1
|
Vergara J, Andreollo NA, Starmer HM, Miles A, Baraçal-Prado ACC, Junqueira AA, Tincani AJ. Swallowing Safety after Remote sub-total Esophagectomy: How Important is Tongue Pressure? Dysphagia 2024:10.1007/s00455-024-10745-8. [PMID: 39153046 DOI: 10.1007/s00455-024-10745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/31/2024] [Indexed: 08/19/2024]
Abstract
The factors related to oropharyngeal dysphagia after remote esophagectomy (greater than five months) remain unclear. This study aimed to assess patient perception of dysphagia, maximum anterior isometric pressure (MAIP), maximum posterior isometric pressure (MPIP), lingual swallowing pressure (LSP) and radiographic physiological components of the oral and pharyngeal phases of swallowing in patients who are post remote sub-total esophagectomy (SE). Patient perception of dysphagia was assessed using the Eating Assessment Tool (EAT-10). MAIP, MPIP, and LSP were measured using the Iowa Oral Performance Instrument. Videofluoroscopy was used to assess the physiologic components of swallowing with the Modified Barium Swallow Impairment Profile (MBSImP) and the Penetration-Aspiration Scale (PAS). Ten patients were included in the study (53.2% male; mean age 54.5 ± 18.0). The mean postoperative time was 30 months (range, 5.0-72 months). Seven patients had elevated EAT-10 scores (> 3). All patients demonstrated impaired oropharyngeal swallowing on at least three MBSImP components (range 3-12) and two patients aspirated (PAS 8). There was a significant difference in MAIP values when comparing patients with normal versus impaired laryngeal elevation and epiglottic movement (p < 0.001). MPIP values were significantly different in patients with normal versus impaired epiglottic movement as well as normal versus elevated PAS scores (p < 0.001). Decreased lingual pressure and physiological changes in swallowing coexist after SE. Our results indicate that the decrease in tongue strength may be one of the factors related to unsafe swallow. The assessment of lingual pressure provides diagnostic value and should be incorporated as part of a comprehensive assessment in this population.
Collapse
Affiliation(s)
- José Vergara
- Department of Surgery, Head and Neck Surgery, University of Campinas, R. Tessália Vieira de Camargo, 126, Campinas, 13083-887, SP, Brazil.
| | - Nelson Adami Andreollo
- Division of Gastrointestinal Surgery, Department of Surgery, School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Heather M Starmer
- Division of Head and Neck Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University, Palo Alto, CA, USA
- School of Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, Auckland, New Zealand
| | | | | | - Alfio José Tincani
- Department of Surgery, Head and Neck Surgery, University of Campinas, R. Tessália Vieira de Camargo, 126, Campinas, 13083-887, SP, Brazil
| |
Collapse
|
2
|
Javorszky SM, Palli C, Domkar S, Iglseder B. Combined systematic screening for malnutrition and dysphagia in hospitalized older adults: a scoping review. BMC Geriatr 2024; 24:445. [PMID: 38773449 PMCID: PMC11110417 DOI: 10.1186/s12877-024-05070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Dysphagia affects about 40% of patients admitted to acute geriatric wards, as it is closely associated with diseases that rise in prevalence with advancing age, such as stroke, Parkinson's disease, and dementia. Malnutrition is a highly associated predictive factor of dysphagia as well as one of the most common symptoms caused by dysphagia. Thus, the two conditions may exist simultaneously but also influence each other negatively and quickly cause functional decline especially in older adults. The purpose of this review was to determine whether institutions have established a protocol combining screenings for dysphagia and malnutrition on a global scale. If combined screening protocols have been implemented, the respective derived measures will be reported. METHODS A scoping review was conducted. A systematic database search was carried out in January and February 2024. Studies were included that examined adult hospitalized patients who were systematically screened for dysphagia and malnutrition. The results were managed through the review software tool Covidence. The screening of titles and abstracts was handled independently by two reviewers; conflicts were discussed and resolved by consensus between three authors. This procedure was retained for full-text analysis and extraction. The extraction template was piloted and revised following feedback prior to extraction, which was carried out in February 2024. RESULTS A total of 2014 studies were found, 1075 of which were included for abstract screening, 80 for full text screening. In the end, 27 studies were extracted and reported following the reporting guideline PRISMA with the extension for Scoping Reviews. CONCLUSION Most of the studies considered the prevalence and association of dysphagia and malnutrition with varying outcomes such as nutritional status, pneumonia, oral nutrition, and swallowing function. Only two studies had implemented multi-professional nutrition teams.
Collapse
Affiliation(s)
- Susanne M Javorszky
- Institute of Nursing Science and Research, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
- FH Campus Wien, Department of Health Sciences, Favoritenstraße, 226, 1100, Vienna, Austria.
| | - Christoph Palli
- FH Joanneum, Institute of Health and Nursing, Alte Post Straße 149, 8020, Graz, Austria
| | - Susanne Domkar
- FH Campus Wien, Department of Health Sciences, Favoritenstraße, 226, 1100, Vienna, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria
| |
Collapse
|
3
|
Takahashi N, Kikutani T, Ebihara K, Genkai S, Takahashi I, Kodama M, Machida R, Tohara T, Tamura F. Factors associated with the maintenance in food texture for dependent older people with dysphagia living in nursing home - A retrospective cohort study. SPECIAL CARE IN DENTISTRY 2024; 44:886-892. [PMID: 37919247 DOI: 10.1111/scd.12937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/19/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Maintaining the texture of the food that nursing home residents eat is critical for maintaining quality of life and preventing malnutrition. The aim of the present study was to identify the conditions necessary for maintaining food texture for this population. MATERIALS AND METHODS The study included 143 people for whom reevaluation 1-year post-baseline was possible from among 256 dependent older people who consumed solid food on admission to a nursing home (baseline). The age, sex, primary disease, activities of daily living, nutritional status, oral status, swallowing ability, primitive reflexes, and food texture of the participants were determined. The participants who ate pureed or jelly after 1 year were identified and evaluated to determine factors related to maintenance of a solid diet. RESULTS A total of 21 participants (14.7%) changed to a pureed or jelly diet after 1 year. Multivariate analysis showed good activities of daily living (p < .05), good swallowing ability (p < .05), and maintained nutritional status (p < .05) to be correlated with solid food maintenance. CONCLUSIONS Maintaining activities of daily living, feeding and swallowing ability, and nutritional status appear to be important factors for the maintenance of a solid diet.
Collapse
Affiliation(s)
- Noriaki Takahashi
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tama Oral Rehabilitation Clinic, Chiyoda-ku, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Takeshi Kikutani
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tama Oral Rehabilitation Clinic, Chiyoda-ku, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Katsuko Ebihara
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Sae Genkai
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Ikumi Takahashi
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Miho Kodama
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Reiko Machida
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Takashi Tohara
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tama Oral Rehabilitation Clinic, Chiyoda-ku, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Fumiyo Tamura
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tama Oral Rehabilitation Clinic, Chiyoda-ku, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| |
Collapse
|
4
|
Shirobe M, Edahiro A, Motokawa K, Morishita S, Motohashi Y, Matsubara C, Iwasaki M, Watanabe Y, Hirano H. Feasibility of Oral Function Evaluation According to Dementia Severity in Older Adults with Alzheimer's Disease. Nutrients 2024; 16:992. [PMID: 38613025 PMCID: PMC11013786 DOI: 10.3390/nu16070992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Oral function evaluation in older adults with dementia is important for determining appropriate and practical dietary support plans; however, it can be challenging due to their difficulties in comprehending instructions and cooperating during assessments. The feasibility of oral function evaluation has not been well studied. This cross-sectional study aimed to determine the feasibility of oral function evaluation in older adults with Alzheimer's disease (AD) according to Functional Assessment Staging of Alzheimer's Disease (FAST) stages. In total, 428 older adults with AD (45 men and 383 women; mean age: 87.2 ± 6.2 years) were included. Multilevel logistic regression models were used to examine the prevalence of participants who were unable to perform oral function evaluations, including oral diadochokinesis (ODK), repeated saliva swallow test (RSST), and modified water swallow test (MWST). In comparison to the reference category (combined FAST stage 1-3), FAST stage 7 was associated with the infeasibility of ODK (adjusted odds ratio, 95% confidence interval = 26.7, 4.2-168.6), RSST (5.9, 2.2-16.1), and MWST (8.7, 1.6-48.5, respectively). Oral function evaluation is difficult in older adults with severe AD. Simpler and more practical swallowing function assessments and indicators that can be routinely observed are required.
Collapse
Affiliation(s)
- Maki Shirobe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan; (M.S.); (A.E.); (S.M.); (M.I.); (Y.W.); (H.H.)
| | - Ayako Edahiro
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan; (M.S.); (A.E.); (S.M.); (M.I.); (Y.W.); (H.H.)
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan; (M.S.); (A.E.); (S.M.); (M.I.); (Y.W.); (H.H.)
| | - Shiho Morishita
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan; (M.S.); (A.E.); (S.M.); (M.I.); (Y.W.); (H.H.)
- School of Health Sciences, Meikai University, Chiba 279-8550, Japan
| | - Yoshiko Motohashi
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan; (M.S.); (A.E.); (S.M.); (M.I.); (Y.W.); (H.H.)
| | - Chiaki Matsubara
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan; (M.S.); (A.E.); (S.M.); (M.I.); (Y.W.); (H.H.)
- Department of Dental Hygiene, University of Shizuoka, Shizuoka Junior College, Shizuoka 422-8021, Japan
| | - Masanori Iwasaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan; (M.S.); (A.E.); (S.M.); (M.I.); (Y.W.); (H.H.)
- Department of Preventive Dentistry, Faculty of Dental Medicine, Graduate School of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan
| | - Yutaka Watanabe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan; (M.S.); (A.E.); (S.M.); (M.I.); (Y.W.); (H.H.)
- Gerodontology, Department of Oral Health Science, Hokkaido University, Hokkaido 060-8586, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo 173-0015, Japan; (M.S.); (A.E.); (S.M.); (M.I.); (Y.W.); (H.H.)
- Dentistry and Oral Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo 173-0015, Japan
| |
Collapse
|
5
|
Drulia T, Szynkiewicz S, Griffin L, Mulheren R, Murray K, Kamarunas E. A Comparison of Lingual Pressure Generation Measures Using Two Devices in Community-Dwelling, Typically Aging Adults: An Important Clinical Implication. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:429-439. [PMID: 38262037 DOI: 10.1044/2023_jslhr-23-00488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
DESIGN A multisite, prospective, and randomized within-subject design study. SETTING Five university settings in varied geographical areas in the United States. PURPOSE The purpose of this study was to compare lingual pressure generation using the Tongueometer (TO) and the Iowa Oral Performance Instrument (IOPI) in typically aging, community-dwelling adults during three measurement tasks: maximum isometric pressure (MIP), regular effort saliva swallow (RESS) pressure, and effortful saliva swallow pressure (ESP). PARTICIPANTS Eighty-seven typically aging, community-dwelling adults (aged 55 years and over) with no self-reported history of swallowing or neurological disorders were recruited to complete this study. RESULTS Strong positive associations were found between the lingual pressure generation measures from the TO and IOPI in all tasks in typically aging adults, with Pearson correlations ranging from r = .780 to .874, p < .001. Agreement between the devices (Lin's concordance correlation coefficient) ranged from moderate for the MIP (ρc = .78) and ESP (ρc = .61) tasks to weak agreement for the RESS task (ρc = .47). MIP, RESS pressure, and ESP were lower when measured by the TO compared with the IOPI, p < .001. CONCLUSIONS The TO measures lingual pressure generation similarly to the IOPI but pressures register lower when using the TO than the IOPI in typically aging persons. This supports the need for developing normative values specific to the TO device or development of a valid and reliable conversion formula from TO to IOPI normative values. At this time, the clinical use of reference values from the TO should not be generalized to IOPI normative values.
