa fibers (p = 0.026) in old. There were no significant effects of citrate synthase activity or PGC-1α expression. Significant differences were found in bolus speed and area (size), but findings were potentially influenced by variability. Our findings suggest that tongue force is influenced by exercise frequency; however, these changes were not reflected in characteristics of the GG muscle assayed in this study. Informed by findings of this study, future work in tongue dose optimization will be required to provide better scientific premise for clinical treatments in humans.
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Affiliation(s)
- Brittany N Krekeler
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Goodnight Hall, 1300 University Ave, Madison, WI, 53706, USA. .,Department of Surgery-Otolaryngology, Clinical Science Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA. .,Department of Communication Sciences and Disorders, Northwestern University, Swallowing Cross-Systems Collaborative, 2240 Campus Drive, Evanston, IL, 60208, USA.
| | - Jacqueline M Weycker
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Goodnight Hall, 1300 University Ave, Madison, WI, 53706, USA.,Department of Surgery-Otolaryngology, Clinical Science Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA
| | - Nadine P Connor
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Goodnight Hall, 1300 University Ave, Madison, WI, 53706, USA.,Department of Surgery-Otolaryngology, Clinical Science Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA
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69
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Abu-Ghanem S, Chen S, Amin MR. Oropharyngeal Dysphagia in the Elderly: Evaluation and Prevalence. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00258-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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70
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Magalhães Junior HV, Pernambuco LDA, Cavalcanti RVA, Lima KC, Ferreira MAF. Validity Evidence of an Epidemiological Oropharyngeal Dysphagia Screening Questionnaire for Older Adults. Clinics (Sao Paulo) 2020; 75:e1425. [PMID: 31939561 PMCID: PMC6945292 DOI: 10.6061/clinics/2020/e1425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/24/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This research aimed to identify evidence of validity of a self-reported Oropharyngeal Dysphagia screening questionnaire for older adults based on test content, response processes, internal structure, relations to other variables, and reliability. METHOD This is a nonrandomized, cross-sectional study employing the concepts and principles of the Standards for Educational and Psychological Testing. Data were collected from 644 community-dwelling older adults (both genders, age: ≥60 years) who agreed to participate in some steps of the validation process. Statistical methods obtained the content representation of the construct, internal structure validation, discriminant and convergent evidence, and reliability, using a 5% significance level. RESULTS The screening tool was re-specified in nine questions that provided the best fit and robust reliability, with proper discriminant and convergent evidence. CONCLUSIONS The screening questionnaire presented valid and reliable results to identify oropharyngeal dysphagia symptoms in older adults, highlighting the importance of the validation process based on the standards to construct an epidemiological instrument.
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Affiliation(s)
| | - Leandro de Araújo Pernambuco
- Departamento de Fonoaudiologia, Centro de Ciencias da Saude, Universidade Federal da Paraíba (UFPB), Joao Pessoa, PB, BR
| | | | - Kenio Costa Lima
- Departamento de Odontologia, Programa de Pos-Graduacao em Saude Coletiva (PPGSCol-UFRN), Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, BR
| | - Maria Angela Fernandes Ferreira
- Departamento de Odontologia, Programa de Pos-Graduacao em Saude Coletiva (PPGSCol-UFRN), Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, BR
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71
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Ebersole B, Lango M, Ridge J, Handorf E, Farma J, Clark S, Jamal N. Dysphagia Screening for Pneumonia Prevention in a Cancer Hospital: Results of a Quality/Safety Initiative. Otolaryngol Head Neck Surg 2019; 162:220-229. [PMID: 31791195 DOI: 10.1177/0194599819889893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Hospital-acquired aspiration pneumonia remains a rare but potentially devastating problem. The best means by which to prevent aspiration in a cancer hospital population has not been evaluated. The aim of this study was to evaluate the impact of dysphagia screening on aspiration pneumonia rates in an acute care oncology hospital. METHODS A prospective single-institution quality improvement dysphagia screening protocol at a comprehensive cancer center. Effect of dysphagia screening implemented in 2016 on hospital-acquired aspiration pneumonia rates coded "aspiration pneumonitis due to food/vomitus" was compared with rates from 2014 to 2015 prior to implementation. Screening compliance, screening outcomes, patient demographics, and medical data were reviewed as part of a post hoc analysis. RESULTS Of 12,392 admissions in 2014 to 2016, 97 patients developed aspiration pneumonia during their hospitalization. No significant change in aspiration pneumonia rate was seen during the dysphagia screening year when compared to prior years (baseline, 7.36; screening year, 8.78 per 1000 discharges; P = .33). Sixty-eight of the cases (66%) were associated with emesis/gastrointestinal obstruction or perioperative aspiration and only 15 (15%) with oropharyngeal dysphagia. Multivariate analysis found that patients admitted to gastrointestinal surgery had an aspiration risk equivalent to patients admitted to head and neck, thoracic, and pulmonary services (odds ratio, 0.65; P = .2). DISCUSSION Nursing-initiated dysphagia screening did not decrease aspiration pneumonia rates. The causes of aspiration-associated pneumonia were heterogeneous. Aspiration of intestinal contents is a more common source of hospital-acquired pneumonia than oropharyngeal dysphagia.
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Affiliation(s)
- Barbara Ebersole
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Speech Pathology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Miriam Lango
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - John Ridge
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Elizabeth Handorf
- Department of Biostatistics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Jeffrey Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Sarah Clark
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Speech Pathology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Nausheen Jamal
- Department of Surgery, University of Texas Rio Grande Valley School of Medicine, University of Texas Health, Edinburg, Texas, USA
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Suebsaen K, Suksatit B, Kanha N, Laokuldilok T. Instrumental characterization of banana dessert gels for the elderly with dysphagia. FOOD BIOSCI 2019. [DOI: 10.1016/j.fbio.2019.100477] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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73
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Changes in etiology and severity of dysphagia with aging. Eur Geriatr Med 2019; 11:139-145. [DOI: 10.1007/s41999-019-00259-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/30/2019] [Indexed: 12/20/2022]
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74
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Predicting the Swallow-Related Quality of Life of the Elderly Living in a Local Community Using Support Vector Machine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214269. [PMID: 31684165 PMCID: PMC6862249 DOI: 10.3390/ijerph16214269] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 02/08/2023]
Abstract
Background and Objectives: This study developed a support vector machine (SVM) algorithm-based prediction model with considering influence factors associated with the swallowing quality-of-life as the predictor variables and provided baseline information for enhancing the swallowing quality of elderly people’s lives in the future. Methods and Material: This study sampled 142 elderly people equal to or older than 65 years old who were using a senior welfare center. The swallowing problem associated quality of life was defined by the swallowing quality-of-life (SWAL-QOL). In order to verify the predictive power of the model, this study compared the predictive power of the Gaussian function with that of a linear algorithm, polynomial algorithm, and a sigmoid algorithm. Results: A total of 33.9% of the subjects decreased in swallowing quality-of-life. The swallowing quality-of-life prediction model for the elderly, based on the SVM, showed both preventive factors and risk factors. Risk factors were denture use, experience of using aspiration in the past one month, being economically inactive, having a mean monthly household income <2 million KRW, being an elementary school graduate or below, female, 75 years old or older, living alone, requiring time for finishing one meal on average ≤15 min or ≥40 min, having depression, stress, and cognitive impairment. Conclusions: It is necessary to monitor the high-risk group constantly in order to maintain the swallowing quality-of-life in the elderly based on the prevention and risk factors associated with the swallowing quality-of-life derived from this prediction model.
