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Ocrospoma S, Restrepo MI. Severe aspiration pneumonia in the elderly. JOURNAL OF INTENSIVE MEDICINE 2024; 4:307-317. [PMID: 39035624 PMCID: PMC11258512 DOI: 10.1016/j.jointm.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 07/23/2024]
Abstract
The global population is aging at an unprecedented rate, resulting in a growing and vulnerable elderly population in need of efficient comprehensive healthcare services that include long-term care and skilled nursing facilities. In this context, severe aspiration pneumonia, a condition that carries substantial morbidity, mortality, and financial burden, especially among elderly patients requiring admission to the intensive care unit, has attracted greater concern. Aspiration pneumonia is defined as a pulmonary infection related to aspiration or dysphagia in etiology. Prior episodes of coughing on food or liquid intake, a history of relevant underlying conditions, abnormalities on videofluoroscopy or water swallowing, and gravity-dependent shadow distribution on chest imaging are among the clues that suggest aspiration. Patients with aspiration pneumonia tend to be elderly, frail, and suffering from more comorbidities than those without this condition. Here, we comprehensively address the epidemiology, clinical characteristics, diagnosis, treatment, prevention, and prognosis of severe aspiration community-acquired pneumonia in the elderly to optimize care of this high-risk demographic, enhance outcomes, and minimize the healthcare costs associated with this illness. Emphasizing preventive measures and effective management strategies is vital in ensuring the well-being of our aging population.
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Affiliation(s)
- Sebastian Ocrospoma
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Marcos I. Restrepo
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
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Kunieda K, Hayashi Y, Yamada M, Nishida S, Moribayashi R, Ohno T, Fujishima I, Kimura A, Shimohata T. The Evaluation of Benzodiazepine-induced Dysphagia Using High-resolution Manometry. Intern Med 2023; 62:3537-3540. [PMID: 37062746 PMCID: PMC10749804 DOI: 10.2169/internalmedicine.1539-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/28/2023] [Indexed: 04/18/2023] Open
Abstract
We evaluated the pathophysiology of dysphagia considered to be induced by benzodiazepine using high-resolution manometry (HRM). A 53-year-old man with Parkinson disease had had dysphagia for over 3 months. He had been taking several benzodiazepines for more than four years. Two weeks after discontinuation of the benzodiazepines, HRM revealed increased pharyngeal contractility and residual pressure at the upper esophageal sphincter. A video-fluoroscopic swallowing study showed improved pharyngeal bolus passage. Benzodiazepine-induced dysphagia may be due to the muscle relaxant effects on the swallowing muscles and attenuation of the barrier function which prevents reflux from the esophagus into the pharynx.
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Affiliation(s)
- Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Japan
| | - Yuichi Hayashi
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
- Department of Nursing, Tsuruga City Nursing University, Japan
| | - Megumi Yamada
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
| | | | | | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Japan
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
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Triadafilopoulos G, Mashimo H, Tatum R, O'Clarke J, Hawn M. Mixed Esophageal Disease (MED): A New Concept. Dig Dis Sci 2023; 68:3542-3554. [PMID: 37470896 DOI: 10.1007/s10620-023-08008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/15/2023] [Indexed: 07/21/2023]
Abstract
We define mixed esophageal disease (MED) as a disorder of esophageal structure and/or function that produces variable signs or symptoms, simulating-fully or in part other well-defined esophageal conditions, such as gastroesophageal reflux disease, esophageal motility disorders, or even neoplasia. The central premise of the MED concept is that of an overlap syndrome that incorporates selected clinical, endoscopic, imaging, and functional features that alter the patient's quality of life and affect natural history, prognosis, and management. In this article, we highlight MED scenarios frequently encountered in medico-surgical practices worldwide, posing new diagnostic and therapeutic challenges. These, in turn, emphasize the need for better understanding and management, aiming towards improved outcomes and prognosis. Since MED has variable and sometimes time-evolving clinical phenotypes, it deserves proper recognition, definition, and collaborative, multidisciplinary approach, be it pharmacologic, endoscopic, or surgical, to optimize therapeutic outcomes, while minimizing iatrogenic complications. In this regard, it is best to define MED early in the process, preferably by teams of clinicians with expertise in managing esophageal diseases. MED is complex enough that is increasingly becoming the subject of virtual, multi-disciplinary, multi-institutional meetings.
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Affiliation(s)
- George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway Street 3rd floor, MC6341, Redwood City, CA, 94063, USA.
| | - Hiroshi Mashimo
- Section of Gastroenterology, Harvard Medical School, VA Boston Healthcare - Roxbury, 1400 VFW Pkwy, West Roxbury, MA, 02132, USA
| | - Roger Tatum
- Department of General Surgery, University of Washington, 1660 S. Columbian Way, Seattle, WA, 98108, USA
| | - John O'Clarke
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Mary Hawn
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
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Nakajima Y, Tsujimura T, Tsutsui Y, Chotirungsan T, Kawada S, Dewa N, Magara J, Inoue M. Atropine facilitates water-evoked swallows via central muscarinic receptors in anesthetized rats. Am J Physiol Gastrointest Liver Physiol 2023; 325:G109-G121. [PMID: 37219016 DOI: 10.1152/ajpgi.00039.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/01/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
Anticholinergic medication causes impaired swallowing with hyposalivation. However, the underlying mechanisms by which these drugs modulate the swallowing reflex remain unclear. This study investigated the effects of the muscarinic acetylcholine receptor (mAChR) nonspecific antagonist atropine on the initiation of swallowing. Experiments were performed on 124 urethane-anesthetized rats. A swallow was evoked by either topical laryngeal application of a small amount of distilled water (DW), saline, citric acid, or capsaicin; upper airway distention with a continuous airflow; electrical stimulation of the superior laryngeal nerve (SLN); or focal microinjection of N-methyl-d-aspartate (NMDA) into the lateral region of the nucleus of the solitary tract (L-nTS). Swallows were identified by electromyographic bursts of the digastric and thyrohyoid muscles. Either atropine, the peripheral mAChR antagonist methylatropine, or antagonists of mAChR subtypes M1-M5 were intravenously delivered. Atropine at a dose of 1 mg/kg increased the number of DW-evoked swallows compared with baseline and did not affect the number of swallows evoked by saline, citric acid, capsaicin, or upper airway distention. Methylatropine and M1-M5 antagonists did not significantly change the number of DW-evoked swallows. Bilateral SLN transection completely abolished DW-evoked swallows, and atropine decreased the swallowing threshold of SLN electrical stimulation. Finally, microinjection of NMDA receptor antagonist AP-5 into the L-nTS inhibited DW-evoked swallows, and atropine facilitated the initiation of swallowing evoked by NMDA microinjection into this region. These results suggest that atropine facilitates DW-evoked swallows via central mAChR actions.NEW & NOTEWORTHY Atropine facilitated the distilled water (DW)-evoked swallows in anesthetized rats. Atropine decreased the swallowing threshold evoked by electrical stimulation of the superior laryngeal nerve, which is a primary sensory nerve for the initiation of DW-evoked swallows. Atropine facilitated the swallows evoked by N-methyl-d-aspartate microinjection into the lateral region of the nucleus of the solitary tract, which is involved in the DW-evoked swallows. We speculate that atropine facilitates the DW-evoked swallows via central muscarinic receptor actions.
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Affiliation(s)
- Yuta Nakajima
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuhei Tsutsui
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Titi Chotirungsan
- Department of Oral Diagnosis, Faculty of Dentistry, Naresuan University, Muang, Phitsanulok, Thailand
| | - Satomi Kawada
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Nozomi Dewa
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Hägglund P, Karlsson P, Karlsson F. The Timed Water Swallow Test (TWST): Normative data on swallowing capacity for healthy people aged 60 years and older. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:479-485. [PMID: 35819269 DOI: 10.1080/17549507.2022.2096925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To provide normative data on swallowing capacity (mL/s) in people older than 60 years using the Timed Water Swallow Test (TWST), stratified by sex. Intra- and inter-rater reliability for swallowing time in TWST was further investigated. METHOD A total of 165 participants, aged 60 years and above, were included in the study. The time taken to consume 150 mL of tap water and the swallowing capacity (mL/s) was observed in a clinical context using the TWST. Video recordings of the performances were collected for 118 of the 165 participants for inter-rater reliability testing, of which a random set of 25 performances were assessed for intra-rater reliability. Analysis of the agreement between TWST rated by an in-person clinician and rated from a video recording was further evaluated. RESULT There were significant age and sex effects observed for swallowing capacity. The average reduction in swallowing capacity in the investigated age range (60-92 years) was 8.8 and 7.3 mL/s, for women and men respectively. The results showed high inter-and intra-rater reliability and agreement between the clinical assessment and the video recording. CONCLUSION The presented measurements indicate a clear effect of age on swallowing capacity and that women may be expected to have lower capacity scores than men when tested using TWST. The provided norms can be used as reference points in the clinical identification of people at risk of dysphagia in the older population.