Collapse
Affiliation(s)
- Teresa Drulia
- Davies School of Communication Sciences & Disorders, Texas Christian University, Fort Worth
| | - Sarah Szynkiewicz
- Department of Communication Sciences & Disorders, Samford University, Birmingham, AL
| | - Lindsay Griffin
- Department of Communication Sciences and Disorders, Emerson College, Boston, MA
| | - Rachel Mulheren
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Kelsey Murray
- Department of Communication Sciences & Disorders, James Madison University, Harrisonburg, VA
| | - Erin Kamarunas
- Department of Communication Sciences & Disorders, James Madison University, Harrisonburg, VA
| |
Collapse
|
6
|
Tian L, Hu Z, Yang L, Xiang Y. The prevalence of dysphagia at risk among older adults in nursing homes: a meta-analysis. Psychogeriatrics 2024; 24:127-137. [PMID: 37919048 DOI: 10.1111/psyg.13034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 11/04/2023]
Abstract
To estimate the prevalence of dysphagia at risk among older adults in nursing homes. Electronic databases of PubMed, Web of Science, CINAHL and Embase for English language, WanFang, VIP and CNKI for Chinese language were systematically searched to identify relevant observational studies published not later than July 4, 2021. Studies conducted in nursing homes and reported dysphagia screening or assessment methods were included. In total, 43 studies involving 56 746 participants were included in this meta-analysis. The overall pooled crude prevalence of dysphagia at risk was 35.9% (95% CI: 29.0-43.4%), with high heterogeneity (I2 = 99.5%). There was a statistically significant difference in prevalence estimates with respect to study locations, dysphagia assessment staff and representativeness of samples. The prevalence of dysphagia among older adults in nursing homes is relatively high. Routine screening strategy for dysphagia is necessary for older adults in nursing homes.
Collapse
Affiliation(s)
- Li Tian
- Changsha Social Work College, Changsha, China
| | - Zhao Hu
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Liu Yang
- Changsha Social Work College, Changsha, China
| | | |
Collapse
|
7
|
Pizzorni N, Ciammola A, Pirola C, Nanetti L, Castaldo A, Poletti B, Mariotti C, Schindler A. Oropharyngeal Dysphagia Phenotypes Across Huntington's Disease Stages: Endoscopic Findings and Tongue Pressure Analysis. J Huntingtons Dis 2024; 13:225-235. [PMID: 38820019 DOI: 10.3233/jhd-231519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Background Oropharyngeal dysphagia (OD) is a common symptom in Huntington's disease (HD) and is associated with severe health and psychosocial consequences. Different OD phenotypes are defined on the basis of characteristic patterns at fiberoptic endoscopic evaluation of swallowing (FEES), and they may vary during disease progression. Objective To describe OD phenotypes in different HD stages and to analyze their association with neurological data and tongue pressure measurements. Methods Twenty-four patients with HD at different stages of disease progression underwent a FEES. Data on penetration/aspiration, pharyngeal residue, and OD phenotypes were gained. Neurological examination was performed with the Unified Huntington's Disease Rating Scale (UHDRS). Patient Maximum tongue pressure (MTP) and tongue endurance were measured. Results We confirmed that the occurrence of penetration/aspiration increased with disease duration and pharyngeal residue increased from 16.7% to 100%, respectively. The most common OD phenotypes were oropharyngeal dyspraxia (91.7%), posterior oral incontinence (87.5%), and delayed pharyngeal phase (87.5%). These types of dysfunctions are already detectable in >80% of patients in the early disease stages. In more advanced stages, we also observed propulsion deficit (66.7%), resistive issue (54.2%), and protective deficit (37.5%). Propulsion deficit was associated with higher disease stage, greater motor dysfunction (UHDRS-I), and lower MTP and tongue endurance (p < 0.05). Conclusions OD in HD results from a combination of different swallowing phenotypes. Early assessment of swallowing and periodical follow-ups are necessary to monitor OD severity and phenotypes and to revise diet recommendations.
Collapse
Affiliation(s)
- Nicole Pizzorni
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milano, Italy
| | - Chiara Pirola
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy
| | - Lorenzo Nanetti
- Department of Diagnostics and Technology, Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Anna Castaldo
- Department of Diagnostics and Technology, Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Caterina Mariotti
- Department of Diagnostics and Technology, Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy
| |
Collapse
|
8
|
da Costa FP, Casseb RF, de Lima DP, Ponsoni A, Guimarães RP, Mourão LF. Isometric tongue endurance and incomplete laryngeal vestibule closure in Parkinson's disease. J Oral Rehabil 2023; 50:1401-1408. [PMID: 37605286 DOI: 10.1111/joor.13568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/20/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Dysphagia is a common symptom of Parkinson's disease (PD). A delay in laryngeal vestibule closure (LVC) and a reduction in tongue pressure, may affect swallowing safety and increase the risk of pulmonary aspiration. OBJECTIVE To verify the relationship between tongue pressure and airway protection in PD patients: (1) comparing tongue pressure measures and physiological events in the pharyngeal phase of swallowing between PD and controls and (2) analysing the association between tongue pressure and LVC in the PD group. METHODS Twenty-three patients with idiopathic PD (64.9 years) and 24 healthy controls (64.1 years) participated in this study. All participants underwent the following procedures to verify tongue pressure measurements using the Iowa Oral Performance Instrument: maximum anterior and posterior pressure, isotonic and isometric tongue endurance and anterior and posterior tongue pressure during saliva swallowing. To verify swallowing safety, videofluoroscopic swallowing studies focusing on the pharyngeal phase were performed based on the MBSImP protocol. RESULTS Compared to healthy controls, PD exhibited a statistically significant decline in tongue pressure tasks: posterior maximum pressure, isotonic endurance, anterior and posterior isometric endurance and tongue pressure during posterior swallowing. Patients with PD had worse pharyngeal scores, including LVC scores, than controls. PD and incomplete LVC had lower anterior isometric endurance scores when compared to those with complete LVC. CONCLUSION PD with incomplete LVC scored lower in the anterior isometric endurance task. We observed a potential clinical use of this task for the assessment and management of dysphagia in patients with PD.
Collapse
Affiliation(s)
| | - Raphael Fernandes Casseb
- Department of Neurology, Neuroimaging Laboratory, University of Campinas (Unicamp), Campinas, Brazil
| | - Daniella Priscila de Lima
- Health, Interdisciplinarity and Rehabilitation Department, University of Campinas (Unicamp), Campinas, Brazil
| | - Adriana Ponsoni
- Gerontology Department, University of Campinas (Unicamp), Campinas, Brazil
| | - Rachel Paes Guimarães
- Department of Neurology, Neuroimaging Laboratory, University of Campinas (Unicamp), Campinas, Brazil
| | - Lucia Figueiredo Mourão
- Interdisciplinarity and Rehabilitation Departments, Center for Studies and Research in Rehabilitation, CEPRE, Gerontology and Health, University of Campinas (Unicamp), Campinas, Brazil
| |
Collapse
|
9
|
Carretero-Randez C, Orts-Cortés MI, Rodríguez-Pérez M, Gonzalez-Chordá VM, Trescastro-López EM, Blanco-Blanco J, Martínez-Soldevila J, Ruiz-Heras-Hera A, Castellano-Santana PR, Marquez-Sixto A, Domingo-Pozo M, Zomeño-Ros AI, Montero-Marco J, Charlo-Bernardos M, Moncho J, Abad-González ÁL, Castillo-García MT, Sánchez-García AB, De Pascual y Medina AM, Clement-Santamaría RA, Franco-Bernal A, Camacho-Bejarano R. Impact of hospitalization on nutritional status in persons aged 65 years and over (NUTRIFRAG Study): Protocol for a prospective observational study. PLoS One 2023; 18:e0288348. [PMID: 37917648 PMCID: PMC10621802 DOI: 10.1371/journal.pone.0288348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/14/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Malnutrition is a recurring problem that has become more relevant in recent years. The aim of this study is to assess the risk of malnutrition and nutritional status on admission and its evolution until discharge in patients aged 65 and over admitted to medical and surgical hospitalization units in hospitals of the Spanish National Health System. METHODS Prospective observational study to be carried out in the medical-surgical hospitalization units of 9 public hospitals between 01/09/2022 and 31/12/2024. Using consecutive sampling, a total of 4077 patients will be included (453 in each hospital). Variables included are related to the care process, functionality, cognition and comorbidity, risk profile, nutritional status and dysphagia; as well as frailty, dietary quality and contextual variables. The incidence of risk of malnutrition, undernutrition and dysphagia during the care process and at discharge will be calculated. The association with risk factors will be studied with logistic regression models and multivariate Cox regression models. In addition, an analysis of participants' satisfaction with food services will be carried out. The study was approved by the Ethics and Research Committee on 30/09/2020, approved for funding on 02/12/2021 and with registration number RBR-5jnbyhk in the Brazilian clinical trials database (ReBEC) for observational studies. DISCUSSION Some studies address nutritional status or dysphagia in older people in various care settings. However, there is a lack of large sample studies including both processes of the impact of hospitalization. The results of the project will provide information on the incidence and prevalence of both pathologies in the study subjects, their associated factors and their relationship with the average length of stay, mortality and early readmission. In addition, early detection of a problem such as malnutrition related to the disease and/or dysphagia during a hospital stay will favor the action of professionals to resolve both pathologies and improve the health status of patients.