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75
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Howells SR, Cornwell PL, Ward EC, Kuipers P. Dysphagia care for adults in the community setting commands a different approach: perspectives of speech-language therapists. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:971-981. [PMID: 31479197 DOI: 10.1111/1460-6984.12499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/11/2019] [Accepted: 07/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Descriptions of community-based speech-language therapy (SLT) dysphagia practices and services are underrepresented in the research literature, despite the prevalence of dysphagia in the community. Owing to a globally ageing population and government drives to support people to remain living at home rather than in hospital or aged care, there is a growing need for SLT services to be responsive to the needs of clients living at home in the community, referred to in this study as 'community-based clients'. Exploration of current SLT services and dysphagia care practices for this population may identify ways services can be designed and enhanced to better meet the needs of clients and carers. AIMS To explore the nature (i.e., characteristics) of dysphagia services and SLT clinical practices for adults with dysphagia living at home in the community. METHODS & PROCEDURES Using a qualitative descriptive approach positioned within an explanatory sequential mixed methods design, this study explored SLT services and practices for adults with dysphagia living in the community to explain further and elaborate on findings from an earlier quantitative study. A total of 15 SLTs working with community-based clients with dysphagia were recruited using purposive representative sampling. Content analysis was used to explore the data. OUTCOMES & RESULTS The overarching theme of community commands a different approach and was illustrated by three subthemes that highlighted how and why a different approach to dysphagia care in the community setting was necessary: (1) skills and mindset require adaptation in the community context; (2) values and approaches are different in the community context; and (3) organizational influences impact service delivery in the community context. From the data, it is apparent that the work undertaken in the community setting differs from dysphagia care in other settings and requires adapted SLT skills, values and approaches that encompass holistic care, client autonomy and carer engagement. SLT practices are also informed by organizational influences such as policies and resourcing, which in some services were enablers, while for others these presented challenges. CONCLUSIONS & IMPLICATIONS Community-based SLT services must continue to foster flexible, responsive practices by SLTs to ensure the needs of clients and carers are met now and in future.
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Affiliation(s)
- Simone R Howells
- Menzies Health Institute, Griffith University, Gold Coast Campus, QLD, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD, Australia
| | - Petrea L Cornwell
- Menzies Health Institute, Griffith University, Gold Coast Campus, QLD, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Buranda, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia Campus, St Lucia, QLD, Australia
| | - Pim Kuipers
- Menzies Health Institute, Griffith University, Gold Coast Campus, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Buranda, QLD, Australia
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The GUSS test as a good indicator to evaluate dysphagia in healthy older people: a multicenter reliability and validity study. Eur Geriatr Med 2019; 10:879-887. [DOI: 10.1007/s41999-019-00249-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/26/2019] [Indexed: 11/26/2022]
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Blanař V, Hödl M, Lohrmann C, Amir Y, Eglseer D. Dysphagia and factors associated with malnutrition risk: A 5‐year multicentre study. J Adv Nurs 2019; 75:3566-3576. [DOI: 10.1111/jan.14188] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/30/2019] [Accepted: 08/13/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Vít Blanař
- Department of Nursing Faculty of Health Studies University of Pardubice Pardubice Czech Republic
| | - Manuela Hödl
- Institute of Nursing Science Medical University of Graz Graz Austria
| | - Christa Lohrmann
- Institute of Nursing Science Medical University of Graz Graz Austria
| | | | - Doris Eglseer
- Institute of Nursing Science Medical University of Graz Graz Austria
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Abstract
There is an increase in the demand for community services to provide care closer to home, and care teams are placing a growing emphasis on admission avoidance and early discharge. Community and district nurses are key professionals in this care delivery and are required to be alert to the risk factors for clinical deterioration, such as dysphagia (swallowing problems). Especially in older adults and those with frailty, dysphagia can cause a wide range of problems, from dehydration and malnutrition to respiratory tract infections that warrant antibiotic use and even hospitalisation. This article describes how dysphagia can be identified and managed in the community setting and explains the benefits and impact of speech and language therapy and wider multidisciplinary team intervention.
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Affiliation(s)
- Sarah Minshall
- Team Leader of the Adult Community Team, Speech and Language Therapy
| | - Sue Pownall
- Head of Speech and Language Therapy and Clinical Lead in Dysphagia, both at Sheffield Teaching Hospitals NHS Foundation Trust
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Poorjavad M, Talebian Moghadam S, Ansari NN. Effects of the head lift exercise and neuromuscular electrical stimulation on swallowing muscles activity in healthy older adults: a randomized pilot study. Clin Interv Aging 2019; 14:1131-1140. [PMID: 31417244 PMCID: PMC6594008 DOI: 10.2147/cia.s209055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 05/18/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Swallowing physiology exhibits several changes in advanced ages. The present study aimed to investigate and compare effects of a period of the head lift exercise (HLE) and neuromuscular electrical stimulation (NMES) on swallowing muscles activity in healthy elderly. PATIENTS AND METHODS A total of 23 older adults were randomized to either the HLE or NMES group for ten therapy sessions. They received pre- and post-therapy surface electromyography (sEMG) during water swallowing. RESULTS For the HLE group, duration of suprahyoid muscles activity was significantly reduced at post-intervention compared to pre-intervention (p=0.036). Moreover after treatments, duration and latency between onset and peak amplitude of suprahyoid muscles activity was significantly shorter in the HLE group compare to the NMES group (respectively, p=0.007 and p=0.003). CONCLUSION Our findings suggest that the HLE, against the NMES, may be effective in reducing some aging effects on the suprahyoid muscles activity, especially in elders who demonstrate prolonged duration and latency between onset and peak of the suprahyoid muscles activity during swallowing.