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Affiliation(s)
- Patricia Hägglund
- Department of Clinical Sciences, Speech-Language Pathology, Umeå University, Umeå, Sweden
| | - Pernilla Karlsson
- Department of Clinical Sciences, Speech-Language Pathology, Umeå University, Umeå, Sweden
| | - Fredrik Karlsson
- Department of Clinical Sciences, Speech-Language Pathology, Umeå University, Umeå, Sweden
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Tan PL, Loh TJ, Chan SY. A Pilot Study on Pharmacists' Knowledge, Attitudes and Practices towards Medication Dysphagia via Asynchronous Online Focus Group Discussion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2858. [PMID: 36833554 PMCID: PMC9956395 DOI: 10.3390/ijerph20042858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
Medication dysphagia (MD) refers to difficulty swallowing oral medications. To cope, patients may inappropriately modify or skip medications, leading to poorer outcomes. Little is known about healthcare professionals' (HCPs') perspectives in managing MD. This study investigated pharmacists' knowledge, attitudes, and practices (KAP) in caring for patients with MD. An asynchronous online focus group was pilot tested in seven pharmacists, with up to two questions posted daily on an online platform over 15 days. Thematic analysis of the transcripts revealed five interrelated themes: (1) knowledge about MD; (2) management of MD; (3) expectations of patient proactivity; (4) desire for objectivity; (5) professional roles. The findings provided insight into pharmacists' KAP and may be incorporated into a full-scale study involving various HCPs.
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Affiliation(s)
| | | | - Sui Yung Chan
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117559, Singapore
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Desai N, Hunold T, Kaperak C, Wang W, Kavitt R. Pharmacologic causes of dysphagia. Dysphagia 2023. [DOI: 10.1016/b978-0-323-99865-9.00003-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Dell'Aquila G, Peladic NJ, Nunziata V, Fedecostante M, Salvi F, Carrieri B, Liperoti R, Carfì A, Eusebi P, Onder G, Orlandoni P, Cherubini A. Prevalence and management of dysphagia in nursing home residents in Europe and Israel: the SHELTER Project. BMC Geriatr 2022; 22:719. [PMID: 36042405 PMCID: PMC9429699 DOI: 10.1186/s12877-022-03402-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022] Open
Abstract
Background Dysphagia is a frequent condition in older nursing home residents (NHRs) which may cause malnutrition and death. Nevertheless, its prevalence is still underestimated and there is still debate about the appropriateness and efficacy of artificial nutrition (AN) in subjects with severe dysphagia. The aim is to assess the prevalence of dysphagia in European and Israeli NHRs, its association with mortality, and the relationship of different nutritional interventions, i.e. texture modified diets and AN—with weight loss and mortality. Methods A prospective observational study of 3451 European and Israeli NHRs older than 65 years, participating in the SHELTER study from 2009 to 2011, at baseline and after 12 months. All residents underwent a standardized comprehensive evaluation using the interRAI Long Term Care Facility (LTCF). Cognitive status was assessed using the Cognitive Performance Scale (CPS), functional status using Activities of Daily Living (ADL) Hierarchy scale. Trained staff assessed dysphagia at baseline by clinical observation. Data on weight loss were collected for all participants at baseline and after 12 months. Deaths were registered by NH staff. Results The prevalence of dysphagia was 30.3%. During the one-year follow-up, the mortality rate in subjects with dysphagia was significantly higher compared with that of non-dysphagic subjects (31.3% vs 17.0%,p = 0,001). The multivariate analysis showed that NHRs with dysphagia had 58.0% higher risk of death within 1 year compared with non-dysphagic subjects (OR 1.58, 95% CI, 1.31–1.91). The majority of NHRs with dysphagia were prescribed texture modified diets (90.6%), while AN was used in less than 10% of subjects. No statistically significant difference was found concerning weight loss and mortality after 12 months following the two different nutritional treatments. Conclusions Dysphagia is prevalent among NHRs and it is associated with increased mortality, independent of the nutritional intervention used. Noticeably, after 12 months of nutritional intervention, NHRs treated with AN had similar mortality and weight loss compared to those who were treated with texture modified diets, despite the clinical conditions of patients on AN were more compromised.
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Affiliation(s)
- Giuseppina Dell'Aquila
- Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
| | - Nikolina Jukic Peladic
- Clinical Nutrition Unit, IRCCS INRCA Ancona, Via della Montagnola 81, 60127, Ancona, Italy
| | - Vanessa Nunziata
- Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy. .,Geriatrics and Geriatric Emergency Care, Italian National Research Center On Aging (IRCCS-INRCA), Via della Montagnola, 81, 60127, Ancona, Italy.
| | - Massimiliano Fedecostante
- Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
| | - Fabio Salvi
- Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy. .,Geriatrics and Geriatric Emergency Care, Italian National Research Center On Aging (IRCCS-INRCA), Via della Montagnola, 81, 60127, Ancona, Italy.
| | - Barbara Carrieri
- Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Carfì
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Eusebi
- Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore Di Sanità, Via Giano della Bella 34, 00161, Rome, Italy
| | - Paolo Orlandoni
- Clinical Nutrition Unit, IRCCS INRCA Ancona, Via della Montagnola 81, 60127, Ancona, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
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Romanzi A, D'Alba L, Campagna P, Mancini R, Pernazza G. Robotic Heller‐Dor procedure for oesophageal achalasia: Fluorescence‐guided intraoperative assessment of myotomy. A retrospective single‐centre experience. Int J Med Robot 2022; 18:e2411. [PMID: 35472736 DOI: 10.1002/rcs.2411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/03/2022] [Accepted: 04/21/2022] [Indexed: 01/02/2023]
Affiliation(s)
- Andrea Romanzi
- Department of General Surgery Valduce Hospital Como Italy
| | - Lucia D'Alba
- Department of Gastroenterology and Digestive Endoscopy Azienda Ospedaliera San Giovanni Addolorata Rome Italy
| | | | - Raffaello Mancini
- Department of Robotic General Surgery Azienda Ospedaliera San Giovanni Addolorata Rome Italy
| | - Graziano Pernazza
- Department of Robotic General Surgery Azienda Ospedaliera San Giovanni Addolorata Rome Italy
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Yoshimura Y, Matsumoto A, Momosaki R. Pharmacotherapy and the Role of Pharmacists in Rehabilitation Medicine. Prog Rehabil Med 2022; 7:20220025. [PMID: 35633757 PMCID: PMC9098939 DOI: 10.2490/prm.20220025] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/04/2022] [Indexed: 12/19/2022] Open
Abstract
Pharmacotherapy is important in older patients undergoing rehabilitation because such patients, especially those with frailty and physical disabilities, are susceptible to drug-related functional impairment. Drug-related problems include polypharmacy, potentially inappropriate medications (PIMs), and potential prescription omissions. These problems are associated with adverse drug events such as dysphagia, depression, drowsiness, falls and fractures, incontinence, decreased appetite, and Parkinson's syndrome, leading to impaired improvement in activities of daily living (ADL), quality of life (QOL), and nutritional status. Moreover, the anticholinergic burden is associated with impaired physical and cognitive functions. Therefore, pharmacist-centered multidisciplinary pharmacotherapy should be performed to maximize rehabilitation outcomes. Pharmacotherapy includes a review of all medications, the assessment of drug-related problems, goal setting, correction of polypharmacy and PIMs, monitoring of drug prescriptions, and reassessment of drug-related problems. The goal of pharmacotherapy in rehabilitation medicine is to optimize drug prescribing and to maximize the improvement of ADL and QOL as patient outcomes. The role of pharmacists during rehabilitation is to treat patients as part of multidisciplinary teams and as key members of nutritional support teams. In this review, we aim to highlight existing evidence regarding pharmacotherapy in older adults, including drug-related functional impairment and the association between pharmacotherapy and functional, cognitive, and nutritional outcomes among patients undergoing rehabilitation. In addition, we highlight the important role of pharmacists in maximizing improvements in rehabilitation outcomes and minimizing drug-related adverse effects.
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Affiliation(s)
- Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto
Rehabilitation Hospital, Kumamoto, Japan
| | - Ayaka Matsumoto
- Department of Pharmacy, Kumamoto Rehabilitation Hospital,
Kumamoto, Japan
| | - Ryo Momosaki
- Department of rehabilitation medicine, Mie University
Graduate School of Medicine, Tsu, Japan
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Bu K, Patel D, Morris R, Han W, Umeukeje G, Zhu T, Cheng F. Dysphagia Risk in Patients Prescribed Rivastigmine: A Systematic Analysis of FDA Adverse Event Reporting System. J Alzheimers Dis 2022; 89:721-731. [PMID: 35964196 DOI: 10.3233/jad-220583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dysphagia has been reported as an adverse event for patients receiving rivastigmine for Alzheimer's disease (AD) treatment. OBJECTIVE The purpose of this study was to determine the association between dysphagia and the usage of rivastigmine by using the pharmacovigilance data from the FDA Adverse Event Reporting System (FAERS). METHODS The risk of dysphagia in patients who took rivastigmine was compared with those of patients who took other medications. In addition, this study sought to determine if the dysphagia risk was influenced by sex, age, dosage, and medication routes of administration. RESULTS When compared to patients prescribed donepezil, galantamine, or memantine, individuals prescribed rivastigmine were almost twice as likely to report dysphagia as an adverse event. The dysphagia risk in individuals prescribed rivastigmine is comparable to individuals prescribed penicillamine but significantly higher than clozapine, drugs of which have been previously shown to be associated with elevated dysphagia likelihood. Individuals older than 80 were 122% more likely to report having dysphagia after being prescribed rivastigmine than patients that were 50-70 years of age. Oral administration of rivastigmine was associated with approximately 2 times greater likelihood of reporting dysphagia relative to users of the transdermal patch. In addition, dysphagia showed higher association with pneumonia than other commonly reported adverse events. CONCLUSION Patients prescribed rivastigmine were at greater risk of reporting dysphagia as an adverse event than patients prescribed many other medicines. This increase in dysphagia occurrence may be attributed to the dual inhibition of both acetylcholinesterase and butyrylcholinesterase.