Collapse
Affiliation(s)
- Cristina Carretero-Randez
- Nursing Department, Community Health and History of Science Team, University of Alicante, Alicante, Spain
- Nursing Research Group: Infection, Inflammation and Chronicity (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Pneumology and Intermediate Respiratory Care Unit, Hospital Arnau de Vilanova, Valencia, Spain
| | - María Isabel Orts-Cortés
- Nursing Department, University of Alicante (BALMIS), Alicante Institute for Health and Biomedical Research (ISABIAL, Group 23), Alicante, Spain
- Institute of Health Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain
- (CIBERFES) Institute of Health Carlos III, CIBER of Frailty and Healthy Ageing, Madrid, Spain
| | | | - Víctor Manuel Gonzalez-Chordá
- Institute of Health Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain
- Nursing Department, Nursing Research Group (241), Universitat Jaume I, Castellón, Spain
| | - Eva María Trescastro-López
- Alicante Institute for Health and Biomedical Research (ISABIAL, Group 23), Balmis Research Group in History of Science, Health Care and Food, Alicante, Spain
| | - Joan Blanco-Blanco
- (CIBERFES) Institute of Health Carlos III, CIBER of Frailty and Healthy Ageing, Madrid, Spain
- Nursing and Pysiotherapy Department and Grup d’Estudis Societat, Salut, Educació i Cultura (GESEC), University of Lleida, Lleida, Spain
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Health Care Research Group (GRECS), IRBLLEIDA, Lleida, Spain
| | - Jordi Martínez-Soldevila
- Nursing and Pysiotherapy Department and Grup d’Estudis Societat, Salut, Educació i Cultura (GESEC), University of Lleida, Lleida, Spain
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Health Care Research Group (GRECS), IRBLLEIDA, Lleida, Spain
| | - Aránzazu Ruiz-Heras-Hera
- Diet Department, University Hospital of Navarra, Pamplona, Spain
- Faculty of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
| | - Pedro Raúl Castellano-Santana
- Surgery Unit of the Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Nursing Department, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | - Manuela Domingo-Pozo
- Department of Nursing University of Alicante, Alicante Institute for Health and biomedical Research (ISABIAL, Group 23), Nursing Information Systems Unit Dr Balmis General University Hospital, Alicante, Spain
| | - Antonia Inmaculada Zomeño-Ros
- Nursing Department, University of Murcia, Murcia, Spain
- Endocrinology and Diet Department, Hospital General Universitario Reina Sofía de Murcia, Murcia, Spain
| | - Jesica Montero-Marco
- Research Unit, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón),. GIIS081-Care Research Group, Zaragoza, Spain
| | - Marta Charlo-Bernardos
- Instituto de Investigación Sanitaria Aragón (IIS Aragón),. GIIS081-Care Research Group, Zaragoza, Spain
- Continued Training Unit, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Joaquín Moncho
- Department of comunity Nursing, Research Unit for the Analysis of Mortality and Health Statistics, Preventive Medicine, Public health and History of Science, University of Alicante, Alicante, Spain
| | - Ángel Luís Abad-González
- Endocrinology Department, Dr. Balmis General University Hospital, Institute for Health and Biomedical Research (ISABIAL, Group 20), Alicante, Spain
| | - María Trinidad Castillo-García
- Department of Nursing University of Alicante, Dr Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL, Group 20), Alicante, Spain
| | - Ana Belén Sánchez-García
- Nursing Department, University of Murcia, Murcia, Spain
- Institute Murciano for Biosanitary Research (IMIB), Nursing and Healthcare Research Unit ENFERAVANZA, El Palmar, Murcia, Spain
- Research Ethics Committee UM and University General Hospital Reina Sofía, Murcia, Spain
| | - Ana María De Pascual y Medina
- Evaluation Unit of the Canary Islands Health Service, Tenerife, Spain
- Red de Agencias de Evaluación de Tecnologías Sanitarias del Ministerio de Sanidad, Madrid, Spain
- GREISSEC Grupo Español de Investigación de Cuidados en Servicios de Salud en Enfermedades Crónicas, Unidad de Investigación en Cuidados de Salud (Investén-isciii), Madrid, Spain
| | - Rosa Ana Clement-Santamaría
- Department of Nursing University of Alicante, Alicante Institute for Health and biomedical Research (ISABIAL, Group 23), Nursing Information Systems Unit Dr Balmis General University Hospital, Alicante, Spain
| | - Ascensión Franco-Bernal
- Nursing Research Group: Infection, Inflammation and Chronicity (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Area Manager of Outpatient Care (Day Hospital), Hospital Universitario la Fe, Valencia, Spain
| | - Rafaela Camacho-Bejarano
- Institute of Health Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain
- Nursing Faculty, Department of Nursing, University of Huelva, Campus El Carmen, Huelva, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Barcelona, Spain
| |
Collapse
|
10
|
Namasivayam-MacDonald A, Lam B, Ma J, Affoo R. Prevalence, Incidence, and Predictors of Self-reported Swallowing Difficulties in Community-Dwelling Adults: A Population-Based Study from the Canadian Longitudinal Study on Aging (CLSA). Dysphagia 2023; 38:1406-1420. [PMID: 37031453 DOI: 10.1007/s00455-023-10570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/28/2023] [Indexed: 04/10/2023]
Abstract
There is a paucity of evidence from population-based studies identifying prevalence and incidence of dysphagia, as well as health and sociodemographic risk factors that may contribute to its development. As such, the current study aimed to determine prevalence, incidence, and associated predictors of dysphagia in adults. The Canadian Longitudinal Study on Aging is a nationally representative population study that follows 51,338 Canadians over 45 years of age. Biological, medical, psychological, social, lifestyle and economic data are collected. A secondary analysis of the data was conducted to determine prevalence, incidence, and the predictors of self-reported swallowing difficulty in adults between 45 and 85 years of age. Rates of swallowing difficulty by demographic risk factor, as well as lifestyle and health factors were analyzed using descriptive statistics. Associations between lifestyle and health variables with dysphagia were tested using Chi-square tests or t tests, as appropriate. Logistic regression was used to determine the predictors of self-reported swallowing difficulties. Overall prevalence of self-reported swallowing difficulties in adults over the age of 45 was 10.6% and increased to 13.7% after 3 years. Significant differences (p < 0.001) in self-reported swallowing difficulty at baseline were apparent across smoking status, requiring help to prepare meals, life satisfaction, social participation, all disease categories except dementia, number of medications, cognition, oral health status, and frailty. Incidence of dysphagia was 8.6%. Regression analyses suggested the following independent predictors of reports of swallowing difficulty: older age; non-white ethnicity; female sex; poor oral health; malnutrition; and frailty. These predictors should be carefully considered to ensure we are screening at-risk populations. Social determinants of health, such as ethnicity, must also be considered to ensure equitable care across the population.
Collapse
Affiliation(s)
- Ashwini Namasivayam-MacDonald
- School of Rehabilitation Science, McMaster University, 1280 Main Street West, IAHS 403, Hamilton, ON, L8S 4L8, Canada.
| | - Bonnie Lam
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Rebecca Affoo
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, Canada
| |
Collapse
|
11
|
Pavlidou E, Kyrgidis A, Vachtsevanos K, Constantinidis J, Triaridis S, Printza A. Efficacy of High-Intensity Training in Patients with Moderate to Severe Dysphagia after Glossectomy. J Clin Med 2023; 12:5613. [PMID: 37685680 PMCID: PMC10488737 DOI: 10.3390/jcm12175613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Dysphagia is the main impairment arising from glossectomy for tongue cancer treatment. The study aimed to determine if an eight-week training protocol paired with accuracy tasks and swallowing exercises is effective and can improve tongue strength and swallowing in patients after tongue resection. Maximum isometric pressures, tongue endurance, swallowing pressures, mealtime duration, and oropharyngeal swallow function were studied in patients with moderate to severe dysphagia after glossectomy. Twenty-five (25) patients and thirty-one (31) healthy participants were enrolled in the study. The therapy group (TG) consisted of seventeen (17) patients who followed an 8-week treatment protocol and had multiple measurements. The follow-up control group (FUG) consisted of eight non-treated patients who had a baseline and an 8-week follow-up examination. Healthy participants served as the reference group (RF). Maximum isometric pressures, endurance, and swallowing pressures increased significantly in the TG versus the FUG. Significant improvement was documented in the TG regarding the EAT-10 questionnaire, the Penetration-Aspiration Scale scores at thickened and solid boluses, and post-swallow residues at thickened and solid boluses. The treatment protocol with tongue strength exercises combined with accuracy tasks and swallowing exercises improves the post-operative swallowing function in patients after glossectomy. Patients in the TG had more significant and quicker improvement in pressures and endurance compared to FUG.
Collapse
Affiliation(s)
- Elena Pavlidou
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
| | - Athanasios Kyrgidis
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (A.K.); (K.V.)
| | - Konstantinos Vachtsevanos
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (A.K.); (K.V.)
| | - Jannis Constantinidis
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
| | - Stefanos Triaridis
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
| | - Athanasia Printza
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
| |
Collapse
|
12
|
Hastaoğlu F, Hastaoğlu E, Bağlam N, Taş İN. Sensorial and Nutritional Properties of a Collagen-Fortified Snack Bar Designed for the Elderly. Nutrients 2023; 15:3620. [PMID: 37630810 PMCID: PMC10459847 DOI: 10.3390/nu15163620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This study aimed to develop a highly consumable collagen-containing bar that contributes to enriching the diets of elderly individuals, in terms of energy and nutrients. METHOD For this purpose, five different bar samples (C, P1, P2, D1, D2) containing different amounts of collagen, date puree, and pumpkin puree were developed and subsequently evaluated in terms of their sensory and nutritional properties by a panel of 30 adult trained sensorial analysists. RESULTS The bars with the highest flavor score were those with high levels of collagen and pumpkin puree (P2) and date puree (D2). For the analyses of multiple criteria among multiple samples, the TOPSIS technique showed that among the snack bar samples with different contents, the most liked sample was the one with a high level of collagen and date puree (D2). One serving of the developed bars contains approximately 300-400 kcal of energy and 6.8-8.8 g of protein. Considering age-related decreased appetite, as well as chewing and swallowing problems in elderly individuals, regular consumption of nutrient-rich small meals or snacks with enhanced sensory characteristics could contribute to improving nutritional and functional status.
Collapse
Affiliation(s)
- Fatma Hastaoğlu
- Department of Elderly Care, Vocational School of Health, Sivas Cumhuriyet University, Sivas 58140, Turkey;
- Gerontology Studies Research and Application Center, Sivas Cumhuriyet University, Sivas 58140, Turkey
| | - Emre Hastaoğlu
- Department of Gastronomy and Culinary Arts, Faculty of Tourism, Sivas Cumhuriyet University, Sivas 58140, Turkey;
- Food Studies Research and Application Center, Sivas Cumhuriyet University, Sivas 58140, Turkey
| | - Nurcan Bağlam
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas 58140, Turkey;
| | - İrem Nur Taş
- Department of Gastronomy and Culinary Arts, Faculty of Tourism, Sivas Cumhuriyet University, Sivas 58140, Turkey;
| |
Collapse
|
13
|
Leira J, Maseda A, Lorenzo-López L, Cibeira N, López-López R, Lodeiro L, Millán-Calenti JC. Dysphagia and its association with other health-related risk factors in institutionalized older people: A systematic review. Arch Gerontol Geriatr 2023; 110:104991. [PMID: 36906939 DOI: 10.1016/j.archger.2023.104991] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Dysphagia is considered a geriatric syndrome that is characterized by inability to or difficulty in safely and effectively forming or moving the food bolus toward the esophagus. This pathology is very common and affects approximately 50% of institutionalized older people. Dysphagia is often accompanied by high nutritional, functional, social, and emotional risks. This relationship implies a higher rate of morbidity, disability, dependence, and mortality in this population. This review is aimed at studying the relationship between dysphagia and different health-related risk factors in institutionalized older people. METHOD We conducted a systematic review. The bibliographic search was performed in the Web of Science, Medline, and Scopus databases. Data extraction and methodological quality were evaluated by two independent researchers. RESULTS Twenty-nine studies met the inclusion and exclusion criteria. A clear relationship between the development and progression of dysphagia and a high nutritional, cognitive, functional, social, and emotional risk in institutionalized older adults was found. CONCLUSIONS There is an important relationship between these health conditions that shows the need for research and new approaches to considerations such as their prevention and treatment as well as the design of protocols and procedures that will help reduce the percentage of morbidity, disability, dependence, and mortality in older people.
Collapse
Affiliation(s)
- Julia Leira
- Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - Ana Maseda
- Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - Laura Lorenzo-López
- Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - Nuria Cibeira
- Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - Rocío López-López
- Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - Leire Lodeiro
- Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - José C Millán-Calenti
- Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| |
Collapse
|
14
|
The Relationship between Low Skeletal Muscle Mass and Subsequent Oral Intake Ability among the Aged Population. Healthcare (Basel) 2023; 11:healthcare11050729. [PMID: 36900734 PMCID: PMC10001338 DOI: 10.3390/healthcare11050729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
This study aimed to determine the relationship between skeletal muscle mass in an aged population with limited oral intake upon admission and functional oral intake at the subsequent 3-month follow-up. Methods: This was a retrospective cohort study using the Japanese Sarcopenia Dysphagia Database involving older adults (≥60 years) with limited oral intake (Food Intake Level Scale [FILS] level of ≤8). People without skeletal muscle mass index (SMI) data, unknown methods of SMI evaluation, and SMI evaluation by DXA were excluded. Data for 76 people (47 women, 29 men) were analyzed (mean [standard deviation] age: 80.8 [9.0] years; median SMI: women, 4.80 kg/m2; men, 6.50 kg/m2). There were no significant differences in age, FILS upon admission and methods of nutrition intake between the low (n = 46) and the high skeletal muscle mass groups (n = 30), although the proportion of sex between the two groups was different. The FILS level at the time of follow-up differed significantly between the groups (p < 0.01). The SMI upon admission (odds ratio: 2.99, 95% confidence interval: 1.09-8.16) were significantly associated with the FILS level at the time of follow-up after adjustment for sex, age, and history of stroke and/or dementia (p < 0.05, power = 0.756). Conclusion: A low skeletal muscle mass is a disadvantage for achieving a subsequent fully functional oral intake ability among the aged population with limited oral intake upon admission.