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Affiliation(s)
- Marziyeh Poorjavad
- Department of Speech Therapy, School of Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Talebian Moghadam
- Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Yamamoto T, Aida J, Shinozaki T, Tsuboya T, Sugiyama K, Yamamoto T, Kondo K, Sasaki K, Osaka K. Cohort Study on Laryngeal Cough Reflex, Respiratory Disease, and Death: A Mediation Analysis. J Am Med Dir Assoc 2019; 20:971-976. [PMID: 30904458 DOI: 10.1016/j.jamda.2019.01.155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate quantitatively whether the presence of cough associated with dysphagia (laryngeal cough reflex) increased mortality through respiratory disease among community-dwelling older Japanese. DESIGN A 6-year follow-up prospective cohort study (from 2010 to 2017). SETTING Thirteen municipalities in Japan. PARTICIPANTS Community-dwelling individuals aged 65 years or older (N = 32,682). MEASURES The baseline survey was conducted through self-reported questionnaire. Exposure was experience of laryngeal cough reflex while drinking. The outcome was all-cause mortality. All covariates were selected from demographic, socioeconomic variables, baseline health and functional status, smoking, alcohol drinking, number of remaining teeth, and stroke. The mediator variable was respiratory disease. Cox proportional hazards regression was used to estimate hazard ratios (HRs) for mortality. Parametric mediation analysis was conducted to estimate the effect of laryngeal cough reflex on the mean residual time to death mediated through respiratory disease. RESULTS Among the 32,682 participants (mean age = 74.1 years, standard deviation = 5.9 years), 5550 (17.0%) experienced laryngeal cough reflex at baseline. A total of 4037 deaths occurred. Crude mortality rates of the participants with or without laryngeal cough reflex were 16.3% and 11.6%, respectively. After adjusting for covariates, laryngeal cough reflex [HR = 1.10; 95% confidence interval (CI) = 1.02 to 1.19] and respiratory disease (HR = 1.80; 95% CI = 1.62 to 2.00) were associated with mortality. The mediation analysis showed that respiratory disease significantly (P < .001) and partially mediated the association between laryngeal cough reflex, an indicator of 1 or more conditions such as chronic aspiration and mortality. CONCLUSIONS/IMPLICATIONS Laryngeal cough reflex was a prevalent condition, and it was associated with all-cause mortality in community-dwelling older Japanese individuals. Clinicians could contribute to reduce mortality risk by addressing swallowing function problems using their interprofessional collaboration team (speech-language pathologist, dentist, rehabilitation doctor, otolaryngologist, respiratory physician, and gerontologist).
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Affiliation(s)
- Takafumi Yamamoto
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan; Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Jun Aida
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.
| | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Toru Tsuboya
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kemmyo Sugiyama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Tatsuo Yamamoto
- Division of Dental Sociology, Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan; Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Xu Z, Gu Y, Li J, Wang C, Wang R, Huang Y, Zhang J. Dysphagia and aspiration pneumonia in elderly hospitalization stroke patients: Risk factors, cerebral infarction area comparison. J Back Musculoskelet Rehabil 2019; 32:85-91. [PMID: 30223382 DOI: 10.3233/bmr-170801] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Stroke is the most common neurological disease that is associated with deglutition disorders. The aim of this study was to analyze dysphagia and aspiration pneumonia risk factors in post-stroke elderly inpatients. METHOD We consecutively enrolled 212 stroke patients over sixty years of age from July 2014 to June 2015. Seventeen patients were eliminated. Stroke patients' demographics, clinical symptoms and biochemistry data were collected. Modified water swallowing test was used for the assessment of deglutition difficulty. These inpatients were classified into two groups: territorial anterior circulation infarction (n= 114) and territorial posterior circulation infarction (n= 82). Finally, dysphagia and aspiration pneumonia risk factor were analyzed between these two groups. RESULT Number of previous cerebral infarction, National Institutes of Health Stroke Scale (NIHSS) score, masticatory muscle paralysis, abolition of gag reflex were correlated with the deglutition difficulty in these patients. In addition, NIHSS score (p= 0.017) and dysphagia (p= 0.02) were correlated with aspiration pneumonia. CONCLUSION In stroke inpatients over sixty years of age, it is necessary to distinguish the patients with multiple previous cerebral infarctions, high NIHSS score, masticatory muscle paralysis, and abolition of gag reflex for early detection and rehabilitation of dysphagia.
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Affiliation(s)
- Zeqin Xu
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing 100053, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing 100053, China
| | - Jianxin Li
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing 100053, China
| | - Chunmei Wang
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing 100053, China
| | - Rong Wang
- Department of Central Laboratory, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ying Huang
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing 100053, China
| | - Jian Zhang
- Department of Vascular Surgery, Xuanwu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing 100053, China
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Torres O, Yamada A, Rigby NM, Hanawa T, Kawano Y, Sarkar A. Gellan gum: A new member in the dysphagia thickener family. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.biotri.2019.02.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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83
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Balou M, Herzberg EG, Kamelhar D, Molfenter SM. An intensive swallowing exercise protocol for improving swallowing physiology in older adults with radiographically confirmed dysphagia. Clin Interv Aging 2019; 14:283-288. [PMID: 30804667 PMCID: PMC6375531 DOI: 10.2147/cia.s194723] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose The aim of this study was to investigate improvements in swallowing function and physiology in a series of healthy older adults with radiographically confirmed dysphagia, following completion of an exercise-based swallowing intervention. Patients and methods Nine otherwise healthy older adults (six females, mean age =75.3, SD =5.3) had confirmed impairments in swallowing safety and/or efficiency on a modified barium swallow study. Each participant completed an 8-week swallowing treatment protocol including effortful swallows, Mendelsohn maneuvers, tongue-hold swallows, supraglottic swallows, Shaker exercises and effortful pitch glides. Treatment sessions were conducted once per week with additional daily home practice. Penetration–Aspiration Scale and the Modified Barium Swallowing Impairment Profile (MBSImP) were scored in a blind and randomized fashion to examine changes to swallowing function and physiology from baseline to post-treatment. Results There were significant improvements in swallowing physiology as represented by improved oral and pharyngeal composite scores of the MBSImP. Specific components to demonstrate statistical improvement included initiation of the pharyngeal swallow, laryngeal elevation and pharyngeal residue. There was a nonsignificant reduction in median PAS scores. Conclusion Swallowing physiology can be improved using this standardized high-intensity exercise protocol in healthy adults with evidence of dysphagia. Future research is needed to examine the individual potential of each exercise in isolation and to determine ideal dose and frequency. Studies on various etiological groups are warranted.