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Affiliation(s)
- Kun Bu
- Department of Mathematics & Statistics, College of Art and Science, University of South Florida, Tampa, FL, USA
| | - Devashru Patel
- College of Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Robert Morris
- Department of Pharmaceutical Science, Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
- Department of Biostatistics & Epidemiology, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Weiru Han
- Department of Mathematics & Statistics, College of Art and Science, University of South Florida, Tampa, FL, USA
| | - Gibret Umeukeje
- Department of Pharmaceutical Science, Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Tianrui Zhu
- Department of Pharmaceutical Science, Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Feng Cheng
- Department of Pharmaceutical Science, Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
- Department of Biostatistics & Epidemiology, College of Public Health, University of South Florida, Tampa, FL, USA
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Prevalence of oropharyngeal dysphagia in geriatric patients and real-life associations with diseases and drugs. Sci Rep 2021; 11:21955. [PMID: 34754078 PMCID: PMC8578645 DOI: 10.1038/s41598-021-99858-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 09/27/2021] [Indexed: 12/19/2022] Open
Abstract
Risk factors for oropharyngeal dysphagia (OD) in elderly patients are mainly central nervous system (CNS) and structural organic diseases or presbyphagia. We analysed the OD prevalence and association of OD with multimorbidity and polypharmacy using real-life data to complete this spectrum, with a focus on further and iatrogenic risk. This was a cross-sectional retrospective study based on a random sample of 200 patients admitted to a geriatric hospital. Data analysis included diagnoses, the detailed list of drugs, and an intense clinical investigation of swallowing according to Stanschus to screen for OD in each patient. The mean patient age was 84 ± 6.5 years. The prevalence of OD was 29.0%, without an effect of age, but a higher rate was found in men and in nursing home residents and an elevated risk of pneumonia. OD risk was slight in diabetes mellitus and COPD, and pronounced in CNS diseases. A relevant OD association was found, even after adjusting for CNS diseases, with antipsychotics, benzodiazepines, anti-Parkinson drugs, antidepressants, and antiepileptics. Further risk of OD was found with beta-blockers, alpha-blockers, opioids, antiemetics, antivertiginosa or antihistamines, metoclopramide, domperidone, anticholinergics, loop diuretics, urologics, and ophthalmics. From real-life data in patients with and without CNS diseases, we identified drug groups associated with a risk of aggravating/inducing OD. Restrictive indications for these drugs may be a preventative contribution, requiring implementation in dysphagia guidelines and an integrative dysphagia risk scale that considers all associated and cumulative medication risks in addition to diseases.
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Pu D, Wong MCH, Yiu EML, Chan KMK. Profiles of polypharmacy in older adults and medication associations with signs of aspiration. Expert Rev Clin Pharmacol 2021; 14:643-649. [PMID: 33764819 DOI: 10.1080/17512433.2021.1909474] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Polypharmacy and specific medication classes are prevalent in older adults. Their relationships with swallowing disorders are not well explored, which would best be managed holistically, with consideration of medication profiles. This study aimed to establish profiles of polypharmacy in older adults and investigate the associations of polypharmacy and medication class with signs of aspiration during swallowing. METHODS This was a secondary retrospective analysis of data from 291 adults aged 60 years and older. Polypharmacy was profiled numerically and described. Multivariate logistic regression was used to identify associations between medication classes with signs of aspiration, while controlling for independent variables of demographics, functional status, and medical history. RESULTS Three distinct profiles of polypharmacy were described. Higher numbers of medications were associated with higher age, lower functional status, nursing home residency, multimorbidity, and showing signs of aspiration. Thirty-four classes of medications were found in this study, benzodiazepines were the only class independently associated with signs of aspiration. CONCLUSIONS Different profiles of polypharmacy can be observed in older adults, but none were independently associated with signs of aspiration. In addition to known demographic and functional status variables, benzodiazepine-use was found to be independently associated with signs of aspiration (p = .005, B = 7.94).
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Affiliation(s)
- Dai Pu
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Michael C H Wong
- Registered Pharmacist, Pharmacy & Poisons Board of Hong Kong, Hong Kong, China
| | - Edwin M L Yiu
- Swallowing Research Laboratory, Faculty of Education, the University of Hong Kong, Hong Kong, China
| | - Karen M K Chan
- Swallowing Research Laboratory, Faculty of Education, the University of Hong Kong, Hong Kong, China
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15
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Fabian E, Gröchenig HP, Bauer PK, Eherer AJ, Gugatschka M, Binder L, Langner C, Fickert P, Krejs GJ. Clinical-Pathological Conference Series from the Medical University of Graz : Case No 171: A 37-year-old engineer with bolus hold-up (esophageal food impaction). Wien Klin Wochenschr 2021; 132:551-559. [PMID: 32601726 PMCID: PMC7518999 DOI: 10.1007/s00508-020-01694-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Elisabeth Fabian
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Hans Peter Gröchenig
- Department of Internal Medicine, Hospital Brothers of St. John of God, Sankt Veit an der Glan, Austria
| | - Philipp K Bauer
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Andreas J Eherer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Markus Gugatschka
- Division of Phoniatrics, Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria
| | - Lukas Binder
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Cord Langner
- Department of Pathology, Medical University of Graz, Graz, Austria
| | - Peter Fickert
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Guenter J Krejs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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16
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Abstract
Dysphagia is a common symptom which can vary in severity and aetiology; at one end, it can be a benign inconvenience, on the other, there can be serious morbidity associated with malnutrition. It is crucial to identify those with mucosal and structural disease, including malignancy as a priority first. Reflux disease is commonly a culprit and treating empirically with acid reducing medicines should follow exclusion of organic disease. Other benign conditions (including eosinophilic oesophagitis) should be considered. The clinical assessment of dysphagia begins with a detailed history and a focus on symptom severity as well as the pre-test probability of a given condition. Tests are then directed at assessing function, and should employ both high-resolution manometry and barium studies. For motility disorders, begin by assessing the oesophago-gastric junction for obstruction (eg achalasia), followed by oesophageal body function. The latter is divided into major and minor motility disorders. Treatment is directed according to the dysmotility phenotype and is based upon background fitness, age and appetite to intervention. Invasive treatment for achalasia is aimed at disrupting the lower oesophageal sphincter muscle while that of oesophageal body disorders is directed at reducing hypercontraction, improving peristalsis or reducing symptoms.
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Affiliation(s)
- Amir Mari
- Nazareth Hospital EMMS, Nazareth, Israel and Bar Ilan University, Safed, Israel
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17
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González-Fernández M, Arbones-Mainar JM, Ferrer-Lahuerta E, Perez-Nogueras J, Serrano-Oliver A, Torres-Anoro E, Sanz-Paris A. Ultrasonographic Measurement of Masseter Muscle Thickness Associates with Oral Phase Dysphagia in Institutionalized Elderly Individuals. Dysphagia 2021; 36:1031-1039. [PMID: 33462765 DOI: 10.1007/s00455-020-10234-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Oral phase dysphagia is dependent on ability to chew. As people age, general muscle atrophy contributes to decreased masseter strength. The main objective of this study was to assess the relationship between the thickness of the masseter muscle measured by ultrasonography and the presence of dysphagia in a group of institutionalized elderly people. As a secondary objective, we aimed to establish cutoff points of masseters muscle thickness (MMT) to identify elderly individuals at risk of oral dysphagia. METHODS Cross-sectional study of all residents from 3 nursing homes. All individuals underwent ultrasonographic measurements of left and right MMT and were classified according to the presence of dysphagia assessed by both the EAT-10 screening questionnaire and the volume-viscosity swallow test (V-VST). RESULTS 469 patients (69% women, mean age 84.7 yrs) were recruited. Dysphagia was present in 41.6% and 26% of individuals according the EAT-10 and V-VST, respectively. Multivariate logistic regression showed that 1 mm increase in MMT reduced the risk of dysphagia by 21% according to the EAT-10 tool and by 30% using the V-VST after adjusting for age, sex, mini-nutritional assessment score, and body mass index. We used receiver operative characteristic (ROC) curves to identify cutoff points of MMT to detect dysphagic individuals according to either EAT-10 or V-VST. CONCLUSIONS The MMT measured by ultrasonography is reduced in elderly individuals with dysphagia. Based on MMT, clinicians may be better informed about the patients'´ ability to masticate solid foods and identify potential nutrient deficiencies in geriatric settings.