Collapse
|
15
|
Ozola L, Shengjuler D, Galoburda R, Kruma Z, Straumite E, Kampuse S. Development and Characteristics of Plant-Based Product Prototypes for Oro-Pharyngeal Dysphagia Diet. Foods 2023; 12:foods12030474. [PMID: 36766006 PMCID: PMC9914909 DOI: 10.3390/foods12030474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Patients with dysphagia diseases require food with acceptable textural characteristics. Additionally, due to the consumption of smaller portions, these patients receive insufficient amounts of nutrients. Therefore, this study aimed to develop plant-based purée as a meal for an oro-pharyngeal dysphagia (OD) diet, enriched with proteins, fiber and antioxidant vitamins. The suitability of three protein sources-soy protein isolate, whey protein isolate and brown pea protein concentrate-was tested through evaluation of their effect on the rheological properties of protein-enriched plant-based purées for OD diets. Based on the rheological analysis, whey protein was selected for incorporation into the new product formulations. Two prototypes of soups and two prototypes of desserts produced in this study demonstrated acceptable textural properties and high nutritional value.
Collapse
|
16
|
Abstract
BACKGROUND The oropharyngeal dysphagia is an underestimated symptom with various causes in the geriatric population. Clinical presentation is often insidious and dysphagia symptoms are seldomly mentioned by elderly patients although causing many life-threatening complications. The aim of this work was to introduce an easy applicable tool to be used by the caregivers and general practitioners for screening of dysphagia in geriatrics for early detection of at risk individuals. METHODS A sample of 200 Egyptian Arabic-speaking elderly patients (65 years or older) not complaining of dysphagia was recruited from nursing homes in Greater Cairo Area. They or their caregivers completed the designed screening tool, including; the designed questionnaires of dysphagia manifestations and eating habits. General, oral motor and bedside evaluation were also performed. In addition to filling in the EAT10 questionnaire and FEES that was performed for only suspected cases for the purpose of validation of the screening tool. RESULTS The dysphagia manifestations questionnaire was significantly correlated with EAT 10 with p value of 0.001. It was correlated in some of its aspects with FEES showing quite reliability with p values' range between 0.012 and 0.044. The Questionnaire of eating habits reliability of r- value of 0.568 slightly exceeding EAT10 reliability of r -value of 0.721 in the subjects under study. The cutoff point of total score of the dysphagia manifestations was > 5, with a sensitivity of 17.65% & a specificity of 94.20%. The cutoff point of total score of the bedside evaluation was ≤ 1 with a sensitivity of 66.9% & a specificity of 56.9%. CONCLUSION the use of this easy applicable screening tool managed to suspect and later on diagnose cases with oropharyngeal dysphagia in non-complaining aging subjects.
Collapse
|
17
|
The Relationship Between Lingual Strength and Functional Swallowing Outcomes in Parkinson’s Disease. Dysphagia 2022:10.1007/s00455-022-10543-0. [DOI: 10.1007/s00455-022-10543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
|
18
|
Bandini A, Gandhi P, Sutton D, Steele CM. Bolus Texture Testing as a Clinical Method for Evaluating Food Oral Processing and Choking Risk: A Pilot Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2806-2816. [PMID: 36251878 PMCID: PMC9911109 DOI: 10.1044/2022_ajslp-22-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/04/2022] [Accepted: 06/21/2022] [Indexed: 05/03/2023]
Abstract
PURPOSE Choking on food is a leading cause of accidental death in several populations, including children, people with intellectual/developmental disability, and older adults in residential care facilities. One contributor to choking risk is incomplete oral processing and failure to convert food to a cohesive, nonsticky bolus with a maximum particle size that will not block the airway. Clinical tests of mastication do not evaluate properties of chewed food boluses. We characterized expectorated boluses, after oral processing, using methods developed by the International Dysphagia Diet Standardisation Initiative (IDDSI). METHOD Seventeen adults without dysphagia (seven women and 10 men), aged 23-55 years, chewed samples of a cracker, a raw baby carrot, and a circular, dome-shaped gummy candy. Chewing metrics were obtained up to the point when the person indicated that they were ready to swallow. The bolus was then either expectorated or swallowed; IDDSI tests were used to characterize the expectorated boluses. RESULTS Measures of chewing did not differ between spit and swallow conditions. Expectorated cracker and carrot boluses had maximum particle size consistent with IDDSI Level SB6 Soft & Bite-Sized foods or lower. The gummy candy samples remained at IDDSI Level RG7 Regular food consistency. CONCLUSIONS This study suggests that expectorated ready-to-swallow boluses are representative of boluses that are swallowed and that oral processing in adults without dysphagia typically results in boluses at IDDSI's Level SB6 or lower. IDDSI's testing methods provide a practical method for evaluating oral processing by characterizing expectorated ready-to-swallow boluses and may guide food texture recommendations for persons who have increased risk of choking.
Collapse
Affiliation(s)
- Andrea Bandini
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute – Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- The BioRobotics Institute, Suola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Pooja Gandhi
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute – Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Danielle Sutton
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute – Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute – Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| |
Collapse
|
19
|
Drancourt N, El Osta N, Decerle N, Hennequin M. Relationship between Oral Health Status and Oropharyngeal Dysphagia in Older People: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13618. [PMID: 36294196 PMCID: PMC9602827 DOI: 10.3390/ijerph192013618] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this review is to investigate the relationship between oral health status and oropharyngeal dysphagia (OD) in older people and to collect a list of oral health indicators that can enable carers and health professionals to screen for risk of dysphagia in older people during oral examinations. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P 2015) guidelines. The analysis methods and inclusion criteria were documented in a protocol published in the Prospective International Register of Systematic Reviews (PROSPERO) under the registration number CRD42020140458. A total of 19 articles published between 2002 and 2020 were retained by the search criteria for the qualitative synthesis. Eighteen studies demonstrated at least one positive association between an oral health component (dental, salivary and/or muscular) and dysphagia. This review highlights that oral health and OD are associated but was not able to determine causality. The lack of scientific evidence could be explained by the observational approach of the majority of the studies and the irrelevant choice of oral health indicators. A relationship may exist between oral health and dysphagia, but this review highlights the lack of valid and standardized oral health indicators that would be needed to assess the impact of oral health on the overall health status of individuals.
Collapse
Affiliation(s)
- Noemie Drancourt
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
- CHU of Clermont-Ferrand, Service d’Odontologie, F-63003 Clermont-Ferrand, France
| | - Nada El Osta
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Nicolas Decerle
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
- CHU of Clermont-Ferrand, Service d’Odontologie, F-63003 Clermont-Ferrand, France
| | - Martine Hennequin
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
- CHU of Clermont-Ferrand, Service d’Odontologie, F-63003 Clermont-Ferrand, France
| |
Collapse
|
20
|
Tongue Pressure Declines Early on in Patients with Malocclusion. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
(1) Background: The tongue plays a key role in the stomatognathic system in carrying out oral functions. The aim of this study was to identify the association between tongue pressure and orthodontic parameters. (2) Methods: This study is a cross-sectional multicentered cohort study with IRB approval. During routine orthodontic initial examinations, the following data were recorded: age, sex, angle classification, overjet (OJ), overbite (OB), arch sizes, tongue width, and maximum tongue pressure (MTP). The association between MTP and orthodontic parameters was analyzed using Pearson’s correlation analysis and the Student’s t-test. (3) Results: There is a positive correlation between MTP and age between ages 10 and 20 (R = 0.47, p < 0.01). There is a negative correlation with MTP and age between 20 and 40 (R = −0.30, p < 0.05). There are negative correlations between MTP and OJ (R = −0.278, p < 0.01)) and OB (R = −0.374, p < 0.01). While there is no statistical significance between MTP and tongue width, there is a statistically significant difference between age and tongue width (R = 0.22482, p < 0.05). There is no statistical significance between MTP and sex, angle classification, arch length, intercanine width, and intermolar width. (4) Conclusion: An earlier decline in MTP is observed with patients with malocclusion. This implies that patients with malocclusion should seek early treatment for the malocclusion.
Collapse
|
21
|
Critical analysis of the evaluation of postoperative dysphagia following an anterior cervical discectomy and fusion. Am J Otolaryngol 2022; 43:103466. [PMID: 35427936 DOI: 10.1016/j.amjoto.2022.103466] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Postoperative dysphagia is a known complication of anterior cervical discectomy and fusion (ACDF) with reported incidences ranging from 1 to 79%. No standardized guidelines exist for spine surgeons to evaluate postoperative dysphagia after ACDF. A systematic method may be beneficial in distinguishing transient postoperative dysphagia secondary to intubation from those with postoperative complications. This study evaluates the causes, recognition, and clinical evaluation of postoperative dysphagia following ACDF. METHODS International classification of disease (ICD) and current procedural terminology (CPT) codes were used to identify ACDF patients and compared to anterior lumbar discectomy and fusion (ALDF), serving as a control group, between the years 2015-2019 and those diagnosed with dysphagia within 1 year. Demographics, operative details, and clinical evaluation were reviewed. Exclusion criteria included history of head and neck procedures, cancer, stroke, radiation, and trauma. RESULTS One hundred thirty-one ACDF and 93 ALDF patients met inclusion criteria. Twenty-seven (20.6%) ACDF patients were diagnosed with dysphagia within 1 year. Less than half of the dysphagia patients had the word "dysphagia" documented in their 1-month spine surgeon follow up visit. Only 66% of dysphagia patients had specialist evaluation and one third of those patients were referred by their surgeon. Only six patients received diagnostic barium swallow evaluations. CONCLUSION Postoperative dysphagia risk increases in ACDF compared to ALDF, likely due to underlying anatomy. Postoperative dysphagia symptoms are not effectively documented by spine surgeons and as a result underevaluated by dysphagia specialists. Patients may benefit from more extensive pre- and post-operative screening, evaluation, and referral regarding dysphagia symptoms following ACDF.
Collapse
|
22
|
Is There a Correlation Between NRS-2002 and EAT-10 Score? TOP CLIN NUTR 2022. [DOI: 10.1097/tin.0000000000000277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Effect of decreased tongue pressure on dysphagia and survival rate in elderly people requiring long-term care. J Dent Sci 2022; 17:856-862. [PMID: 35756815 PMCID: PMC9201529 DOI: 10.1016/j.jds.2021.09.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/21/2021] [Indexed: 12/11/2022] Open
Abstract
Background/purpose Tongue pressure plays an important role in swallowing function. The purpose of this study is to investigate whether decreased tongue pressure is associated with dysphagia and the development of pneumonia in the elderly requiring long-term care. Materials and methods Tongue pressure measurement and swallowing videoendoscopic (VE) examination were performed in 60 hospitalized elderly people (33 males and 27 females, with an average age of 84.3 years) to investigate the relationship with the clinical course. Factors related with dysphagia was analyzed by Fisher's exact test and one-way ANOVA, followed by multivariate logistic regression. The relationship between each variable and survival were analyzed by cox regression. Results Twenty-one patients had dysphagia by VE examination. Multivariate analysis showed that smaller BMI and reduced tongue pressure were significantly correlated with dysphagia. Smaller number of remaining teeth and dysphagia were significantly related to pneumonia-related death. No patients with tongue pressure of larger than 20 kpa died by pneumonia within one year, while in those with tongue pressure of smaller than 20 kpa, one-year cumulative survival rate by pneumonia was 44.3%. Conclusion Decreased tongue pressure was significantly associated with dysphagia and may increase the risk of pneumonia-related death in the elderly requiring long-term care.