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Affiliation(s)
- Matina Balou
- Department of Otolaryngology, New York University School of Medicine, Head & Neck Surgery, New York, NY, USA
| | - Erica G Herzberg
- Department of Speech-Language Pathology, New York University Langone Health, Rusk Rehabilitation, New York, NY, USA
| | - David Kamelhar
- New York University School of Medicine, Department of Pulmonary Medicine, New York, NY, USA
| | - Sonja M Molfenter
- Department of Communicative Sciences and Disorder, Communicative Sciences and Disorders, New York University Steinhardt, New York, NY, USA,
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84
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Igarashi K, Kikutani T, Tamura F. Survey of suspected dysphagia prevalence in home-dwelling older people using the 10-Item Eating Assessment Tool (EAT-10). PLoS One 2019; 14:e0211040. [PMID: 30673750 PMCID: PMC6343899 DOI: 10.1371/journal.pone.0211040] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/07/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study was carried out to determine the prevalence of suspected dysphagia and its features in both independent and dependent older people living at home. MATERIALS AND METHODS The 10-Item Eating Assessment Tool (EAT-10) questionnaire was sent to 1,000 independent older people and 2,000 dependent older people living at home in a municipal district of Tokyo, Japan. The participants were selected by stratified randomization according to age and care level. We set the cut-off value of EAT-10 at a score of ≥3. The percentage of participants with an EAT-10 score ≥3 was defined as the prevalence of suspected dysphagia. The chi-square test was used for analyzing prevalence in each group. Analysis of the distribution of EAT-10 scores, and comparisons among items, age groups, and care levels to identify symptom features were performed using the Kruskal-Wallis test and Mann-Whitney U test. RESULTS Valid responses were received from 510 independent older people aged 65 years or older (mean age 75.0 ± 7.2) and 886 dependent older people (mean age 82.3 ± 6.7). The prevalences of suspected dysphagia were 25.1% and 53.8%, respectively, and showed significant increases with advancing age and care level. In both groups, many older people assigned high scores to the item about coughing, whereas individuals requiring high-level care assigned higher scores to the items about not only coughing but also swallowing of solids and quality of life. CONCLUSION In independent people, approximately one in four individuals showed suspected dysphagia and coughing was the most perceivable symptom. In dependent people, approximately one in two individuals showed suspected dysphagia and their specifically perceivable symptoms were coughing, difficulties in swallowing solids and psychological burden.
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Affiliation(s)
- Kumi Igarashi
- Division of Clinical Oral Rehabilitation, The Nippon Dental University Graduate School of Life Dentistry, Tokyo, Japan
| | - Takeshi Kikutani
- Division of Clinical Oral Rehabilitation, The Nippon Dental University Graduate School of Life Dentistry, Tokyo, Japan
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Tokyo, Japan
- * E-mail:
| | - Fumiyo Tamura
- The Nippon Dental University, Tama Oral Rehabilitation Clinic, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tokyo, Japan
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Shune SE, Namasivayam-MacDonald AM. Swallowing Impairments Increase Emotional Burden in Spousal Caregivers of Older Adults. J Appl Gerontol 2019; 39:172-180. [DOI: 10.1177/0733464818821787] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The aim of this study was to determine the type and extent of caregiver burden uniquely experienced by spousal caregivers of older adults with dysphagia. Method: Using the Round 1 surveys from the National Health and Aging Trends Study and the National Study of Caregiving, we analyzed data on 422 community-dwelling older adults and their spousal caregivers. Results: Approximately 17% of care recipients reported swallowing difficulties. Logistic regression analysis revealed that caregivers of spouses with dysphagia were significantly more likely to experience emotional burden, p = .038; odds ratio (OR) = 2.06; 95% confidence interval (CI): [1.04, 4.09]. Of those spouses caring for partners with dysphagia who reported emotional burden, nearly 70% rated the burden moderate to severe. Discussion: Dysphagia in community-dwelling older adults is associated with increased emotional burden among spousal caregivers. Given the intricate relationship between the health and well-being of both members of the caregiving dyad, these findings support the need for interventions that prioritize dyadic health.
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86
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Howells SR, Cornwell PL, Ward EC, Kuipers P. Understanding Dysphagia Care in the Community Setting. Dysphagia 2019; 34:681-691. [DOI: 10.1007/s00455-018-09971-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/31/2018] [Indexed: 02/06/2023]
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Sarcopenia is an Independent Risk Factor for Dysphagia in Community-Dwelling Older Adults. Dysphagia 2019; 34:692-697. [DOI: 10.1007/s00455-018-09973-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/31/2018] [Indexed: 01/06/2023]
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Madhavan A, Carnaby GD, Chhabria K, Crary MA. Preliminary Development of a Screening Tool for Pre-Clinical Dysphagia in Community Dwelling Older Adults. Geriatrics (Basel) 2018; 3:E90. [PMID: 31011125 PMCID: PMC6371185 DOI: 10.3390/geriatrics3040090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 11/30/2022] Open
Abstract
Evidence suggests that community dwelling older adults (CDOA) are at risk for dysphagia (swallowing difficulties). Dysphagia is often unidentified until related morbidities like under nutrition or pneumonia occur. These cases of unidentified dysphagia, prior to any clinical intervention, may be termed 'pre-clinical dysphagia'. Identifying pre-clinical dysphagia is challenged by the lack of validated tools appropriate for CDOA. This study addresses preliminary development of a novel patient reported outcome (PRO) screening tool for pre-clinical dysphagia. Initially, 34 questions were developed from literature review and expert opinion. Following pilot testing (n = 53), the questionnaire was revised and tested on 335 additional CDOA. Face validity, content validity, item analysis, reliability (internal consistency), and construct validity (exploratory factor analysis) measures were completed. Psychometric validation resulted in a 17-question PRO tool. Construct analysis identified a three-factor model that explained 67.345% of the variance. Emergent factors represented swallowing effort, physical function, and cognitive function. The results revealed strong construct validity and internal consistency (Cronbach's α = 0.90). A novel, simple PRO incorporating multiple function domains associated with aging demonstrated strong preliminary psychometric properties. This tool is more comprehensive and aging-focused than existing dysphagia screening tools. Inclusion of multiple domains may be key in early identification of pre-clinical dysphagia.