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Affiliation(s)
| | - Jose M Arbones-Mainar
- Instituto de Investigacion Sanitaria Aragon (IIS-Aragon), Zaragoza, Spain. .,Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, University Hospital Miguel Servet, Instituto Aragones de Ciencias de la Salud (IACS), 50009, Zaragoza, Spain. .,Centro de Investigacion Biomedica en Red Fisiopatología Obesidad Y Nutricion (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.
| | | | | | | | | | - Alejandro Sanz-Paris
- Department of Nutrition, University Hospital Miguel Servet, Zaragoza, Spain.,Instituto de Investigacion Sanitaria Aragon (IIS-Aragon), Zaragoza, Spain
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18
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Drumond N, Stegemann S. Better Medicines for Older Patients: Considerations between Patient Characteristics and Solid Oral Dosage Form Designs to Improve Swallowing Experience. Pharmaceutics 2020; 13:pharmaceutics13010032. [PMID: 33379258 PMCID: PMC7824227 DOI: 10.3390/pharmaceutics13010032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 02/07/2023] Open
Abstract
Oral drug administration provided as solid oral dosage forms (SODF) remains the major route of drug therapy in primary and secondary care. There is clear evidence for a growing number of clinically relevant swallowing issues (e.g., dysphagia) in the older patient population, especially when considering the multimorbid, frail, and polymedicated patients. Swallowing impairments have a negative impact on SODF administration, which leads to poor adherence and inappropriate alterations (e.g., crushing, splitting). Different strategies have been proposed over the years in order to enhance the swallowing experience with SODF, by using conventional administration techniques or applying swallowing aids and devices. Nevertheless, new formulation designs must be considered by implementing a patient centric approach in order to efficiently improve SODF administration by older patient populations. Together with appropriate SODF size reductions, innovative film coating materials that can be applied to SODF and provide swallowing safety and efficacy with little effort being required by the patients are still needed. With that in mind, a literature review was conducted in order to identify the availability of patient centric coating materials claiming to shorten esophageal transit times and improve the overall SODF swallowing experience for older patients. The majority of coating technologies were identified in patent applications, and they mainly included well-known water soluble polymers that are commonly applied into pharmaceutical coatings. Nevertheless, scientific evidence demonstrating the benefits of given SODF coating materials in the concerned patient populations are still very limited. Consequently, the availability for safe, effective, and clinically proven solutions to address the increasing prevalence of swallowing issues in the older patient population is still limited.
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Affiliation(s)
- Nélio Drumond
- Correspondence: (N.D.); (S.S.); Tel.: +49-178-2144689 (N.D.); +49-172-6054869 (S.S.)
| | - Sven Stegemann
- Correspondence: (N.D.); (S.S.); Tel.: +49-178-2144689 (N.D.); +49-172-6054869 (S.S.)
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19
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Piersiala K, Akst LM, Hillel AT, Best SR. Laryngeal Pathologies and Their Associations With Mental Health Disorders. Laryngoscope 2020; 131:E231-E239. [PMID: 32511753 DOI: 10.1002/lary.28755] [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] [Received: 02/28/2020] [Revised: 04/03/2020] [Accepted: 04/27/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Mental health disorders are very common. Understanding their clinical manifestations in terms of voice and laryngeal disorders (VLD) is important because they constitute a significant proportion of all patients seen by otolaryngology-head and neck surgery. In this study, we examine different mental disorders (MDs) and their presenting symptoms and diagnoses of VLD. METHODS Case series study, retrospective chart review of patients seen between January 2016 and December 2017 at the Johns Hopkins Voice Center. Diagnoses, demographic data, and comorbidities were collected. VLD were grouped into categories (laryngeal pathology, functional voice disorders, airway, swallowing, other) for statistical analysis. RESULTS Of a total 4,249 patients, 836 patients (19.7%) suffered from at least one MD. Those patients presented more frequently with swallowing problems (24.9% of all diagnoses in MD compared to 21.2% in control group; adjusted odds ratio [aOR] 1.280, 95% confidence interval [CI] 1.107-1.480, P = .001) and less frequently with vocal cord pathology (30.9% of all diagnoses in MD compared to 33.9% in control group, aOR 0.793, 95% CI 0.694-0.907, P = .001). Patients suffering from depression had significantly increased odds for dysphagia (aOR 1.570, 95% CI 1.216-2.026, P = .001). VLD clinical presentation profile was created for every MD studied. CONCLUSION Patients suffering from mental health disorders present more frequently with swallowing complaints, in particular for dysphagia. Awareness of this can guide appropriate referrals. Objective laryngeal findings are common in patients with substance abuse disorders. They should be screened with careful diagnostic laryngoscopy. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E231-E239, 2021.
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Affiliation(s)
- Krzysztof Piersiala
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, Sweden.,Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Lee M Akst
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, Sweden
| | - Alexander T Hillel
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, Sweden
| | - Simon R Best
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, Sweden
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20
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Nishida T, Yamabe K, Ide Y, Honda S. Utility of the Eating Assessment Tool-10 (EAT-10) in Evaluating Self-Reported Dysphagia Associated with Oral Frailty in Japanese Community-Dwelling Older People. J Nutr Health Aging 2020; 24:3-8. [PMID: 31886801 DOI: 10.1007/s12603-019-1256-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of the present study was to verify the associations between dysphagia as screened by the Eating Assessment Tool-10 (EAT-10) and indicators in the 100-mL water swallowing test (WST) or medical history among community-dwelling older people. STUDY DESIGN A cross-sectional study. SETTING AND PARTICIPANTS The study participants were 202 community-dwelling older Japanese adults aged ≥65 years. MEASUREMENTS We investigated the participants' basic attributes, including age, sex, body mass index, medical history (cerebrovascular disease, respiratory disease: chronic obstructive pulmonary disease [COPD], and history of pneumonia within the previous year), and number of prescribed medications. Dysphagia assessment was performed using the EAT-10 and the 100-mL WST as subjective and objective examinations, respectively. The 100-mL WST used four indicators (SC: swallowing capacity, VS: volume per swallow, TS: time per swallow, and choking signs). Patients with and without dysphagia according to the EAT-10 were divided into two groups according to a cutoff score of 3, and the two groups were then compared in terms of their characteristics including medical history and 100-mL WST indicators. A multiple logistic regression model was used to determine whether the indicators of the 100-mL WST or medical history were independently associated with dysphagia in the EAT-10. RESULTS The multiple logistic regression analysis revealed that dysphagia in the EAT-10 was independently associated with male sex (odds ratio [OR] = 2.78; 95% confidence interval [CI] = 0.98-7.90), COPD (OR = 14.68; 95% CI = 3.14-68.85), and VS and TS in the 100-mL WST (OR = 0.85; 95% CI = 0.80-0.90 and OR = 3.03; 95% CI = 1.78-5.16, respectively). CONCLUSIONS Our results revealed that the EAT-10 was independently associated with the 100-mL WST and respiratory disease. We propose that swallowing rehabilitation incorporating respiratory training could be effective for older people screened using the EAT-10.
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Affiliation(s)
- T Nishida
- Sumihisa Honda, Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8520, Japan, TEL.: +81-95-819-7945, FAX.: +81-95-819-7907, E-mail:
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21
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Symptoms Suggestive of Dysphagia and the Quality of Life in Cocaine and/or Crack Users. Dysphagia 2019; 35:121-128. [PMID: 31055647 DOI: 10.1007/s00455-019-10013-0] [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] [Received: 10/31/2018] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
Abstract
Users of cocaine and/or crack may present symptoms of dysphagia due to changes in anatomical structures caused by the use of these substances. The objective of this study was to investigate the presence of symptoms suggestive of dysphagia in users of cocaine and/or crack seeking treatment, as well as to investigate the quality of life of these individuals related to their swallowing condition. A cross-sectional study from September 2015 to December 2016, with 121 users of cocaine and/or crack, was conducted. 59 of them called a telemarketing service and 61 sought treatment at the Centro de Atenção Psicossocial Álcool e Drogas in Porto Alegre (Psychosocial Alcohol and Drug Center). Users were screened and asked to fill the Eating Assessment Tool questionnaire. Users who presented themselves at the center were submitted to the Tool Volume-Viscosity Swallow Test. Users with symptoms of dysphagia responded to the Quality of Life in Swallowing questionnaire. Of all the interviewees, 22.3% (n = 27) reported symptoms suggestive of dysphagia and 2% of the individuals, submitted to swallowing test, presented cough in the liquid consistency. The scores showed a negative impact on quality of life, mainly related to fatigue, sleep, feeding duration, and fear of eating. Significant numbers of users of cocaine and/or crack referred to symptoms suggestive of dysphagia and significant impairments in quality of life, which require specific care in feeding this population in order to assist in their rehabilitation.