Collapse
|
24
|
A simplified method for evaluating swallowing ability and estimating malnutrition risk: A pilot study in older adults. PLoS One 2022; 17:e0263896. [PMID: 35171950 PMCID: PMC8849596 DOI: 10.1371/journal.pone.0263896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 01/29/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The aim of this pilot study was to develop a Thai-version of a simple swallowing questionnaire, called the T-SSQ, and to evaluate the association between malnutrition risk and swallowing ability, determined objectively by tongue strength and subjectively by the T-SSQ. Sensitivity analysis was also performed to determine which swallowing indices better estimate malnutrition in older adults. Methods This cross-sectional study comprised two phases: Phase I, development and cross-cultural translation of the T-SSQ; and Phase II, application of the T-SSQ in 60 older adults. In Phase I, content and face validity of the T-SSQ was evaluated by 10 experts and 15 older adults. In Phase II, the convergent validity of the T-SSQ was evaluated by determining its association with objective tongue strength. Nutritional status was evaluated using the Thai-version of the Mini-Nutritional Assessment. Covariates included sociodemographic characteristics, and oral and health-related status. Adjusting for covariates, the associations between the two swallowing indices and malnutrition risk were determined using multivariable regression analyses. A cut-off value for low tongue strength was determined using a receiver operating characteristic (ROC) curve, and sensitivity analysis between the swallowing indices and malnutrition risk was performed. Results The T-SSQ comprised 4-items of common signs and symptoms of a swallowing problem. Its content and face validity were verified. Older adults were considered as having a swallowing problem when at least one item was reported. Convergent validity of the subjective index was shown by significantly different tongue strength values between the participants with and without a swallowing problem (p for independent t-test = 0.014). Based on the highest area under the ROC curve, an 18-kPa cut-off value was chosen to classify low tongue strength. Having a swallowing problem and low tongue strength was significantly associated with malnutrition risk. The positive predictive value of the subjective swallowing index was 1.8-fold higher than objective tongue strength. Conclusions Self-reported swallowing problems determined by the T-SSQ can be used as a subjective index for evaluating swallowing ability in older adults. Subjective swallowing problems and objective tongue strength were associated with malnutrition risk. However, the T-SSQ estimated malnutrition risk better than the objective index.
Collapse
|
25
|
Liu F, Yin J, Wang J, Xu X. Food for the elderly based on sensory perception: A review. Curr Res Food Sci 2022; 5:1550-1558. [PMID: 36161227 PMCID: PMC9489541 DOI: 10.1016/j.crfs.2022.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/23/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background The impairments of physiological functions caused by aging are common problems in the elderly, especially the impairments of sensory perception. Besides, close relationship between food sensory perception and nutritional status also suggests the importance of dietary management for the elderly population. The foods taking sensory perception into account are urgently needed by the elderly. Scope and approach This review analyzed sensory perception changes and their effects on food behaviors and nutritional status. Besides, sensory properties essential for aged-foods and acquisition methods, as well as current status of such foods were summarized. Key findings and conclusions Soft, smooth and moisty foods were more suitable for the elderly with chewing and swallowing dysfunction, which can be prepared by gelation, enzyme treatment, blade tenderization and other non-thermal technologies. Flavor enhancement/enrichment, irritant addition and packet sauces were recommended to compensate the impairment of chemical sensory. Molds, piping bag and 3D printing were suggested for refining appearance of pureed foods, and improving appetite of the elderly. Sensory perception changes of the elderly affect food behaviors and health. Soft, smooth, and moisty foods are more suitable for the elderly. Gelation and enzyme treatment are applied to modify the texture of aged food. Packet sauces may meet the heterogenetic flavor requirements of the elderly. Visually attractive food made by 3D printing can increase the appetite of elderly.
Collapse
|
26
|
Swallowing difficulty in the older adults: presbyphagia or dysphagia with sarcopenia? Int J Rehabil Res 2021; 44:336-342. [PMID: 34545853 DOI: 10.1097/mrr.0000000000000494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Oropharyngeal dysphagia is an important cause of mortality and morbidity in older adults. It has been reported in the literature that 11-68% of older adults experience swallowing difficulties. This study aimed to investigate the presence of dysphagia in older adults, whether this dysphagia is related to age (presbyphagia) or sarcopenia by comparing it with adults. Two hundred twenty-five patients were included in this cross-sectional study. The participants were divided into two groups by age as 'adults' and 'older adults'. Sarcopenia, dysphagia and malnutrition evaluations were performed. Older adult and adult groups were compared in terms of malnutrition, dysphagia and sarcopenia. The number of patients with dysphagia was significantly higher (P = 0.007) in the older adults. In older adults, all sarcopenic evaluation parameters were found significantly lower than adults (P < 0.05). The number of older adults with malnutrition was significantly lower in patients with normal swallowing (P < 0.05). The swallowing difficulty can be detected in older adults even if it does not cause any complaint. While most swallowing disorders may be due to age-related changes, about a third may be accompanied by sarcopenia.
Collapse
|
27
|
Sella-Weiss O. Association between swallowing function, malnutrition and frailty in community dwelling older people. Clin Nutr ESPEN 2021; 45:476-485. [PMID: 34620358 DOI: 10.1016/j.clnesp.2021.06.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND & AIMS Swallowing function decreases with age and impacts nutritional state and frailty. The aim of the study was to test the relationship between swallowing function, dysphagia, frailty, malnutrition and depression in community dwelling older participants. METHODS Community dwelling older participants (n = 180), were enrolled (74 men aged 75.9 ± 7.8, 65-91 years, and 107 women aged 75.9 ± 8.0, 65-95 years). Swallowing function was assessed by the Test of Mastication and Swallowing Solids (TOMASS) and the Timed Water Swallow Test (TWST). Dysphagia was identified using Hebrew 10-Item Eating Assessment Tool (H-EAT-10). Frailty was assessed by grip strength and the FRAIL Questionnaire. The Mini Nutritional Assessment - Short Form (MNA-SF) was used to identify nutritional status. Depression was screened with the Geriatric Depression Scale - Short Form (GDS-SF). RESULTS 18.3% of the participants had a score of 3 or above in H-EAT-10, indicating suspected dysphagia. 17.8% of the participants were malnourished or at risk of malnutrition, and 48.3% were defined as frail or pre-frail. The odds of being malnourished/at risk of malnutrition were 3 times greater in those with suspected dysphagia. The odds of being frail/pre-frail were also 3 times greater in those with suspected dysphagia. Moreover, suspected dysphagia and frail/pre-frail health status coincided in 69.7% of participants. Participants that were malnourished/at risk of malnutrition required more masticatory cycles (p < .05) and more time (p < .05) to eat a cracker and drink 150 mL of water (p < .05), and had reduced swallowing capacity (volume/sec) in the TWST (p < .05) than those who were at normal nutritional statues. Similar results were found for frail/pre-frail participants versus robust health status. A decrease in grip strength was associated with increased (worse) frailty score, decreased nutritional score, decreased chewing function in TOMASS and decreased water drinking function in TWST (p < .05). MNA-SF score, age, GDS-SF score and EAT-10 were the best predictors of FRAIL score. CONCLUSION A simple multi-dimensional screen should be employed by trained allied health professionals, nurses and their assistants to improve early identification and early referral to relevant health providers in order to provide preventive intervention for dysphagia, nutrition, frailty and depression.
Collapse
Affiliation(s)
- Oshrat Sella-Weiss
- Department of Communication Sciences and Disorders, University of Haifa, Israel; Department of Communication Disorders, Ono Academic Collage, Israel.
| |
Collapse
|
28
|
Galek K, Bice EM, Marquez G. Tongue and Lip Comparisons between Healthy and Nondysphagic Poststroke Individuals. Folia Phoniatr Logop 2021; 74:46-53. [PMID: 34261062 DOI: 10.1159/000517170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 05/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The lips and tongue play a substantial role in efficient clearance of food from the mouth and pharynx into the esophagus. No study has compared oral pressures between healthy individuals and poststoke individuals who report functional swallow abilities. AIM The current study aimed to investigate the presence of differences in oral pressures between healthy individuals and poststroke individuals who report functional swallowing abilities. DESIGN This is a controlled matched pair study. POPULATION Eighteen control participants (CG) and 18 nondysphagic poststroke participants (NDSG) were enrolled into this study. METHODS The Iowa Oral Performance Instrument (IOPI) was used to measure and compare tongue strength, endurance, and functional lingual and labial pressures between sex and age-matched pairs. RESULTS Six paired, two-tailed t tests revealed that tongue and lip pressures were different between the 2 groups. Maximum anterior tongue pressures and posterior tongue pressures were also different, i.e., t(17) = -2.89 (p = 0.010) and t(17) = -2.85 (p = 0.011), with the CG presenting higher pressures. Right lip pressures were significantly lower in the NDSG compared to the CG, i.e., t(17) = 2.45 (p = 0.0001). Left lip pressures were significantly lower in the NDSG compared to the CG, i.e., t(17) = -5.43 (p = 0.0001). Tongue endurance, i.e., t(17) = 0.092 (p = 0.928) and saliva swallow pressures, i.e., t(17) = -0.490 (p = 0.63) were not different. CONCLUSION Although poststroke participants reported functional swallowing abilities, there were differences in tongue and lip pressures but not in endurance or saliva swallow pressures. CLINICAL REHABILITATION IMPACT Poststroke individuals without complaints of dysphagia who are not assessed may experience subclinical dysphagia that could negatively impact their nutrition and quality of life.
Collapse
Affiliation(s)
- Kristine Galek
- Speech Pathology and Audiology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Ed M Bice
- Clinical Education, IOPI Medical L.L.C., Woodinville, Washington, USA
| | - Giselle Marquez
- Speech Pathology and Audiology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| |
Collapse
|
29
|
Xavier JS, Gois ACB, Travassos LDCP, Pernambuco L. Oropharyngeal dysphagia frequency in older adults living in nursing homes: an integrative review. Codas 2021; 33:e20200153. [PMID: 34161439 DOI: 10.1590/2317-1782/20202020153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/13/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To synthesize the scientific knowledge on the frequency of oropharyngeal dysphagia in older adults living in nursing homes. RESEARCH STRATEGIES The study question followed the PECO strategy and the search was performed in the Pubmed/Medline, Web of Science, Scopus, LILACS and SciELO databases, using keywords and specific free terms. SELECTION CRITERIA articles with no time or language restrictions that reported the frequency of oropharyngeal dysphagia in older adults living in nursing homes and the diagnostic criteria. DATA ANALYSIS it was analyzed the population characteristics, the concept of "oropharyngeal dysphagia", the methods for identifying the outcome and the frequency of oropharyngeal dysphagia. The evaluation of the methodological quality of the articles followed the criteria of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). RESULTS Fifteen articles were included. There was great variability in relation to the sample size, with a predominance of longevous old women. The concept of dysphagia, when mentioned, was heterogeneous. Diagnostic criteria were diverse and mostly comprised of questionnaires or clinical trials results. No studies used instrumental tests. The frequency of oropharyngeal dysphagia in the studied population ranged from 5.4% to 83.7%, being higher in studies that used clinical tests, but with greater precision of confidence intervals in studies that used questionnaires and large sample size. CONCLUSION The frequency of oropharyngeal dysphagia in older adults living in nursing homes has wide variability. Methodological discrepancies among studies compromise the reliability of frequency estimates and highlight the need for research with better defined and standardized methodological criteria.