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Affiliation(s)
- Aarthi Madhavan
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, PA 16802, USA.
| | - Giselle D Carnaby
- Swallowing Research Laboratory, School of Communication Sciences and Disorders, University of Central Florida, Orlando, FL 32816, USA.
| | - Karishma Chhabria
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Michael A Crary
- Swallowing Research Laboratory, School of Communication Sciences and Disorders, University of Central Florida, Orlando, FL 32816, USA.
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A tough pill to swallow: Medicolegal liability and dysphagia. Am J Otolaryngol 2018; 39:698-703. [PMID: 30153949 DOI: 10.1016/j.amjoto.2018.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/24/2018] [Indexed: 11/24/2022]
Abstract
LEVEL OF EVIDENCE Level 4 (Case Series). OBJECTIVE Dysphagia is a debilitating condition that is associated with many etiologies. It can have a devastating effect on a patient's quality of life with long-term sequelae that make it a source of medical malpractice litigation. This study analyzed medical malpractice cases involving dysphagia and looked for factors determining legal liability. METHODS The Westlaw Next legal database (Thomson Reuters, New York, NY) was searched for relevant malpractice cases and assessed for several factors including if the dysphagia was iatrogenic, the amount paid by the defendant, and the medical specialty of the defendants. RESULTS A total of 45 cases of dysphagia were included. The majority of these cases were jury verdicts for the defendant (73.3%). Iatrogenic dysphagia was alleged in 55.5% of cases. Settlements and verdicts favoring the plaintiff resulted in awards ranging between $25,000 and $5,003,000 with a mean of $1,014,015. The most frequent physician specialists named were general surgeons (24.1), internists (11.1%), anesthesiologists (9.3%), gastroenterologists (7.4%), and otolaryngologists (5.6%). Iatrogenic dysphagia (OR 8.89 CI 1.02-77.32), medication-related iatrogenesis (OR 18.86 CI 1.82-195.41), and cases naming multiple specialties as a defendant (OR 5.90, CI 1.07-32.55) were factors associated with a verdict for the plaintiff or a settlement. CONCLUSION Dysphagia is a condition with medicolegal consequences for many specialties. While the majority of these cases are decided in favor of the defendant the cost of a negative outcome is considerable. Iatrogenic dysphagia and naming more than one defendant specialty were associated with increased odds of a plaintiff verdict or settlement.
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90
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Dysphagia Onset in Older Adults during Unrelated Hospital Admission: Quantitative Videofluoroscopic Measures. Geriatrics (Basel) 2018; 3:geriatrics3040066. [PMID: 31011101 PMCID: PMC6371158 DOI: 10.3390/geriatrics3040066] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 02/07/2023] Open
Abstract
New-onset swallowing difficulties in older patients during unrelated hospital admissions are well recognized and may result in prolonged hospital stay and increased morbidity. Presbyphagia denotes age-related swallowing changes which do not necessarily result in pathological effects. The trajectory from presbyphagia to dysphagia is not well understood. This retrospective observational study compared quantitative videofluoroscopic measures in hospitalized older adults aged 70-100 years, reporting new dysphagia symptoms during admission (n = 52), to healthy asymptomatic older (n = 56) and younger adults (n = 43). Significant physiological differences seen in hospitalized older adults but not healthy adults, were elevated pharyngeal area (p < 0.001) and pharyngeal constriction ratio (p < 0.001). Significantly increased penetration (p < 0.001), aspiration (p < 0.001) and pharyngeal residue (p < 0.001) were also observed in the hospitalized older cohort. Reasons for onset of new swallow problems during hospitalization are likely multifactorial and complex. Alongside multimorbidity and polypharmacy, a combination of factors during hospitalization, such as fatigue, low levels of alertness, delirium, reduced respiratory support and disuse atrophy, may tip the balance of age-related swallowing adaptations and compensation toward dysfunctional swallowing. To optimize swallowing assessment and management for our aging population, care must be taken not to oversimplify dysphagia complaints as a characteristic of aging.
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91
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Agrawal D, Kern M, Edeani F, Balasubramanian G, Hyngstrom A, Sanvanson P, Shaker R. Swallow strength training exercise for elderly: A health maintenance need. Neurogastroenterol Motil 2018; 30:e13382. [PMID: 29956861 PMCID: PMC6160333 DOI: 10.1111/nmo.13382] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/22/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent studies have shown high prevalence of oropharyngeal dysphagia associated with frailty- and age-related muscle weakness. Strength training exercises have been advocated for locomotive health maintenance in the elderly and have shown positive outcomes. As muscles involved in oropharyngeal phase of swallowing are also comprised of striated muscles, the aim of this study was to determine biomechanical effect of a novel resistance exercise program, Swallowing Against Laryngeal Restriction (SALR), on pharyngeal phase swallowing in the healthy elderly. METHODS A total of 28 volunteers (75 + 7 years; 17 females) with no complaint of dysphagia were studied using video fluoroscopy before and after 6 weeks of the swallow strength training exercise. Eighteen of these volunteers also underwent high-resolution pharyngeal manometry non-concurrent with fluoroscopy. Ten additional volunteers (81 + 6 years; 9 females) were studied by videofluoroscopy before and after 6 weeks of a sham exercise. KEY RESULTS Swallow resistance exercise but not the sham exercise resulted in a significant increase in maximum upper esophageal sphincter opening (P < .01), superior and anterior laryngeal excursion (P < .01) as well as posterior pharyngeal wall thickness (P < .01). Resistance exercise but not sham exercise also resulted in a significant increase in deglutitive pharyngeal contractile integral (P < .01). CONCLUSIONS & INFERENCES Strength training of muscles involved in the pharyngeal phase of swallowing using the swallowing against laryngeal restriction technique is feasible and significantly improves key physiologic features of the pharyngeal phase of swallowing. These findings provide the basis for consideration of developing an exercise-based swallow health maintenance program for the elderly swallow health maintenance program for the elderly.