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22
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Clinical Characteristics and Associated Systemic Diseases in Patients With Esophageal "Absent Contractility"-A Clinical Algorithm. J Clin Gastroenterol 2019; 53:184-190. [PMID: 29356781 DOI: 10.1097/mcg.0000000000000989] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
GOALS This study was carried out to assess the clinical characteristics and associated systemic diseases seen in patients diagnosed with absent contractility as per the Chicago Classification version 3.0, allowing us to propose a diagnostic algorithm for their etiologic testing. BACKGROUND The Chicago Classification version 3.0 has redefined major and minor esophageal motility disorders using high-resolution esophageal manometry. There is a dearth of publications based on research on absent contractility, which historically has been associated with myopathic processes such as systemic sclerosis (SSc). STUDY We conducted a retrospective, multicenter study. Data of patients diagnosed with absent contractility were pooled from Cleveland Clinic, Cleveland, OH (January 2006 to July 2016) and Metrohealth Medical Center, Cleveland, OH (July 2014 to July 2016) and included: age, gender, associated medical conditions, surgical history, medications, and specific antibody testing. RESULTS A total of 207 patients, including 57 male individuals and 150 female individuals, with mean age of 56.1 and 60.0 years, respectively, were included. Disease distribution was as follows: SSc (diffuse or limited cutaneous) 132, overlap syndromes 7, systemic lupus erythematosus17, Sjögren syndrome 4, polymyositis 3, and dermatomyositis 3. Various other etiologies including gastroesophageal reflux disease, postradiation esophagitis, neuromuscular disorders, and surgical complications were seen in the remaining cohort. CONCLUSIONS Most practitioners use the term "absent contractility" interchangeably with "scleroderma esophagus"; however, only 63% of patients with absent contractility had SSc. Overall, 20% had another systemic autoimmune rheumatologic disease and 16% had a nonrheumatologic etiology for absent contractility. Therefore, alternate diagnosis must be sought in these patients. We propose an algorithm for their etiologic evaluation.
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23
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Swallowing dysfunction as risk factor for undernutrition in older people admitted to Swedish short-term care: a cross-sectional study. Aging Clin Exp Res 2019; 31:85-94. [PMID: 29663160 DOI: 10.1007/s40520-018-0944-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/03/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Swallowing dysfunction and risk of undernutrition increase the risk of pneumonia, morbidity, and mortality. Short-term care is an unexplored care context, where many older people stay yearly. AIM This cross-sectional study aimed to describe and analyze the relationship between swallowing dysfunction and risk of undernutrition among older people in short-term care, including potential gender-related differences. METHODS In total, 391 people (209 women), aged ≥ 65 years (median age 84 years) and admitted to short-term care in five Swedish counties participated. They went through a timed water swallow test to assess swallowing dysfunction, including abnormal swallowing capacity and signs of aspiration (i.e., cough and voice change). Risk for undernutrition was assessed using the Minimal Eating Observation and Nutrition Form-version II. RESULTS Swallowing dysfunction was observed in 248 of 385 (63%) participants, including abnormal swallowing capacity in 213 of 385 (55%) and aspiration signs in 127 of 377 (34%). Abnormal swallowing capacity was more frequent among women (p = 0.030), whereas men with normal swallowing capacity exhibited signs of aspiration more frequently (cough p = 0.038, voice change p = 0.004). Risk of undernutrition was found in 91 of 390 (23%) participants, more frequently among women (p = 0.007). A logistic regression model revealed an increased risk of undernutrition among older people with abnormal swallowing capacity (OR 1.74, 95% CI 1.04-2.92, p = 0.034). CONCLUSIONS The high prevalence of swallowing dysfunction and risk of undernutrition highlight the need for a systematic screening program and feasible treatment to improve swallowing function for adequate and safe food intake among older people in short-term care. CLINICAL TRIAL REGISTRATION This study was registered with ClinicalTrials.gov on July 4, 2016, under NCT02825927.
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Sestili M, Logrippo S, Cespi M, Bonacucina G, Ferrara L, Busco S, Grappasonni I, Palmieri GF, Ganzetti R, Blasi P. Potentially Inappropriate Prescribing of Oral Solid Medications in Elderly Dysphagic Patients. Pharmaceutics 2018; 10:pharmaceutics10040280. [PMID: 30558366 PMCID: PMC6321461 DOI: 10.3390/pharmaceutics10040280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 12/10/2018] [Indexed: 11/16/2022] Open
Abstract
Pharmaceutical formulations suitable for dysphagic patients are not always commercially available, motivating caregivers to crush tablets or open capsules to facilitate swallowing. Since this action may modify the characteristics of the medicine, it should be considered potentially inappropriate. This paper is the first to focus on how hospitalization affected the rate of potentially inappropriate prescriptions (PIPs) and the incidence of dosage form-related PIPs in elderly patients with dysphagia. Data was collected by reviewing patient medical records in the Italian National Research Center on Aging of Ancona. The therapy at admission and discharge was analysed in terms of: inappropriate drug associations, inappropriate drugs for dysphagic patients, inappropriate dosage forms and inappropriate dosage form modifications. Forty-one dysphagic patients with an average age of 88.3 years were included in the study and 451 prescriptions were analysed. PIPs were widespread at admission, and hospitalization did not improve the situation in a statistically significant manner. The most common PIPs identified (>80%) were related to dosage form selection and modification. This study highlights a clear need for continuing medical education about prescription appropriateness and modification of solid dosage forms in patients with dysphagia.
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Affiliation(s)
- Matteo Sestili
- Hospital Pharmacy, Italian National Research Center on Aging (INRCA), via della Montagnola 81, 60127 Ancona, Italy.
| | - Serena Logrippo
- School of Pharmacy, University of Camerino, via Gentile III da Varano, 62032 Camerino, Italy.
- International School of Advanced Studies (ISAS), University of Camerino, Via Camillo Lili 55, 62032 Camerino, Italy.
| | - Marco Cespi
- School of Pharmacy, University of Camerino, via Gentile III da Varano, 62032 Camerino, Italy.
| | - Giulia Bonacucina
- School of Pharmacy, University of Camerino, via Gentile III da Varano, 62032 Camerino, Italy.
| | - Letizia Ferrara
- Medical Direction, Italian National Research Center on Aging (INRCA), via della Montagnola 81, 60127 Ancona, Italy.
| | - Silvia Busco
- School of Pharmacy, University of Camerino, via Gentile III da Varano, 62032 Camerino, Italy.
| | - Iolanda Grappasonni
- School of Pharmacy, University of Camerino, via Gentile III da Varano, 62032 Camerino, Italy.
| | | | - Roberta Ganzetti
- Hospital Pharmacy, Italian National Research Center on Aging (INRCA), via della Montagnola 81, 60127 Ancona, Italy.
| | - Paolo Blasi
- School of Pharmacy, University of Camerino, via Gentile III da Varano, 62032 Camerino, Italy.
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Mulheren RW, Humbert IA, Cappola AR, Fried LP, González-Fernández M. Taste Perception and Water Swallow Screen Results in Old-Old Women. Geriatrics (Basel) 2018; 3:geriatrics3040083. [PMID: 31011118 PMCID: PMC6371139 DOI: 10.3390/geriatrics3040083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/09/2018] [Accepted: 11/15/2018] [Indexed: 11/30/2022] Open
Abstract
Changes in both swallowing and taste commonly occur in advanced age, though the relationship between the two is unknown. This study examined the association between a water swallow screen test and taste identification and intensity rating. Participants included 47 community-dwelling women aged 85–94 years. Participants completed three trials of a water swallow screen and were observed for signs of aspiration, which, if present, indicated failure. Four pure taste stimuli at low and high concentrations and water were presented, and participants selected one of five taste labels and rated their intensity on the generalized Labeled Magnitude Scale. Ratios of intensity ratings were computed for each taste stimulus to compare the perception of low and high concentrations. The association between water swallow screen failure, correct taste identification, and taste intensity ratio was evaluated with logistic regression modeling, with mediating factors of frailty and number of comorbidities. Failure of three water swallow screen trials was associated with a higher taste intensity ratio for caffeine (bitter) and a lower taste intensity ratio for sucrose (sweet). Correct identification of taste, frailty, and number of comorbidities were not associated with failure of any number of water swallow screen trials. Intensity ratings of certain tastes may be associated with swallowing in old-old women. Heightened vigilance in this population may be necessary to prevent complications related to dietary intake.
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Affiliation(s)
- Rachel W Mulheren
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Ianessa A Humbert
- Swallowing Systems Core, Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL 32612, USA.
- Rehabilitation Sciences, College of Health and Health Professions, University of Florida, Gainesville, FL 32612, USA.
- Department of Neurology, University of Florida, Gainesville, FL 32612, USA.
| | - Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Linda P Fried
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | - Marlís González-Fernández
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Oesophageal dysphagia: a stepwise approach to diagnosis and management. Lancet Gastroenterol Hepatol 2018; 2:604-609. [PMID: 28691686 DOI: 10.1016/s2468-1253(17)30001-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 12/19/2022]
Abstract
Dysphagia is a common symptom in the general population. Incidence varies depending on the specific definition used. A good medical history is vital for distinguishing true oesophageal dysphagia from oropharyngeal dysphagia or other causes. Oesophageal dysphagia is a so-called red flag alarm symptom requiring oesophagogastroduodenoscopy. However, even after investigations including oesophagogastroduodenoscopy (with biopsy), barium swallow, and oesophageal manometry, no obstructive cause may be found. This Review suggests an algorithm of history-taking and investigation to allow the causes of non-obstructive dysphagia to be identified, including functional dysphagia. The Review then discusses management strategies and outcomes for functional dysphagia.