Collapse
Affiliation(s)
- Jessica Soares Xavier
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil
| | - Amanda Cibelly Brito Gois
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte - UFRN - Natal (RN), Brasil
| | | | - Leandro Pernambuco
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil.,Programa de Pós-graduação em Modelos de Decisão e Saúde, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil.,Departamento de Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil
| |
Collapse
|
30
|
Shimizu A, Fujishima I, Maeda K, Wakabayashi H, Nishioka S, Ohno T, Nomoto A, Shigematsu T, Kayashita J. Effect of low tongue pressure on nutritional status and improvement of swallowing function in sarcopenic dysphagia. Nutrition 2021; 90:111295. [PMID: 34107332 DOI: 10.1016/j.nut.2021.111295] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/08/2021] [Accepted: 04/18/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study aimed to evaluate the effect of low tongue pressure on the improvement of swallowing function in people with sarcopenic dysphagia and ongoing dysphagia or physical rehabilitation. In addition, we investigated whether sarcopenic dysphagia at admission was associated with severity of malnutrition. METHODS This was a prospective cohort study of 146 people with sarcopenic dysphagia (mean age 84.6 ± 7.4 y; 68.4% women, 31.6% men) in a postacute rehabilitation hospital. Sarcopenic dysphagia was defined as the presence of both sarcopenia and dysphagia but not neurogenic dysphagia, such as dysphagia due to stroke. Low tongue pressure was classified as "probable" and normal tongue pressure as "possible" sarcopenic dysphagia. Swallowing function was assessed using the Food Intake Level Scale. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition criteria. Study outcomes included the amount of change in Food Intake Level Scale score during the rehabilitation period and the association between probable sarcopenic dysphagia and the severity of malnutrition on admission. Statistical significance was set at P < 0.05. RESULTS There were 83 participants (58.6%) with probable sarcopenic dysphagia. The severity of malnutrition (moderate malnutrition: adjusted odds ratio, 3.388; P = 0.042) and severe malnutrition (adjusted odds ratio, 3.663; P = 0.015) was a contributing factor to probable sarcopenic dysphagia. Probable sarcopenic dysphagia (regression coefficient, -0.384; P = 0.017) was negatively associated with the amount of change in Food Intake Level Scale score. CONCLUSIONS Probable sarcopenic dysphagia with low tongue pressure was associated with poorer improvement in swallowing function and severe malnutrition during postacute rehabilitation. Patients with probable sarcopenic dysphagia may require aggressive nutritional therapy.
Collapse
Affiliation(s)
- Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
| | | |
Collapse
|
31
|
Rodd BG, Tas AA, Taylor KDA. Dysphagia, texture modification, the elderly and micronutrient deficiency: a review. Crit Rev Food Sci Nutr 2021; 62:7354-7369. [PMID: 33905267 DOI: 10.1080/10408398.2021.1913571] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Dysphagia is an underlying symptom of many health issues affecting a person's ability to swallow. Being unable to swallow correctly may limit food intake and subsequently micronutrient status. The elderly may be the most at risk group of suffering dysphagia as well as most likely to be deficient in micronutrients. The use of texture-modified meals is a common approach to increasing dysphagia sufferer's food intake. The modification of food may affect the micronutrient content and currently there is a limited number of studies focusing on micronutrient content of texture-modified meals. This review considers the prevalence of dysphagia within the elderly UK community whilst assessing selected micronutrients. Vitamin B12, C, D, folate, zinc and iron, which are suggested to be most likely deficient in the general elderly UK population, were reviewed. Each micronutrient is considered in terms of prevalence of deficiency, metabolic function, food source and processing stability to provide an overview with respect to elderly dysphagia sufferers.
Collapse
Affiliation(s)
- B G Rodd
- National Centre for Food Manufacturing, College of Science, University of Lincoln, Lincoln, UK
| | - A A Tas
- National Centre for Food Manufacturing, College of Science, University of Lincoln, Lincoln, UK
| | - K D A Taylor
- National Centre for Food Manufacturing, College of Science, University of Lincoln, Lincoln, UK
| |
Collapse
|
32
|
Nutritional Assessment in Adult Patients with Dysphagia: A Scoping Review. Nutrients 2021; 13:nu13030778. [PMID: 33673581 PMCID: PMC7997289 DOI: 10.3390/nu13030778] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 02/06/2023] Open
Abstract
Malnutrition negatively affects the quality of life of patients with dysphagia. Despite the need for nutritional status assessment in patients with dysphagia, standard, effective nutritional assessments are not yet available, and the identification of optimal nutritional assessment items for patients with dysphagia is inadequate. We conducted a scoping review of the use of nutritional assessment items in adult patients with oropharyngeal and esophageal dysphagia. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched to identify articles published in English within the last 30 years. Twenty-two studies met the inclusion criteria. Seven nutritional assessment categories were identified: body mass index (BMI), nutritional screening tool, anthropometric measurements, body composition, dietary assessment, blood biomarkers, and other. BMI and albumin were more commonly assessed in adults. The Global Leadership Initiative on Malnutrition (GLIM), defining new diagnostic criteria for malnutrition, includes the categories of BMI, nutritional screening tool, anthropometric measurements, body composition, and dietary assessment as its required components, but not the blood biomarkers and the “other” categories. We recommend assessing nutritional status, including GLIM criteria, in adult patients with dysphagia. This would standardize nutritional assessments in patients with dysphagia and allow future global comparisons of the prevalence and outcomes of malnutrition, as well as of appropriate interventions.
Collapse
|
33
|
Curtis JA, Laus J, Schneider SL, Troche MS. Examining the Relationships Between Lingual Strength, Perihyoid Strength, and Swallowing Kinematics in Dysphagic Adults: A Retrospective Cross-Sectional Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:405-416. [PMID: 33439740 DOI: 10.1044/2020_jslhr-20-00143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The aim of this study was to examine the relationships of clinical measures of lingual and perihyoid strength with displacement swallowing kinematics and swallowing safety in a heterogenous group of dysphagic adults. Method A retrospective analysis was completed of videofluoroscopic swallow studies of consecutive dysphagic outpatient adults presenting to a tertiary swallowing center from January 1, 2015, to December 31, 2017. Videofluoroscopic swallow study records were included if containing displacement swallowing kinematics of a 20-ml single liquid swallow and clinical measures of anterior (L-MIPA) or posterior (L-MIPP) lingual maximal isometric press, saliva mean swallowing pressures (S-MSP), and/or open mouth-maximal isometric press (OM-MIP). Regression analyses were used to examine the relationships between clinical measures of lingual (L-MIPA, L-MIPP, S-MSP) and perihyoid (OM-MIP) strength and displacement swallowing kinematics, and binomial logistic regressions were used to examine the relationships between clinical measures of lingual and perihyoid strength and swallowing safety (Penetration-Aspiration Scale [PAS]). Results Multivariate regressions revealed significant relationships of L-MIPA, L-MIPP, S-MSP, and OM-MIP with group-level changes to the displacement swallowing kinematics. Univariate analyses revealed significant relationships of L-MIPA and L-MIPP with pharyngeal constriction ratio, maximal extent of upper esophageal segment opening, and PAS. Conclusions Weak relationships were identified of clinical measures of lingual and perihyoid strength with displacement swallowing kinematics. These findings suggest that clinical measures of lingual and perihyoid strength do not fully explain impairments in swallowing kinematics across a heterogenous group of dysphagic patients. Weak-to-moderate relationships were identified between clinical measures of lingual strength and PAS, suggesting that they may have value in predicting functional measures of swallowing safety. Further research is needed to examine how findings may differ between specific patient populations.
Collapse
Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Joey Laus
- UCSF Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Sarah L Schneider
- UCSF Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| |
Collapse
|
34
|
Shimizu A, Maeda K, Wakabayashi H, Nishioka S, Ohno T, Nomoto A, Kayashita J, Fujishima I. Sarcopenic Dysphagia with Low Tongue Pressure Is Associated with Worsening of Swallowing, Nutritional Status, and Activities of Daily Living. J Nutr Health Aging 2021; 25:883-888. [PMID: 34409966 DOI: 10.1007/s12603-021-1641-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES According to the recently proposed diagnostic criteria for sarcopenic dysphagia, sarcopenic dysphagia can be classified as probable or possible based on tongue pressure. However, it is unclear whether patients with probable and possible sarcopenic dysphagia have different characteristics. Therefore, this study aimed to investigate whether patients with possible and probable sarcopenic dysphagia have different clinical characteristics. DESIGN A cross-sectional study. SETTING A rehabilitation hospital. PARTICIPANTS In total, 129 patients aged ≥65 years with sarcopenic dysphagia were included. METHODS A tongue pressure of <20 kPa was indicative of probable sarcopenic dysphagia, and a tongue pressure of ≥20 kPa was indicative of possible sarcopenic dysphagia. Kuchi-Kara Taberu (KT) index scores were compared between the probable or possible sarcopenic dysphagia groups. RESULTS According to the tongue pressure, 76 and 53 patients were classified into the probable and possible sarcopenic dysphagia groups, respectively. In multiple linear regression analysis, the presence of probable sarcopenic dysphagia was independently associated with the total KT index score (standardized coefficient: -0.313, regression coefficient: -4.500, 95% confidence interval [CI], -6.920 to -2.080, P < 0.001). The presence of probable sarcopenic dysphagia was independently associated with some subitems of the KT index (willingness to eat, cognitive function while eating, oral preparatory and propulsive phase, severity of pharyngeal dysphagia, eating behavior, and daily living activities). CONCLUSIONS Patients with probable sarcopenic dysphagia were characterized by poor overall eating-related conditions, especially poor swallowing ability, ability to perform activities of daily living, and nutritional status.
Collapse
Affiliation(s)
- A Shimizu
- Keisuke Maeda, M.D., Ph.D., Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi 474-8511, Japan, Phone: +81-562-46-2311; Fax: +81-562-44-8518, E-mail:
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Effects of Tongue-Strengthening Self-Exercises in Healthy Older Adults: A Non-Randomized Controlled Trial. Dysphagia 2020; 36:925-935. [PMID: 33215265 PMCID: PMC8464581 DOI: 10.1007/s00455-020-10216-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
Tongue-strengthening exercises (TSE) using a device have been proposed as an intervention for improving tongue strength and endurance. However, devices for TSE have been expensive and difficult to manipulate and are not commonly used in home or clinical settings. This study therefore aimed to investigate whether tongue-strengthening self-exercises (TSsE) using a tongue-strengthening self-exercise tool at home can improve tongue strength in healthy older adults. This study included 27 participants (exercise group, η = 16, 7 men, 9 women, median age 84.5 years; control group, n = 11, 2 men, 9 women, median age 79.0 years). Exercises in the exercise group consisted of pushing the anterior tongue against the hard palate 30 times, 3 times a day, 5 days a week, for 8 weeks using a tongue-strengthening self-exercise tool. This tool is available in five levels of hardness. The most suitable hardness of the tool for each participant was calculated based on 60% of maximum tongue pressure (MTP) during the first 2 weeks of the training period and 80% of MTP for the remainder of the training period, as assessed using a tongue pressure-measuring device. The exercise group showed a significant improvement of 4.1 kPa in MTP (an 11.53% increase) and 4.53 s in endurance of tongue pressure (ETP) (a 99.86% increase). Furthermore, adherence in the exercise group was 99.2%. In conclusion, performing TSsE for 8 weeks was effective for increasing MTP and ETP in healthy older adults. This indicates that TSsE may be useful in older individuals at home to prevent age-related tongue muscle weakness.
Collapse
|
36
|
Huang YF, Liu SP, Muo CH, Chang CT. The impact of occluding pairs on the chewing patterns among the elderly. J Dent 2020; 104:103511. [PMID: 33212204 DOI: 10.1016/j.jdent.2020.103511] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/25/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES This study aims to investigate the impact of occluding pairs (OPs) on chewing strokes, chewing time, mealtime duration, and bite force in an aging population. METHODS The 100 participants included 52 women and 48 men with average age of 71.2 years. The subjects were restricted to those who can eat what they wanted and had no temporomandibular joint disorder (TMD) and dysphagia history; their OPs were counted in the posterior occlusal support zone in accordance with the Eichner classification. Free habitual mastication of a cornstarch cookie was analyzed by recording the number of chewing strokes and the amount of time needed for complete mastication. Strokes were counted by considering the opening and closing mandibular movements. Mealtime was defined as the time spent to finish a lunchbox and accomplish swallowing. Bite force was estimated with a T-Scan III®. A linear regression analysis was used to evaluate the impact of the OPs on the chewing strokes, chewing time, mealtime duration, and bite force. RESULTS In this study, 76% of the participants had 4 OPs and 12% participants had 3 OPs. Increasing the OPs significantly shortened the chewing time and mealtime duration (P = 0.02). The mealtime duration did not notably affect the chewing time (P = 0.237). There was significant association between OPs and bite force (P < 0.0001). CONCLUSIONS In elderly, increasing OPs significantly raised the bite force and shortened the chewing time and strokes. More OPs might be the key to maintain good chewing function. CLINICAL SIGNIFICANCE Among the elderly, increasing OPs significantly raised the bite force and shortened the chewing time and mealtime duration. To provide better chewing function, good oral hygiene is important to maintain as many OPs as possible; how to gain more OPs is essential concern in the prosthodontic treatment plan making.