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Affiliation(s)
- Dilpesh Agrawal
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin
| | - Mark Kern
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin
| | - Francis Edeani
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin
| | | | - Allison Hyngstrom
- College of Health Sciences Physical Therapy, Marquette University Milwaukee, WI, USA
| | - Patrick Sanvanson
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin
| | - Reza Shaker
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin
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Lim Y, Kim C, Park H, Kwon S, Kim O, Kim H, Lee Y. Socio-demographic factors and diet-related characteristics of community-dwelling elderly individuals with dysphagia risk in South Korea. Nutr Res Pract 2018; 12:406-414. [PMID: 30323908 PMCID: PMC6172174 DOI: 10.4162/nrp.2018.12.5.406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/09/2018] [Accepted: 08/06/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/OBJECTIVES The objective of this study was to determine dysphagia risk among community-dwelling elderly people living at home. We also examined the impact of socio-demographic variables on dysphagia risk as well as the relationship between dysphagia risk and dietary characteristics. SUBJECTS/METHODS The study sample included 568 community-dwelling individuals, aged 65 years and above, who were living independently in their own home in Seoul, Gyeonggi, or Gwangju in South Korea. We used a dysphagia risk assessment scale to screen for dysphagia risk and the Mini nutritional assessment to evaluate the nutritional status. Associations between dysphagia risk and other variables were assessed using logistic regression analysis. RESULTS Of the 568 subjects, 350 (61.6%) were classified into the dysphagia risk group (DR) and 218 (38.4%) were classified into the normal group (non-DR). Being female (odds ratio (OR) = 1.82, 95% confidence interval (CI) = 1.28-2.59), being 75 years and older (OR = 2.40, 95% CI = 1.69-3.42), having a lower education level (OR = 2.29, 95% CI = 1.33-3.97), and having a lower perceived economic status (OR = 2.18, 95% CI = 1.32-3.60) were more frequently observed with dysphagia risk compared to those who did not have such characteristics. Lowered mastication ability (OR = 14.40, 95% CI = 4.43-46.95), being at risk of malnutrition or malnourished (OR = 2.72, 95% CI = 1.75-4.23), lowered appetite (OR = 3.27, 95% CI = 2.16-4.93), and decreased food intake (OR = 2.95, 95% CI = 1.83-4.78) were observed more frequently in the DR group than in the non-DR group when adjusting for potential confounding factors. CONCLUSIONS It is necessary to develop and apply integrated programs to improve the dietary habits and nutritional status of elderly individuals at risk for dysphagia, especially for women aged 75 years or older with lower educational and economic levels.
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Affiliation(s)
- Youngsuk Lim
- Department of Food & Nutrition, Myoungji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 17058, Korea
| | - Chorong Kim
- Department of Food & Nutrition, Myoungji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 17058, Korea.,Food & Nutrition Team, Korea University Guro Hospital, Seoul 08308, Korea
| | - Haeryun Park
- Department of Food & Nutrition, Myoungji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 17058, Korea
| | - Sooyoun Kwon
- Department of Food & Nutrition, Shingu University, Gyeonggi 13174, Korea
| | - Oksun Kim
- Department of Food & Nutrition, Jangan University, Gyeonggi 18331, Korea
| | - Heeyoung Kim
- Department of Occupational Therapy, Honam University, Gwangju 62399, Korea
| | - Youngmi Lee
- Department of Food & Nutrition, Myoungji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 17058, Korea
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Taveira KVM, Santos RS, Leão BLCD, Stechman Neto J, Pernambuco L, Silva LKD, De Luca Canto G, Porporatti AL. Diagnostic validity of methods for assessment of swallowing sounds: a systematic review. Braz J Otorhinolaryngol 2018; 84:638-652. [PMID: 29456200 PMCID: PMC9452251 DOI: 10.1016/j.bjorl.2017.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/07/2017] [Accepted: 12/27/2017] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may lead to outcomes of aspiration pneumonia, ranging from hospitalization to death. This assessment proposes a non-invasive, acoustic-based method to differentiate between individuals with and without signals of penetration and aspiration. OBJECTIVE This systematic review evaluated the diagnostic validity of different methods for assessment of swallowing sounds, when compared to videofluroscopy swallowing study to detect oropharyngeal dysphagia. METHODS Articles in which the primary objective was to evaluate the accuracy of swallowing sounds were searched in five electronic databases with no language or time limitations. Accuracy measurements described in the studies were transformed to construct receiver operating characteristic curves and forest plots with the aid of Review Manager v. 5.2 (The Nordic Cochrane Centre, Copenhagen, Denmark). The methodology of the selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. RESULTS The final electronic search revealed 554 records, however only 3 studies met the inclusion criteria. The accuracy values (area under the curve) were 0.94 for microphone, 0.80 for doppler, and 0.60 for stethoscope. CONCLUSION Based on limited evidence and low methodological quality because few studies were included, with a small sample size, from all index testes found for this systematic review, doppler showed excellent diagnostic accuracy for the discrimination of swallowing sounds, whereas microphone-reported good accuracy discrimination of swallowing sounds of dysphagic patients and stethoscope showed best screening test.
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Affiliation(s)
| | - Rosane Sampaio Santos
- Universidade Tuiuti do Paraná (UTP), Programa de Pós-graduação em Distúrbios da Comunicação, Curitiba, PR, Brazil
| | | | - José Stechman Neto
- Universidade Tuiuti do Paraná (UTP), Programa de Pós-graduação em Distúrbios da Comunicação, Curitiba, PR, Brazil
| | - Leandro Pernambuco
- Universidade Federal da Paraíba (UFPB), Departamento de Fonoaudiologia, João Pessoa, PB, Brazil
| | - Letícia Korb da Silva
- Instituto de Educação Luterana de Santa Catarina, Departamento de Fonoaudiologia, Joinville, SC, Brazil
| | - Graziela De Luca Canto
- Universidade Federal de Santa Catarina (UFSC), Departamento de Odontologia, Brazilian Centre for Evidence-based Research, Florianópolis, SC, Brazil; University of Alberta, Faculty of Medicine and Dentistry, School of Dentistry, Alberta, Canada
| | - André Luís Porporatti
- Universidade Federal de Santa Catarina (UFSC), Departamento de Odontologia, Brazilian Centre for Evidence-based Research, Florianópolis, SC, Brazil
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Kletzien H, Russell JA, Leverson G, Connor NP. Effect of neuromuscular electrical stimulation frequency on muscles of the tongue. Muscle Nerve 2018; 58:441-448. [PMID: 29797723 DOI: 10.1002/mus.26173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Neuromuscular electrical stimulation (NMES) for the treatment of swallowing disorders is delivered at a variety of stimulation frequencies. We examined the effects of stimulation frequency on tongue muscle plasticity in an aging rat model. METHODS Eighty-six young, middle-aged, and old rats were assigned to either bilateral hypoglossal nerve stimulation at 10 or 100 Hz (5 days/week, 8 weeks), sham, or no-implantation conditions. Muscle contractile properties and myosin heavy chain (MyHC) composition were determined for hyoglossus (HG) and styloglossus (SG) muscles. RESULTS Eight weeks of 100-Hz stimulation resulted in the greatest changes in muscle contractile function with significantly longer contraction and half-decay times, the greatest reduction in fatigue, and a transition toward slowly contracting, fatigue-resistant MyHC isoforms. DISCUSSION NMES at 100-Hz induced considerable changes in contractile and phenotypic profiles of HG and SG muscles, suggesting higher frequency NMES may yield a greater therapeutic effect. Muscle Nerve, 2018.