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Affiliation(s)
- M Payne
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Huppertz VAL, Halfens RJG, van Helvoort A, de Groot LCPGM, Baijens LWJ, Schols JMGA. Association between Oropharyngeal Dysphagia and Malnutrition in Dutch Nursing Home Residents: Results of the National Prevalence Measurement of Quality of Care. J Nutr Health Aging 2018; 22:1246-1252. [PMID: 30498833 PMCID: PMC6302767 DOI: 10.1007/s12603-018-1103-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Nursing home residents often suffer from multi-morbidities and geriatric syndromes leading to lower quality of life or mortality. Oropharyngeal dysphagia (OD) and malnutrition are profound conditions in this complex profile of multi-morbidities and are associated with deprived mental -and physical health status, e.g. aspiration pneumonia or dehydration. This study aimed to assess the association between OD and malnutrition in Dutch nursing home residents. DESIGN Data for this cross-sectional study were obtained from the annual National Prevalence Measurement of Quality of Care (LPZ). SETTING The National Prevalence Measurement of Quality of Care was conducted in Nursing Homes in The Netherlands. PARTICIPANTS Participants were nursing home residents age 65 or older and admitted to psychogeriatric- or somatic wards. MEASUREMENTS The measurements were taken by trained nurses from the participating nursing homes. Anthropometric measurements and unintended weight loss (%) were assessed to determine nutritional status (malnutrition). OD was assessed by means of a standardized questionnaire assessing clinically relevant symptoms of OD such as swallowing problems or sneezing/coughing while swallowing. Cox regression was applied to assess the association between malnutrition and clinically relevant symptoms of OD in older Dutch nursing home residents. RESULTS Approximately 12% of the residents suffered from swallowing problems and 7% sneezed/coughed while swallowing liquids or solid foods. Approximately 10% of the residents was malnourished. Residents with OD symptoms were more often malnourished compared to residents without OD symptoms. Approximately 17% of the problematic swallowers were concurrently malnourished. Increased risk for malnutrition was found in residents suffering from swallowing problems (PR 1.5, 95%CI 1.2-1.9), as well as in residents that sneezed/coughed while swallowing (PR 1.3, 95%CI 1.0-1.7). Stratification based on wards revealed that problematic swallowers from somatic wards were at a high risk of malnutrition (PR 1.9, 95%CI 1.3-2.8). CONCLUSION Clinically relevant symptoms of oropharyngeal dysphagia, such as swallowing problems and sneezing/coughing while swallowing are associated with increased risk of malnutrition in psychogeriatric and somatic Dutch nursing home residents.
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Affiliation(s)
- V A L Huppertz
- Viviënne A.L. Huppertz, MSc. Maastricht University: Department of Pulmonology, P.O. Box 616, 6200 MD Maastricht, The Netherlands,
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Prosiegel M, Weber S. Mit Schluckstörungen assoziierte Erkrankungen. DYSPHAGIE 2018:69-133. [DOI: 10.1007/978-3-662-56132-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Philpott H, Garg M, Tomic D, Balasubramanian S, Sweis R. Dysphagia: Thinking outside the box. World J Gastroenterol 2017; 23:6942-6951. [PMID: 29097867 PMCID: PMC5658312 DOI: 10.3748/wjg.v23.i38.6942] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/29/2017] [Accepted: 09/26/2017] [Indexed: 02/07/2023] Open
Abstract
Dysphagia is a common symptom that is important to recognise and appropriately manage, given that causes include life threatening oesophageal neoplasia, oropharyngeal dysfunction, the risk of aspiration, as well as chronic disabling gastroesophageal reflux (GORD). The predominant causes of dysphagia varies between cohorts depending on the interplay between genetic predisposition and environmental risk factors, and is changing with time. Currently in white Caucasian societies adopting a western lifestyle, obesity is common and thus associated gastroesophageal reflux disease is increasingly diagnosed. Similarly, food allergies are increasing in the west, and eosinophilic oesophagitis is increasingly found as a cause. Other regions where cigarette smoking is still prevalent, or where access to medical care and antisecretory agents such as proton pump inhibitors are less available, benign oesophageal peptic strictures, Barrett's oesophagus, adeno- as well as squamous cell carcinoma are endemic. The evaluation should consider the severity of symptoms, as well as the pre-test probability of a given condition. In young white Caucasian males who are atopic or describe heartburn, eosinophilic esophagitis and gastroesophageal reflux disease will predominate and a proton pump inhibitor could be commenced prior to further investigation. Upper gastrointestinal endoscopy remains a valid first line investigation for patients with suspected oesophageal dysphagia. Barium swallow is particularly useful for oropharyngeal dysphagia, and oesophageal manometry mandatory to diagnose motility disorders.
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Affiliation(s)
- Hamish Philpott
- Department of Gastroenterology, Eastern Health Clinical School Monash University, Melbourne 3128, Australia
| | - Mayur Garg
- Department of Gastroenterology, Eastern Health Clinical School Monash University, Melbourne 3128, Australia
| | - Dunya Tomic
- Department of Gastroenterology, Eastern Health Clinical School Monash University, Melbourne 3128, Australia
| | - Smrithya Balasubramanian
- Department of Gastroenterology, Eastern Health Clinical School Monash University, Melbourne 3128, Australia
| | - Rami Sweis
- University College London, London NW1 2BU, United Kingdom
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Pelsőczi P, Lévay G. Effect of Scopolamine on Mice Motor Activity, Lick Behavior and Reversal Learning in the IntelliCage. Neurochem Res 2017; 42:3597-3602. [PMID: 29071534 DOI: 10.1007/s11064-017-2408-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/12/2017] [Accepted: 09/21/2017] [Indexed: 01/03/2023]
Abstract
Automated homecage monitoring systems are now widely recognized and used tools in cognitive neuroscience. However, few of these studies cover pharmacological interventions. Scopolamine, an anticholinergic memory disrupting agent is frequently used to study learning behavior. We studied the impact of scopolamine treatment in a relevant dose-range on activity, drinking behavior and reversal learning of C57BL/DJ mice in a homecage-like, social environment, using the IntelliCage. Naïve mice were first habituated to the IntelliCage, where they learned to nosepoke in any of the four corners in order to gain access to the water reward. Visits, nosepokes, lick numbers and durations were recorded. Mice were then trained to distinguish between a rewarded correct corner and punished, incorrect corners. Later, in the reversal learning phase, the assigned correct corner was rotated clockwise every 24 h. Upon s.c. administration of scopolamine general activity represented by visit and nosepoke numbers increased, but their durations were shorter. Surprisingly, general activity and lick behavior were drastically altered. Scopolamine also significantly reduced the ability to perform a reversal learning task. We not only found significant decline in reversal learning due to scopolamine treatment, but studied the method specific underlying behaviors: the general activity and lick behavior as well.
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Affiliation(s)
- Péter Pelsőczi
- Laboratory of Cognitive Pharmacology, Gedeon Richter Plc., Gyömrői út 19-21, Budapest, 1103, Hungary
| | - György Lévay
- Laboratory of Cognitive Pharmacology, Gedeon Richter Plc., Gyömrői út 19-21, Budapest, 1103, Hungary.
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Tsujimura T, Sakai S, Suzuki T, Ujihara I, Tsuji K, Magara J, Canning BJ, Inoue M. Central inhibition of initiation of swallowing by systemic administration of diazepam and baclofen in anaesthetized rats. Am J Physiol Gastrointest Liver Physiol 2017; 312:G498-G507. [PMID: 28254772 PMCID: PMC6347068 DOI: 10.1152/ajpgi.00299.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 02/15/2017] [Accepted: 02/26/2017] [Indexed: 01/31/2023]
Abstract
Dysphagia is caused not only by neurological and/or structural damage but also by medication. We hypothesized memantine, dextromethorphan, diazepam, and baclofen, all commonly used drugs with central sites of action, may regulate swallowing function. Swallows were evoked by upper airway (UA)/pharyngeal distension, punctate mechanical stimulation using a von Frey filament, capsaicin or distilled water (DW) applied topically to the vocal folds, and electrical stimulation of a superior laryngeal nerve (SLN) in anesthetized rats and were documented by recording electromyographic activation of the suprahyoid and thyrohyoid muscles and by visualizing laryngeal elevation. The effects of intraperitoneal or topical administration of each drug on swallowing function were studied. Systemic administration of diazepam and baclofen, but not memantine or dextromethorphan, inhibited swallowing evoked by mechanical, chemical, and electrical stimulation. Both benzodiazepines and GABAA receptor antagonists diminished the inhibitory effects of diazepam, whereas a GABAB receptor antagonist diminished the effects of baclofen. Topically applied diazepam or baclofen had no effect on swallowing. These data indicate that diazepam and baclofen act centrally to inhibit swallowing in anesthetized rats.NEW & NOTEWORTHY Systemic administration of diazepam and baclofen, but not memantine or dextromethorphan, inhibited swallowing evoked by mechanical, chemical, and electrical stimulation. Both benzodiazepines and GABAA receptor antagonists diminished the inhibitory effects of diazepam, whereas a GABAB receptor antagonist diminished the effects of baclofen. Topical applied diazepam or baclofen was without effect on swallowing. Diazepam and baclofen act centrally to inhibit swallowing in anesthetized rats.