Collapse
Affiliation(s)
- Yi-Fang Huang
- Department of General Dentistry, Chang Gung Memorial Hospital, Linkou 33305, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Shih-Ping Liu
- Program for Aging, College of Medicine, China Medical University, Taichung 40402, Taiwan; Center for Translational Medicine, China Medical University and Hospital, Taichung 40402, Taiwan; Department of Social Work, Asia University, Taichung 41354, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung 40402, Taiwan
| | - Chung-Ta Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei 22056, Taiwan.
| |
Collapse
|
37
|
Developmental Changes in Tongue Strength, Swallow Pressures, and Tongue Endurance. Dysphagia 2020; 36:854-863. [PMID: 33170325 DOI: 10.1007/s00455-020-10200-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
Maximum tongue strength, mean swallow pressures, and tongue endurance were measured in 324 children ages 6-12 years. The purpose of this study was to measure saliva swallow pressures in absolute terms (i.e., kilopascals) and as a percentage of maximum tongue strength to determine functional reserve in across ages in children and to examine factors that may influence tongue strength and swallow pressures including age, tongue endurance, and tongue-tie. The study results showed that maximum tongue strength and swallow pressures increased with age, while tongue endurance did not. Swallow pressures averaged 44% of maximum tongue strength across ages, indicating that children typically have a functional reserve of 56%. Tongue strength and swallow pressures were not decreased in the 20 children with tongue-tie. A sample clinical case is discussed.
Collapse
|
38
|
Shimizu A, Maeda K, Nagami S, Nagano A, Yamada Y, Shimizu M, Ishida Y, Kayashita J, Fujishima I, Mori N, Murotani K, Suenaga M. Low tongue strength is associated with oral and cough-related abnormalities in older inpatients. Nutrition 2020; 83:111062. [PMID: 33348111 DOI: 10.1016/j.nut.2020.111062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Sarcopenic dysphagia is partly characterized by a decline in the strength of the swallowing muscles. However, its associated characteristics and symptoms are unclear. The aim of this study was to clarify the characteristics and symptoms of swallowing ability associated with low tongue muscle strength, which is one of the swallowing muscles in older adults. METHODS This was a cross-sectional study of 197 older patients admitted to the hospital for orthopedic conditions. We measured the maximum tongue pressure (MTP) against the palate. Swallowing-related characteristics were assessed with the Mann assessment of swallowing ability. Sarcopenia was diagnosed using the 2019 Asian Working Group for Sarcopenia. RESULTS The mean age of patients was 81.3 ± 7.6 y, and 80.2% of patients were women. Forty-two patients (21.3%) showed low MTP, defined as <20 kPa. Approximately 50% of participants had sarcopenia. Patients in the low MTP group had a significantly higher incidence of sarcopenia compared with the normal MTP group (71.4% vs. 48.4%; P = .008). After adjusting for potential confounders in the multivariate analyses, low MTP was found to be independently associated with abnormalities in tongue coordination (odds ratio [OR]: 5.251; 95% confidence interval [CI], 2.336-11.807; P < .001), oral transit (OR: 5.248; 95% CI, 1.424-19.345; P = .013), cough reflex (OR: 2.709; 95% CI, 1.280-5.733; P = .009), and voluntary cough (OR: 7.786; 95% CI, 3.329-18.208; P < .001). CONCLUSIONS Patients with low tongue strength are characterized by abnormal oral and cough-related characteristics.
Collapse
Affiliation(s)
- Akio Shimizu
- Department of Nutrition Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.
| | - Shinsuke Nagami
- Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Ayano Nagano
- Department of Nursing Care, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Yumi Yamada
- Rehabilitation Visiting Nursing Station TRY, Aichi, Japan
| | - Midori Shimizu
- Department of Nutrition, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Yuria Ishida
- Department of Nutrition, Aichi Medical University, Nagakute, Japan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | | | - Masaki Suenaga
- Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan
| |
Collapse
|
39
|
Estupiñán Artiles C, Regan J, Donnellan C. Dysphagia screening in residential care settings: A scoping review. Int J Nurs Stud 2020; 114:103813. [PMID: 33220569 DOI: 10.1016/j.ijnurstu.2020.103813] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Older adults with dysphagia are at a higher risk of experiencing serious complications where dysphagia is not identified and adequately managed. Nursing personnel are critical for timely identification and management of dysphagia and prevention of these subsequent serious complications in residential care settings. OBJECTIVES To identify dysphagia screening tools used in residential care and to establish whether validated and used as per guidelines, their diagnostic accuracy and reliability and to identify the prevalence rate of dysphagia in this setting. DESIGN A scoping review based on Arksey & O'Malley (2005) methodological framework. DATA SOURCES An electronic search of databases CINAHL, Pubmed and Scopus was conducted. Reference lists were checked in all identified articles for additional studies. Peer-reviewed publications describing the process of identifying dysphagia and using a screening protocol in residential care settings were considered for inclusion. REVIEW METHODS All identified studies were screened by reading of titles, keywords and abstracts. Those articles that were deemed eligible for inclusion were read in full. RESULTS Nineteen quantitative studies and one mixed-methods study out of 1,674 articles were included in the review. Thirteen different instruments for dysphagia screening were identified, with the Modified Water Swallow Test being the most commonly used. Other diagnostic procedures, such as fiberoptic endoscopic evaluation of swallowing, pulse oximetry or cervical auscultation, were implemented along with the administration of a dysphagia screening tool in six studies. The 3-Ounce Water Swallow Test, the Yale Swallow Protocol and the Gugging Swallowing Screen were identified as the instruments with the best clinical accuracy values. The reported prevalence of dysphagia in this setting ranged from 15% to 70%. CONCLUSIONS Formal dysphagia screening in residential care settings is not common practice. The dysphagia screening tools identified in this review are not validated for use in this setting. The implementation of dysphagia screening protocols specific to this population may facilitate identification of dysphagia and avoid complications.
Collapse
Affiliation(s)
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Faculty of Arts, Humanities and Social Sciences, Trinity College Dublin, Ireland
| | - Claire Donnellan
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, Ireland
| |
Collapse
|
40
|
Wu SA, Morrison‐Koechl J, Slaughter SE, Middleton LE, Carrier N, McAiney C, Lengyel C, Keller H. Family member eating assistance and food intake in long‐term care: A secondary data analysis of the M3 Study. J Adv Nurs 2020; 76:2933-2944. [DOI: 10.1111/jan.14480] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 05/15/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022]
Affiliation(s)
| | | | | | | | | | - Carrie McAiney
- University of Waterloo Waterloo ON Canada
- Schlegel‐University of Waterloo Research Institute for Aging Waterloo ON Canada
| | | | - Heather Keller
- University of Waterloo Waterloo ON Canada
- Schlegel‐University of Waterloo Research Institute for Aging Waterloo ON Canada
| |
Collapse
|
41
|
Pizzorni N, Ginocchio D, Bianchi F, Feroldi S, Vedrodyova M, Mora G, Schindler A. Association between maximum tongue pressure and swallowing safety and efficacy in amyotrophic lateral sclerosis. Neurogastroenterol Motil 2020; 32:e13859. [PMID: 32337820 DOI: 10.1111/nmo.13859] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/22/2020] [Accepted: 03/30/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia (OD) is common in amyotrophic lateral sclerosis (ALS), leading to a reduction of swallowing safety and efficacy. The tongue has an important role in swallowing function for oral processing and bolus propulsion through the pharynx. The study aims to analyze the association between instrumental findings of OD and tongue pressure. METHODS Patients with ALS referred for fiberoptic endoscopic evaluation of swallowing (FEES) were recruited. FEES was conducted to test swallowing function with liquid (5, 10, and 20 ml), semisolid (5, 10, and 20 ml), and solid. FEES recordings were assessed for swallowing safety, using the penetration-aspiration scale (PAS), and for swallowing efficacy, using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). PAS scores >2 were suggestive of penetration, PAS scores >5 of aspiration, and YPRSRS scores >2 of residue. Maximum tongue pressure (MTP) and tongue endurance were measured using the Iowa Oral Performance Instrument. Tongue pressure measurements were compared between patients with and without penetration, aspiration, or residue. KEY RESULTS Fifty-five patients with ALS were included. Mean MTP was 29.7 kPa, and median tongue endurance was 10 seconds. Patients with residue in the pyriform sinus had a significantly lower MTP than patients without residue in the pyriform sinus with semisolids 10 ml (P = .011) and 20 ml (P = .032). Patients with a tongue endurance <10 seconds exhibited higher frequency of penetration with liquids 5 ml (P = .046), liquids 10 ml (P = .015), and solids (P = .22). CONCLUSION AND INFERENCES In patients with ALS, MTP is significantly associated with an impairment of swallowing efficacy and tongue endurance was significantly associated with an impairment of swallowing safety.
Collapse
Affiliation(s)
- Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Daniela Ginocchio
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Federica Bianchi
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Sarah Feroldi
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Miriam Vedrodyova
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Gabriele Mora
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| |
Collapse
|
42
|
Rogus-Pulia NM, Plowman EK. Shifting Tides Toward a Proactive Patient-Centered Approach in Dysphagia Management of Neurodegenerative Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1094-1109. [PMID: 32650651 PMCID: PMC7844336 DOI: 10.1044/2020_ajslp-19-00136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Purpose Persons with neurodegenerative disease frequently develop comorbid dysphagia as part of their disease process. Current "reactive" approaches to dysphagia management address dysphagia once it manifests clinically and consist of compensatory approaches. The purpose of this article is to propose a paradigm shift in dysphagia management of patients with neurodegenerative disease from a "reactive to proactive" approach by highlighting amyotrophic lateral sclerosis (ALS) and dementia as case examples. Method The authors present several areas of special consideration for speech-language pathologists (SLPs) treating dysphagia in patients with neurodegenerative disease. The drawbacks of historical "reactive" approaches to dysphagia management are described. Concepts of functional reserve for swallowing and homeostenosis are discussed. A "proactive" patient-centered paradigm of care for these patients is proposed with evidence to support its importance. A rationale for use of this approach in patients with ALS and dementia is provided with strategies for implementation. Results When treating dysphagia in patients with neurodegenerative disease, SLPs must balance a variety of factors in their decision making, including disease severity and expected progression, cultural considerations, goals of care, patient empowerment, and caregiver support. Reactive approaches to dysphagia management in these populations are problematic in that they disempower patients by focusing on use of compensatory techniques (e.g., diet modification, postural changes, feeding tube placement). Proactive approaches that employ rehabilitative interventions to increase functional reserve, such as resistance training, may result in improvement or maintenance of swallowing function longer into disease progression. An interdisciplinary team with early SLP involvement is necessary. Conclusions SLPs play a critical role in the management of dysphagia in patients with neurodegenerative disease and should be integrated early in the care of these patients. By focusing on a proactive patient-centered approach, patients with neurodegenerative conditions, such as ALS and dementia, will experience improved quality of life and health outcomes for a longer time.