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Affiliation(s)
- Heidi Kletzien
- Department of Biomedical Engineering University of Wisconsin-Madison, 1300 University Avenue, Room 481, Madison, Wisconsin 53706, USA
| | - John A Russell
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Glen Leverson
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nadine P Connor
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Peri-operative outcomes following major surgery for head and neck cancer in the elderly: institutional audit and case–control study. The Journal of Laryngology & Otology 2018; 132:742-747. [DOI: 10.1017/s0022215118001135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveElderly patients have been consistently shown to receive suboptimal therapy for cancers of the head and neck. This study was performed to determine the peri-operative outcomes of these patients and compare them with those of younger patients.MethodsIn this retrospective analysis, 115 patients aged 70 years or more undergoing major surgery for head and neck cancers were matched with 115 patients aged 50–60 years, and univariate analysis was performed.ResultsElderly patients had a reduced performance status (p < 0.001) and more co-morbid illnesses (p = 0.007), but a comparable intra-operative course. They had a longer median hospital stay (p = 0.016), longer intensive care unit stay (p = 0.04), longer median tracheostomy dependence (p = 0.04) and were more often discharged with feeding tubes (p < 0.001). They also had a higher incidence of post-operative non-fatal cardiac events (p = 0.045).ConclusionElderly patients with good performance status should receive curative-intent surgery. Although hospital stay and tube dependence are longer, morbidity and mortality are comparable with younger patients.
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96
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Mundi MS, Patel J, McClave SA, Hurt RT. Current perspective for tube feeding in the elderly: from identifying malnutrition to providing of enteral nutrition. Clin Interv Aging 2018; 13:1353-1364. [PMID: 30122907 PMCID: PMC6080667 DOI: 10.2147/cia.s134919] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
With the number of individuals older than 65 years expected to rise significantly over the next few decades, dramatic changes to our society and health care system will need to take place to meet their needs. Age-related changes in muscle mass and body composition along with medical comorbidities including stroke, dementia, and depression place elderly adults at high risk for developing malnutrition and frailty. This loss of function and decline in muscle mass (ie, sarcopenia) can be associated with reduced mobility and ability to perform the task of daily living, placing the elderly at an increased risk for falls, fractures, and subsequent institutionalization, leading to a decline in the quality of life and increased mortality. There are a number of modifiable factors that can mitigate some of the muscle loss elderly experience especially when hospitalized. Due to this, it is paramount for providers to understand the pathophysiology behind malnutrition and sarcopenia, be able to assess risk factors for malnutrition, and provide appropriate nutrition support. The present review describes the pathophysiology of malnutrition, identifies contributing factors to this condition, discusses tools to assess nutritional status, and proposes key strategies for optimizing enteral nutrition therapy for the elderly.
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Affiliation(s)
- Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA,
| | - Jayshil Patel
- Division of Pulmonary, Critical Care & Sleep Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Stephen A McClave
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, KY, USA
| | - Ryan T Hurt
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, KY, USA.,Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Volumetric Changes to the Pharynx in Healthy Aging: Consequence for Pharyngeal Swallow Mechanics and Function. Dysphagia 2018; 34:129-137. [PMID: 30039259 DOI: 10.1007/s00455-018-9924-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
Pharyngeal lumen volume is prone to increase as a consequence of pharyngeal muscle atrophy in aging. Yet, the impact of this on swallowing mechanics and function is poorly understood. We examined the relationship between pharyngeal volume and pharyngeal swallowing mechanics and function in a sample of healthy community-dwelling seniors. Data were collected from 44 healthy seniors (21 male, mean age = 76.9, SD = 7.1). Each participant swallowed 9 boluses of barium (3 × 5 ml thin, 3 × 20 ml thin, 3 × 5 ml nectar). Pharyngeal shortening, pharyngeal constriction, pyriform sinus and vallecular residue were quantified from lateral view videofluorosopic swallowing studies. Pharyngeal lumen volume was captured during an oral breathing task with acoustic pharyngometry. In addition, within-participant measures of strength and anthropometrics were collected. Four linear mixed effects regression models were run to study the relationship between pharyngeal volume and pharyngeal constriction, pharyngeal shortening, pyriform sinus residue, and vallecular residue while controlling for bolus condition, age, sex, and posterior tongue strength. Increasing pharyngeal lumen volume was significantly related to worse constriction and vallecular residue. In general, larger and thicker boluses resulted in worse pharyngeal constriction and residue. Pharyngeal shortening was only significantly related to posterior tongue strength. Our work establishes the utility of acoustic pharyngometry to monitor pharyngeal lumen volume. Increasing pharyngeal lumen volume appears to impact both pharyngeal swallowing mechanics and function in a sample of healthy, functional seniors.