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Affiliation(s)
- Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and
| | - Shogo Sakai
- 1Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and
| | - Taku Suzuki
- 1Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and
| | - Izumi Ujihara
- 1Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and
| | - Kojun Tsuji
- 1Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and
| | - Jin Magara
- 1Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and
| | | | - Makoto Inoue
- 1Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and
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Effects of Change in Tongue Pressure and Salivary Flow Rate on Swallow Efficiency Following Chemoradiation Treatment for Head and Neck Cancer. Dysphagia 2016; 31:687-96. [PMID: 27492408 DOI: 10.1007/s00455-016-9733-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 07/18/2016] [Indexed: 01/24/2023]
Abstract
Patients treated with chemoradiation for head and neck cancer frequently develop dysphagia. Tissue damage to the oral tongue causing weakness along with decreases in saliva production may contribute to dysphagia. Yet, effects of these variables on swallowing-related measures are unclear. The purpose of this study was (1) to determine effects of chemoradiation on tongue pressures, as a surrogate for strength, and salivary flow rates and (2) to elucidate relationships among tongue pressures, saliva production, and swallowing efficiency by bolus type. Twenty-one patients with head and neck cancer treated with chemoradiation were assessed before and after treatment and matched with 21 healthy control participants who did not receive chemoradiation. Each participant was given a questionnaire to rate dysphagia symptoms. Videofluoroscopic Evaluation of Swallowing (VFES) was used to determine swallowing efficiency; the Saxon test measured salivary flow rate; and the Iowa Oral Performance Instrument (IOPI) was used for oral tongue maximum and endurance measures. Results revealed significantly lower tongue endurance measures for patients post-treatment as compared to controls (p = .012). Salivary flow rates also were lower compared to pre-treatment (p = .000) and controls (p = .000). Simple linear regression analyses showed that change in salivary flow rate was predictive of change in swallow efficiency measures from pre- to post-treatment for 1 mL thin liquid (p = .017), 3 mL nectar-thick liquid (p = .026), and 3 mL standard barium pudding (p = .011) boluses. Based on these findings, it appears that chemoradiation treatment affects tongue endurance and salivary flow rate, and these changes may impact swallow efficiency. These factors should be considered when planning treatment for dysphagia.
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Serrano Santos JM, Poland F, Wright D, Longmore T. Medicines administration for residents with dysphagia in care homes: A small scale observational study to improve practice. Int J Pharm 2016; 512:416-421. [PMID: 26906457 DOI: 10.1016/j.ijpharm.2016.02.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the UK, 69.5% of residents in care homes are exposed to one or more medication errors and 50% have some form of dysphagia. Hospital research identified that nurses frequently crush tablets to facilitate swallowing but this has not been explored in care homes. This project aimed to observe the administration of medicines to patients with dysphagia (PWD) and without in care homes. METHOD A convenient sample of general practitioners in North Yorkshire invited care homes with nursing, to participate in the study. A pharmacist specialised in dysphagia observed nurses during drug rounds and compared these practices with national guidelines. Deviations were classified as types of medication administration errors (MAEs). RESULTS Overall, 738 administrations were observed from 166 patients of which 38 patients (22.9%) had dysphagia. MAE rates were 57.3% and 30.8% for PWD and those without respectively (p<0.001). PWD were more likely to experience inappropriate prescribing (IP). Signs of aspiration were more frequently observed in PWD when IP occurred (p<0.001). CONCLUSION Observation of medication administration practices by independent pharmacists may enable the identification of potentially dangerous practices and be used as a method of staff support. Unidentified signs of aspiration suggest that nurses require training in dysphagia and need to communicate its presence to the resident's GP. Further research should explore the design of an effective training for nurses.
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Affiliation(s)
- Jose Manuel Serrano Santos
- Pharmacy Practice, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.
| | - Fiona Poland
- Social Research Methodology, School of Health Sciences, University of East Anglia, Norfolk NR4 7TJ, United Kingdom.
| | - David Wright
- Pharmacy Practice, School of Pharmacy, University of East Anglia, Norfolk NR4 7TJ, United Kingdom.
| | - Timothy Longmore
- York Road Surgery, Elvington, York, North Yorkshire YO41 4DY, United Kingdom.
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36
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Holmes SRM, Sabel AL, Gaudiani JL, Gudridge T, Brinton JT, Mehler PS. Prevalence and management of oropharyngeal dysphagia in patients with severe anorexia nervosa: A large retrospective review. Int J Eat Disord 2016; 49:159-66. [PMID: 26316316 DOI: 10.1002/eat.22441] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Oropharyngeal dysphagia (OPD) refers to difficulty swallowing food or a liquid bolus from the oral and pharyngeal cavities into the esophagus and increases the risk of possibly life-threatening pneumonia. Little has been reported on OPD in adults with anorexia nervosa (AN). This study includes a description of OPD in severe AN and discusses potentially effective clinical management. METHOD Two hundred and six adults with severe AN, admitted over a five-year period to a national referral center specializing in the multidisciplinary medical stabilization of this population, were retrospectively evaluated by electronic database query and manual chart review. All patients whose initial medical assessment triggered a speech-language pathology (SLP) consultation, due to concerns for OPD, were reviewed in detail. RESULTS Of the 206 total patients, 42 presented with symptoms of OPD and received SLP consultation. In the OPD cohort, 37 (88%) were women, with median age 32 years old, and mean admission weights of 57% ideal body weight (IBW) and body mass index (BMI) of 12 kg/m(2). Compared with those who did not have OPD, OPD patients had significantly lower BMI on admission (12 kg/m(2) vs. 13.1 kg/m(2), p < 0.001), longer stay (21 days vs. 14 days, p < 0.001), and were more medically compromised, including a greater incidence of refeeding hypophosphatemia (60.9% vs. 29.7%, p < 0.004). DISCUSSION Clinical awareness of OPD may reduce the incidence of aspiration pneumonia and promote life-saving oral nutrition in patients with severe AN. Proper, timely evaluation and intervention may improve clinical outcomes.
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Affiliation(s)
- Samantha R M Holmes
- Department of Rehabilitation, Denver Health Medical Center, Denver, Colorado
| | - Allison L Sabel
- Department of Patient Safety and Quality, Denver Health Medical Center, Denver, Colorado.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Denver, Colorado
| | - Jennifer L Gaudiani
- ACUTE Center for Eating Disorders at Denver Health Medical Center, Denver, Colorado.,Department of Medicine, University of Colorado Denver, Denver, Colorado
| | - Tricia Gudridge
- Department of Rehabilitation, Denver Health Medical Center, Denver, Colorado
| | - John T Brinton
- ACUTE Center for Eating Disorders at Denver Health Medical Center, Denver, Colorado.,Department of Medicine, University of Colorado Denver, Denver, Colorado
| | - Philip S Mehler
- ACUTE Center for Eating Disorders at Denver Health Medical Center, Denver, Colorado.,Department of Medicine, University of Colorado Denver, Denver, Colorado.,Eating Recovery Center, Denver, Colorado
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Arens C, Herrmann IF, Rohrbach S, Schwemmle C, Nawka T. Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - Current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc02. [PMID: 26770277 PMCID: PMC4702052 DOI: 10.3205/cto000117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Swallowing disorders are frequent. The main concern is mortality due to aspiration-induced pneumonia and malnutrition. In addition, quality of life is severely affected. The demographic trend indicates an increase of dysphagia in the future. Neurodegenerative diseases, tumors of the digestive tract, and sequelae of tumor treatment in the head and neck region are the main pathologic entities. Predominantly ENT physicians and phoniatricians are asked for diagnostics and therapy, and will coordinate the interdisciplinary treatment according to the endoscopic findings. A differentiated approach in history, diagnostics, and symptom-oriented treatment is necessary for these mostly complex disorders. Integration of non-medical staff such as speech therapists, physiotherapists, and occupational therapists in planning and executing an effective therapy expands and completes the patient-oriented care. Conservative treatment by these therapists is an important pillar in the treatment. Parts of the specific diagnostics can be taken over in close cooperation. In particular, an interdisciplinary cooperation with the staff of intensive care medicine is essential. The diagnostic procedures of specific endoscopy as described in this position paper are part of the primary and fundamental tasks of ENT specialists and phoniatrists. Endoscopy is a medical service that is basically not delegable. Consequently, substitution of the physician is excluded.
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Affiliation(s)
- Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Magdeburg, Otto-von-Guericke-University Magdeburg, Germany
| | | | - Saskia Rohrbach
- Department of Audiology and Phoniatrics, Charité - University Medicine of Berlin, Germany
| | - Cornelia Schwemmle
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Magdeburg, Otto-von-Guericke-University Magdeburg, Germany
| | - Tadeus Nawka
- Department of Audiology and Phoniatrics, Charité - University Medicine of Berlin, Germany
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Arens C, Herrmann IF, Rohrbach S, Schwemmle C, Nawka T. [Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children and adults]. Laryngorhinootologie 2015; 94 Suppl 1:S306-S354. [PMID: 25860495 DOI: 10.1055/s-0035-1545298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Position Paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - Current State of Clinical and Endoscopic Diagnostics, Evaluation, and Therapy of Swallowing Disorders in Children and AdultsSwallowing disorders are frequent. The main concern is mortality due to aspiration induced pneumonia and malnutrition. On the other hand quality of life is severely affected. The demographic trend indicates an increase of dysphagia in the future. Neurodegenerative diseases, tumors of the digestive tract and sequelae of tumor treatment in the head and neck region are the main pathologic entities.Predominantly ENT physicians and phoniatrists, are asked for diagnostics and therapy who will coordinate the interdisciplinary treatment according to the endoscopic findings.A differentiated approach in history, diagnostics, and symptom oriented treatment is necessary for the mostly complex disorders. The integration of non-medical personnel such as logopeds (speech language pathologists), physiotherapists, and occupational therapists in planning and executing an effective therapy expands and completes the patient-oriented care. Conservative treatment by these therapists is an important pillar in the treatment. Parts of the specific diagnostics can be taken over by them in close cooperation.In particular an interdisciplinary cooperation with the staff from intensive care medicine is indispensable.The diagnostic procedures of specific endoscopy as described in this position paper are part of the primary and fundamental tasks of ENT specialists and phoniatrists.Endoscopy is a medical service that is basically not delegable. Consequently substitution of the physician is precluded.