Collapse
Affiliation(s)
- Nicole M. Rogus-Pulia
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Emily K. Plowman
- Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville
- Aerodigestive Research Core, University of Florida, Gainesville
- Department of Neurology, College of Medicine, University of Florida, Gainesville
| |
Collapse
|
43
|
Efficacy of Mealtime Interventions for Malnutrition and Oral Intake in Persons With Dementia: A Systematic Review. Alzheimer Dis Assoc Disord 2020; 34:366-379. [PMID: 32530831 DOI: 10.1097/wad.0000000000000387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Malnutrition and weight loss are highly prevalent in persons with Alzheimer's disease and related dementias. Oral intake is an important interventional target for addressing these nutritional consequences. However, the efficacy of interventions remains poorly understood as prior syntheses have failed to examine the impact of intervention approaches on malnutrition and hypothesized mechanisms of action in persons with dementia. This review aimed to determine the efficacy of mealtime interventions to improve oral intake and nutritional outcomes in persons with dementia. Four databases yielded 1712 studies, resulting in 32 studies that met inclusion criteria. Studies included education, environmental modifications, feeding, oral supplementation, and other pharmacologic/ecopsychological interventions. While the majority of studies reported statistically significant improvements in at least 1 nutritional outcome, study design and outcome measures were heterogenous with many lacking adequate statistical power or blinding. Collectively, we found moderate evidence to suggest the efficacy of oral supplementation, and preliminary evidence to suggest that feeding interventions, education, and environmental modifications may confer improvements. Findings clarify the state of existing evidence regarding various interventional strategies for improving malnutrition in persons with dementia. While some approaches are promising, adequately powered and rigorously designed multidimensional intervention trials are needed to inform clinical decision-making in real-world contexts.
Collapse
|
44
|
Curtis JA, Molfenter S, Troche MS. Predictors of Residue and Airway Invasion in Parkinson's Disease. Dysphagia 2020; 35:220-230. [PMID: 31028481 PMCID: PMC8711115 DOI: 10.1007/s00455-019-10014-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/22/2019] [Indexed: 12/30/2022]
Abstract
Dysphagia is a highly prevalent disorder in Parkinson's Disease (PD) characterized by changes in swallowing kinematics, residue, and airway invasion. These changes can lead to serious medical morbidities including malnutrition, aspiration pneumonia, and death. However, little is known about the most predictive causes of residue and airway invasion in this patient population. Therefore, the aims of this study were to (1) assess how disease severity affects residue, airway invasion, and swallowing kinematics in PD; and (2) determine which swallowing kinematic variables were most predictive of residue and airway invasion. A secondary analysis of forty videofluoroscopic swallow studies (VFSS) from individuals with early through mid-stage PD was performed. Airway invasion (Penetration-Aspiration Scale 'PAS'), residue (Bolus Clearance Ratio 'BCR'), and ten spatiotemporal swallowing kinematic variables were analyzed. Statistical analyses were used to determine if disease severity predicted residue, depth of airway invasion, and swallowing kinematics, and to examine which swallowing kinematic variables were most predictive of residue and the presence of airway invasion. Results revealed that residue and the presence of airway invasion were significantly predicted by swallowing kinematics. Specifically, airway invasion was primarily influenced by the extent and timing of airway closure, while residue was primarily influenced by pharyngeal constriction. However, disease severity did not significantly predict changes to swallowing kinematics, extent of residue, or depth of airway invasion during VFSS assessment. This study comprehensively examined the pathophysiology underlying dysphagia in people with early to mid-stage PD. The results of the present study indicate that disease severity alone does not predict swallowing changes in PD, and therefore may not be the best factor to identify risk for dysphagia in PD. However, the swallowing kinematics most predictive of residue and the presence of airway invasion were identified. These findings may help to guide the selection of more effective therapy approaches for improving swallowing safety and efficiency in people with early to mid-stage PD.
Collapse
Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, 525 West, 120th Street, Thorndike Room 955, New York, NY, 10027, USA.
| | - Sonja Molfenter
- NYU Swallowing Research Lab, New York University, 665 Broadway, 9th Floor, New York, NY, 10012, USA
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, 525 West, 120th Street, Thorndike Room 955, New York, NY, 10027, USA
| |
Collapse
|
45
|
Keller H, Vucea V, Slaughter SE, Jager-Wittenaar H, Lengyel C, Ottery FD, Carrier N. Prevalence of Malnutrition or Risk in Residents in Long Term Care: Comparison of Four Tools. J Nutr Gerontol Geriatr 2019; 38:329-344. [PMID: 31335280 DOI: 10.1080/21551197.2019.1640165] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The ideal tool for determination of malnutrition risk or malnutrition in long term care (LTC) is elusive. This study compares prevalence, association with resident risk factors and sensitivity (SE) and specificity (SP) of malnutrition or risk categorization in 638 residents from 32 LTC homes in Canada using four tools: the Mini-Nutritional Assessment Short Form (MNA-SF); Patient-Generated Subjective Global Assessment (PG-SGA) Global Category Rating and the Pt-Global webtool; and the interRAI Long Term Care Facility undernutrition trigger. Prevalence was most common with MNA-SF (53.7%) and lowest with InterRAI (28.9%), while the PG-SGA Global Category Rating (44%) was higher than the Pt-Global webtool (33.4%). Tools were consistently associated with resident covariates with few exceptions. The PG-SGA Global Category Rating demonstrated the best sensitivity and specificity when compared to all other tools. Further work to determine the predictive validity of this tool in LTC residents is required.
Collapse
Affiliation(s)
- Heather Keller
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo , Waterloo , Canada
- Faculty of Applied Health Sciences, University of Waterloo , Waterloo , ON , Canada
| | - Vanessa Vucea
- Faculty of Applied Health Sciences, University of Waterloo , Waterloo , ON , Canada
| | - Susan E Slaughter
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta , Edmonton , Canada
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences , Groningen , The Netherlands
- Department of Maxillofacial Surgery, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Christina Lengyel
- Faculty of Agricultural and Food Sciences, University of Manitoba , Winnipeg , Canada
| | - Faith D Ottery
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences , Groningen , The Netherlands
- Ottery and Associates , Vernon Hills , IL , USA
| | - Natalie Carrier
- École des sciences des aliments, de nutrition et d'études familiales, Faculté des sciences de la santé et des services communautaires, Université de Moncton , Moncton , Canada
| |
Collapse
|
46
|
Blanař V, Hödl M, Lohrmann C, Amir Y, Eglseer D. Dysphagia and factors associated with malnutrition risk: A 5‐year multicentre study. J Adv Nurs 2019; 75:3566-3576. [DOI: 10.1111/jan.14188] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/30/2019] [Accepted: 08/13/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Vít Blanař
- Department of Nursing Faculty of Health Studies University of Pardubice Pardubice Czech Republic
| | - Manuela Hödl
- Institute of Nursing Science Medical University of Graz Graz Austria
| | - Christa Lohrmann
- Institute of Nursing Science Medical University of Graz Graz Austria
| | | | - Doris Eglseer
- Institute of Nursing Science Medical University of Graz Graz Austria
| |
Collapse
|
47
|
Vucea V, Keller HH, Morrison JM, Duizer LM, Duncan AM, Steele CM. Prevalence and Characteristics Associated with Modified Texture Food Use in Long Term Care: An Analysis of Making the Most of Mealtimes (M3) Project. CAN J DIET PRACT RES 2019; 80:104-110. [DOI: 10.3148/cjdpr-2018-045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: To describe the prevalence and characteristics of modified-texture food (MTF) consumers when applying standard diet terminology. Methods: Making the Most of Mealtimes (M3) is a cross-sectional multi-site study including 32 long-term care (LTC) homes located in 4 Canadian provinces. Resident characteristics were collected from health records using a defined protocol and extraction form. Since homes used 67 different terms to describe MTFs, diets were recategorized using the International Dysphagia Diet Standardization Initiative Framework as a basis for classification. Results: MTFs were prescribed to 47% (n = 298) of participants (n = 639) and prevalence significantly differed among provinces (P < 0.0001). Various resident characteristics were significantly associated with use of MTFs: dysphagia and malnutrition risk, dementia diagnosis, prescription of oral nutritional supplements; lower body weight and calf circumference; greater need for physical assistance with eating; poor oral health status; and dependence in all activities of daily living. Conclusions: This is the first study that used a diverse sample of LTC residents to determine prevalence of MTF use and described consumers. The prevalence of prescribed MTFs was high and diverse across provinces in Canada. Residents prescribed MTFs were more vulnerable than residents on regular texture diets. These findings add value to our understanding of MTF consumers.
Collapse
Affiliation(s)
- Vanessa Vucea
- Department of Kinesiology, University of Waterloo, Waterloo, ON
| | - Heather H. Keller
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON
| | | | - Lisa M. Duizer
- Department of Food Science, University of Guelph, Guelph, ON
| | - Alison M. Duncan
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON
| | - Catriona M. Steele
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON
| |
Collapse
|
48
|
Namasivayam-Macdonald AM, Steele CM, Carrier N, Lengyel C, Keller HH. The Relationship between Texture-Modified Diets, Mealtime Duration, and Dysphagia Risk in Long-Term Care. CAN J DIET PRACT RES 2019; 80:122-126. [PMID: 30907128 DOI: 10.3148/cjdpr-2019-004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Many long-term care (LTC) residents have an increased risk for dysphagia and receive texture-modified diets. Dysphagia has been shown to be associated with longer mealtime duration, and the use of texture-modified diets has been associated with reduced nutritional intake. The current study aimed to determine if the degree of diet modification affected mealtime duration and to examine the correlation between texture-modified diets and dysphagia risk. Data were collected from 639 LTC residents, aged 62-102 years. Nine meal observations per resident provided measures of meal duration, consistencies consumed, coughing and choking, and assistance provided. Dysphagia risk was determined by identifying residents who coughed/choked at meals, were prescribed thickened fluids, and/or failed a formal screening protocol. Degree of texture modification was derived using the International Dysphagia Diet Standardization Initiative Functional Diet Scale. There was a significant association between degree of diet modification and dysphagia risk (P < 0.001). However, there was no association between diet modifications and mealtime duration, even when the provision of physical assistance was considered. Some residents who presented with signs of swallowing difficulties were not prescribed a texture-modified diet. Swallowing screening should be performed routinely in LTC to monitor swallowing status and appropriateness of diet prescription. Physical assistance during meals should be increased.
Collapse
Affiliation(s)
| | - Catriona M Steele
- b Toronto Rehabilitation Institute, Toronto, ON.,c University of Toronto, Toronto, ON
| | | | | | - Heather H Keller
- f University of Manitoba, Winnipeg, MB.,g Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON
| |
Collapse
|
49
|
Effects of Verbal Cueing on Respiratory-Swallow Patterning, Lung Volume Initiation, and Swallow Apnea Duration in Parkinson’s Disease. Dysphagia 2019; 35:460-470. [DOI: 10.1007/s00455-019-10050-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/10/2019] [Indexed: 11/27/2022]
|
50
|
Namasivayam-MacDonald AM, Steele CM, Keller HH. Perception Versus Performance of Swallow Function in Residents of Long-Term Care. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1198-1205. [PMID: 31194919 DOI: 10.1044/2019_ajslp-18-0186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The purpose of this study was to determine if older adults residing in long-term care were able to accurately self-report their swallowing status by comparing subjective complaints of dysphagia and objective methods of swallowing screening. Method Data were collected from 397 residents of long-term care (M age = 86.8 years ± 7.8; 263 female). Cognitive impairment scores were collected, and each resident was asked (a) if they thought they had a swallowing problem, (b) if they coughed/choked when they ate, and (c) if they coughed/choked when they drank. These responses were compared to results of a swallowing screening tool and mealtime observations of coughing and choking. Results Residents who reported swallowing difficulties (10%, n = 41) were 8 times more likely to fail the swallowing screening (p < .001); however, 80% of residents who failed the swallowing screening did not previously report that swallowing was an issue. There was no significant association between self-reports of coughing and choking at meals and observations. There was no difference in level of cognition between residents who accurately reported swallowing status and those who were inaccurate. Conclusions Residents are largely unable to accurately self-report swallowing difficulties and also have difficulty accurately reporting incidences of coughing and choking. These findings suggest that concerted efforts are required to implement regular, formal swallowing screening protocols in long-term care to objectively identify those at risk.
Collapse
Affiliation(s)
| | - Catriona M Steele
- Toronto Rehabilitation Institute, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Heather H Keller
- University of Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| |
Collapse
|