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98
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Molfenter SM, Brates D, Herzberg E, Noorani M, Lazarus C. The Swallowing Profile of Healthy Aging Adults: Comparing Noninvasive Swallow Tests to Videofluoroscopic Measures of Safety and Efficiency. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:1603-1612. [PMID: 29893767 PMCID: PMC6195059 DOI: 10.1044/2018_jslhr-s-17-0471] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/05/2018] [Accepted: 03/12/2018] [Indexed: 05/22/2023]
Abstract
PURPOSE It has been widely reported that a proportion of healthy, community-dwelling seniors will develop dysphagia in the absence of a known neurological, neuromuscular, or structural cause. Our objective was to test whether various feasible, noninvasive measures of swallowing could differentiate safe versus unsafe and efficient versus inefficient swallowing on videofluoroscopy (VF) in a sample of healthy seniors. METHOD VFs from 44 (21 male, 23 female) healthy community-dwelling seniors (> 65 years old) were compared with a series of feasible, noninvasive swallowing metrics: maximal tongue strength (anterior and posterior), hand grip strength, pharyngeal volume, age, body mass index, 3-oz water swallow challenge, the 10-item Eating Assessment Tool questionnaire, and the Frailty Index. The VF protocol included 9 liquid barium boluses (3 × 5 ml thin, 3 × 20 ml thin, and 3 × 5 ml nectar). Each swallow was rated (randomized and blind) for safety using the Penetration-Aspiration Scale score and for efficiency using the Normalized Residue Ratio Scale (NRRS). Participants were deemed "unsafe" if they had any single Penetration-Aspiration Scale scores ≥ 3 and "inefficient" if they had any NRRS valleculae score > 0.082 or NRRS pyriform sinus score > 0.067. Univariate analyses of variance were run for each continuous swallowing measure by swallowing safety and swallowing efficiency status. Pearson's chi-square analyses were used to compare binary outcomes by swallow safety and efficiency status. Bonferroni corrections were applied to control for multiple comparisons. RESULTS None of the swallowing measures significantly differentiated safe from unsafe swallows. Although several variables trended to distinguishing efficient from inefficient swallows (age, 10-item Eating Assessment Tool, 3-oz water swallow challenge), only one variable, pharyngeal volume, was significantly different between efficient and inefficient swallows (p = .002). CONCLUSION Our findings support the notion that larger pharyngeal volumes (measured using acoustic pharyngometry) are associated with worse swallowing efficiency, a finding we attribute to atrophy of the pharyngeal musculature in healthy aging.
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Affiliation(s)
- Sonja M. Molfenter
- Department of Communicative Sciences and Disorders, NYU Steinhardt, New York
| | - Danielle Brates
- Department of Communicative Sciences and Disorders, NYU Steinhardt, New York
| | - Erica Herzberg
- Department of Communicative Sciences and Disorders, NYU Steinhardt, New York
| | - Mehak Noorani
- Department of Communicative Sciences and Disorders, NYU Steinhardt, New York
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Roy N, Tanner KM, Merrill RM, Wright C, Pierce JL, Miller KL. Epidemiology of Swallowing Disorders in Rheumatoid Arthritis: Prevalence, Risk Factors, and Quality of Life Burden. Ann Otol Rhinol Laryngol 2018; 127:577-587. [DOI: 10.1177/0003489418780136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: This investigation examined the prevalence, symptoms, risk factors, and quality-of-life burden of swallowing disorders in rheumatoid arthritis (RA), a chronic, progressive autoimmune inflammatory disease. Methods: One hundred individuals with RA (84 women, 16 men; mean age = 61.1 years, SD = 13.1) were interviewed regarding the presence, nature, and impact of swallowing symptoms and disorders. Associations between swallowing disorders, medical factors, RA disease severity, and quality of life were examined. Results: Forty-one percent of participants reported a current swallowing disorder that began gradually and was longstanding (most experiencing symptoms on a daily basis for at least 4 years). Symptoms compatible with solid food dysphagia contributed disproportionately to reporting a current swallowing disorder. Risk factors for dysphagia included a self-reported voice disorder, thyroid problems, esophageal reflux, and being physically inactive. Swallowing disorders increased with self-reported RA disease severity and contributed to a significantly greater burden on overall quality of life. Conclusion: Chronic, longstanding swallowing disorders are common in individuals with RA and appear to increase with disease severity. Those individuals with dysphagia reported greater reductions in quality of life as compared to those without, highlighting the need for improved awareness, exploration, and management of swallowing disorders in this population.
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Affiliation(s)
- Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, USA
| | - Kristine M. Tanner
- The Department of Communication Disorders, Brigham Young University, Provo, Utah, USA
| | - Ray M. Merrill
- The Department of Health Science, Brigham Young University, Provo, Utah, USA
| | - Charisse Wright
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, USA
| | - Jenny L. Pierce
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, USA
| | - Karla L. Miller
- The Division of Rheumatology, Department of Internal Medicine, the University of Utah, Salt Lake City, Utah, USA
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Brochier CW, Hugo FN, Rech RS, Baumgarten A, Hilgert JB. Influence of dental factors on oropharyngeal dysphagia among recipients of long-term care. Gerodontology 2018; 35:333-338. [PMID: 29882353 DOI: 10.1111/ger.12345] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The study evaluated the association of the sociodemographic, behavioural variables and the oral conditions with the presence of oropharyngeal dysphagia in long-term care older persons. BACKGROUND Due to the influence of ageing, swallowing may be altered both in people with natural teeth and in those who have dentures or tooth loss. MATERIALS AND METHODS This cross-sectional study evaluated 115 individuals older than 60 years, living in long-term care institutions of the State of Rio Grande do Sul in 2016. The diagnosis of dysphagia happen using a clinical speech evaluation, based on the research of signals and symptoms of alterations during deglutition, and on an oral sensory-motor evaluation. The dental clinical evaluation examined the oral cavity, teeth and dental prostheses, including a Xerostomia assessment. Poisson Regressions with robust variance was calculated were used to estimate crude and adjusted Prevalence Ratios(PR) and their IC95%. RESULTS The sample was mostly comprised of older women (67.0%), with more than 81 years of age (44.3%) and edentulous (54.3%). Diagnosis of oropharyngeal dysphagia was verified in 60.9% of the participants. In the final model, older persons who presented no pair (PR=1.52(CI95%=1.02-2.40)) had a highest prevalence of oropharyngeal dysphagia, when compared to older persons who presented 8 to 14 mixed pairs, as well as those older persons who had more complaints related to symptoms of Xerostomia (PR=2.86(CI95% 1.58-5.18)). CONCLUSION Institutionalised older persons with a poor oral health condition are associated with a higher prevalence of oropharyngeal dysphagia, as well as with the presence of Xerostomia.
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Affiliation(s)
| | - Fernando Neves Hugo
- Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Center of Community Dental Health Research, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Studies Program in Dentistry, Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafaela Soares Rech
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandre Baumgarten
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Balbinot Hilgert
- Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Studies Program in Dentistry, Faculty of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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