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Affiliation(s)
- C Arens
- Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Magdeburg AöR, Otto-von-Guericke-Universität, Magdeburg
| | | | - S Rohrbach
- Klinik für Audiologie und Phoniatrie, Charité - Universitätsmedizin Berlin, Berlin
| | - C Schwemmle
- Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Magdeburg AöR, Otto-von-Guericke-Universität, Magdeburg
| | - T Nawka
- Klinik für Audiologie und Phoniatrie, Charité - Universitätsmedizin Berlin, Berlin
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Abstract
Drug-induced gastrointestinal disorders can mimic conditions, such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) and, hence, recognition can prevent unnecessary investigations and treatment. While the knowledge and awareness relating to the adverse gastrointestinal effects of some medications, such as non-steroidal anti-inflammatory drugs are well established, other commonly prescribed drugs, such as antipsychotics, antidepressants and metformin are less well understood and warrant further study. This review attempts to integrate recent information regarding adverse drug reactions and place this in a useful clinical context.
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Affiliation(s)
- H L Philpott
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia Box Hill Hospital, Melbourne, Australia The Alfred Hospital, Melbourne, Australia
| | - S Nandurkar
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia Box Hill Hospital, Melbourne, Australia
| | - J Lubel
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia Box Hill Hospital, Melbourne, Australia
| | - P R Gibson
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia Box Hill Hospital, Melbourne, Australia The Alfred Hospital, Melbourne, Australia
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Philpott HL, Nandurkar S, Lubel J, Gibson PR. Drug-induced gastrointestinal disorders. Frontline Gastroenterol 2014; 5:49-57. [PMID: 28839751 PMCID: PMC5369702 DOI: 10.1136/flgastro-2013-100316] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 05/16/2013] [Indexed: 02/04/2023] Open
Abstract
Drug-induced gastrointestinal disorders can mimic conditions, such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) and, hence, recognition can prevent unnecessary investigations and treatment. While the knowledge and awareness relating to the adverse gastrointestinal effects of some medications, such as non-steroidal anti-inflammatory drugs are well established, other commonly prescribed drugs, such as antipsychotics, antidepressants and metformin are less well understood and warrant further study. This review attempts to integrate recent information regarding adverse drug reactions and place this in a useful clinical context.
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Affiliation(s)
- H L Philpott
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia,Box Hill Hospital, Melbourne, Australia,The Alfred Hospital, Melbourne, Australia
| | - S Nandurkar
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia,Box Hill Hospital, Melbourne, Australia
| | - J Lubel
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia,Box Hill Hospital, Melbourne, Australia
| | - P R Gibson
- Department of Gastroenterology, Monash University, Eastern Health, Melbourne, Victoria, Australia,Box Hill Hospital, Melbourne, Australia,The Alfred Hospital, Melbourne, Australia
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Swallowing dysfunction and dysphagia is an unrecognized challenge for oral drug therapy. Int J Pharm 2012; 430:197-206. [DOI: 10.1016/j.ijpharm.2012.04.022] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/30/2012] [Accepted: 04/02/2012] [Indexed: 01/03/2023]
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Swallowing disorders, pneumonia and respiratory tract infectious disease in the elderly. Rev Mal Respir 2011; 28:e76-93. [DOI: 10.1016/j.rmr.2011.09.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Dysphagia clinicians are aware that best practices guidelines recommend a medications review as part of the assessment process. This article aims to review the literature to date regarding the impact that medications may have on the physiology of swallowing. It is important to consider the side effects of all medications, not only medications listing swallowing difficulties as a known side effect. Medications that impact upon arousal, awareness, and xerostomia should also be considered as part of a comprehensive dysphagia evaluation. Speech-language pathologists should consider the pharmacist an integral dysphagia team member and a valuable resource.
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Abstract
Aspiration pneumonia and pneumonitis are common clinical syndromes that occur in hospitalized patients. Aspiration pneumonia occurs in patients with dysphagia and usually presents as a community-acquired pneumonia with a focal infiltrate in a dependent bronchopulmonary segment. Patients with aspiration pneumonia require treatment with broad-spectrum antibiotics and management of the underlying dysphagia. Aspiration pneumonitis follows the aspiration of gastric contents, usually in patients with a marked decreased level of consciousness. Treatment of aspiration pneumonitis is essentially supportive; however, corticosteroids and other immunomodulating agents may have a role in these patients.
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Affiliation(s)
- Paul E Marik
- Eastern Virginia Medical School, Norfolk, VA 23507, USA.
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47
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Abstract
The effects of drugs on the gastrointestinal tract are diverse and depend on numerous factors. Diagnosis is centered on histologic findings, with mostly nonspecific patterns of injury that must be interpreted in the correct clinical context. Nonsteroidal antiinflammatory drugs are a common cause of drug-induced gastrointestinal injury, with effects primarily in the gastric mucosa but also throughout the gastrointestinal tract. Another common class of drugs causing a variety of pathologic findings in the gut is chemotherapeutic agents. This article discusses the differential diagnosis of the various patterns of injury, including ischemic damage, and the histologic findings specific for certain drugs.
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Affiliation(s)
- Ilyssa O Gordon
- Department of Pathology, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 6101, Chicago, IL 60637, USA
| | - Vani Konda
- Section of Gastroenterology, Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 4076, Chicago, IL 60637, USA
| | - Amy E Noffsinger
- Department of Pathology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0529, USA.
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Abstract
We report a case of quetiapine-induced dysphagia in a geriatric patient which improved with discontinuation of the antipsychotic. The patient had developed dysphagia while being treated with antipsychotics for bipolar disorder. The patient's dysphagia showed significant improvement when she was taken off quetiapine. We review the available literature on antipsychotic-related dysphagia and suggest that clinicians need to be aware of the potential for this syndrome even with lower potency antipsychotics.
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Affiliation(s)
- Izchak Kohen
- Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY 11004, USA.
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49
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Puisieux F, D'andrea C, Baconnier P, Bui-Dinh D, Castaings-Pelet S, Crestani B, Desrues B, Ferron C, Franco A, Gaillat J, Guenard H, Housset B, Jeandel C, Jebrak G, Leymarie-Selles A, Orvoen-Frija E, Piette F, Pinganaud G, Salle JY, Strubel D, Vernejoux JM, De Wazières B, Weil-Engerer S. [Swallowing disorders, pneumonia and respiratory tract infectious disease in the elderly]. Rev Mal Respir 2009; 26:587-605. [PMID: 19623104 DOI: 10.1016/s0761-8425(09)74690-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Swallowing disorders (or dysphagia) are common in the elderly and their prevalence is often underestimated. They may result in serious complications including dehydration, malnutrition, airway obstruction, aspiration pneumonia (infectious process) or pneumonitis (chemical injury caused by the inhalation of sterile gastric contents). Moreover the repercussions of dysphagia are not only physical but also emotional and social, leading to depression, altered quality of life, and social isolation. While some changes in swallowing may be a natural result of aging, dysphagia in the elderly is mainly due to central nervous system diseases such as stroke, parkinsonism, dementia, medications, local oral and oesophageal factors. To be effective, management requires a multidisciplinary team approach and a careful assessment of the patient's oropharyngeal anatomy and physiology, medical and nutritional status, cognition, language and behaviour. Clinical evaluation can be completed by a videofluoroscopic study which enables observation of bolus movement and movements of the oral cavity, pharynx and larynx throughout the swallow. The treatment depends on the underlying cause, extent of dysphagia and prognosis. Various categories of treatment are available, including compensatory strategies (postural changes and dietary modification), direct or indirect therapy techniques (swallow manoeuvres, medication and surgical procedures).
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Affiliation(s)
- F Puisieux
- Service de Gériatrie, Hôpital des Bateliers, CHRU de Lille, France.
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50
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Grajić MM, Matanović DD, Railić ZK, Vukasinović M, Mustur DV, Milovanović AN. [Dysphagia rehabilitation]. ACTA CHIRURGICA IUGOSLAVICA 2009; 56:89-94. [PMID: 20218110 DOI: 10.2298/aci0903089g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Dysphagia and aspiration are important problems among the elderly population, particularly in neurological patients and patients with cancers of the oropharingeal area or laryngs. Early detection and rehabilitation are crucial because adequate management can reduce morbidity and complications like aspiration pneumonia, dehidratation and malnutrition. We overviewed rehabilitation procedures including nutritional management, postures, maneuvers, exercises and stimulation techniques and their efficacy in treatment of patients with dysphagias.
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Affiliation(s)
- M M Grajić
- Medicinski fakultet Univerziteta u Beogradu, Klinika za fizikalnu medicinu i rehabilitaciju, KCS, Beograd
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