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Valentin B, Maes-Festen D, Schoufour J, Oppewal A. Sarcopenia predicts 5-year mortality in older adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1161-1173. [PMID: 37608512 DOI: 10.1111/jir.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/06/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND People with intellectual disabilities (ID) have a lower life expectancy than their peers without ID. A contributing factor to the lower life expectancy and early mortality could be sarcopenia: low muscle mass and low muscle function. In the general population, sarcopenia strongly predicts early mortality, but this association is unknown in people with ID. Therefore, this study aims to explore the association between sarcopenia and 5-year mortality in older adults with ID. METHODS In the Healthy Ageing and Intellectual Disabilities (HA-ID) study, the prevalence of sarcopenia was measured at baseline among 884 older adults (≥50 years) with ID. All-cause mortality was measured over a 5-year follow-up period. Univariable and multivariable Cox proportional hazard models were applied to determine the association between sarcopenia (no sarcopenia, pre-sarcopenia, sarcopenia, severe sarcopenia) and early mortality, adjusted for age, sex, level of ID, presence of Down syndrome, and co-morbidity (chronic obstructive pulmonary disease, diabetes type 2 and metabolic syndrome). RESULTS The unadjusted hazard ratio (HR) for sarcopenia was 2.28 [95% confidence interval (CI) 1.48-3.42], P < 0.001), and 2.40 (95% CI 1.40-4.10, P = 0.001) for severe sarcopenia. When adjusted for age, sex, level of ID, and Down syndrome, sarcopenia (HR = 1.72, 95% CI 1.08-2.75, P = 0.022) and severe sarcopenia (HR = 1.86, 95% CI 1.07-3.23, P = 0.028) were significantly associated with early mortality. When additionally adjusted for co-morbidity, the adjusted HR decreased to 1.62 (95% CI 1.02-2.59, P = 0.043) and 1.81 (95% CI 1.04-3.15, P = 0.035) for sarcopenia and severe sarcopenia, respectively. CONCLUSION Sarcopenia is an independent risk factor for early mortality in older adults with ID over a 5-year follow-up period. Our results stress the need to delay the incidence and development of sarcopenia in older adults with ID.
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Affiliation(s)
- B Valentin
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Faculty of Sports and Nutrition, Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - D Maes-Festen
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J Schoufour
- Faculty of Sports and Nutrition, Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - A Oppewal
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Maki Y, Takagawa M, Goda A, Katsura J, Yanagibashi K. Successful Continuation of Oral Intake in a Dysphagic and Tetraplegic Patient With Alternate Right and Left Complete Lateral Decubitus Positions in Rehabilitation. Cureus 2023; 15:e38667. [PMID: 37292544 PMCID: PMC10246513 DOI: 10.7759/cureus.38667] [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] [Accepted: 05/05/2023] [Indexed: 06/10/2023] Open
Abstract
Cervical spinal cord injury can result in dysphagia and tetraplegia. Dysphagia therapy can be required to avoid aspiration pneumonia during oral intake for persons with cervical spinal cord injury. Complete lateral decubitus position may be a specific position for safe swallowing. However, the literature on dysphagia therapy in complete lateral decubitus position for persons with tetraplegia and dysphagia is limited. We present the case of a 76-year-old man with dysphagia and tetraplegia secondary to cervical cord injury. As the patient wished for oral intake, swallowing training in an elevated position of the head at 60° was already initiated. Two days after admission, aspiration pneumonia occurred. As the spasticity increased continuously, the patient could not comfortably undertake swallowing training in an elevated head position of 60°. The flexible endoscopic evaluation of swallowing (FEES) was performed for the patient. The patient did not swallow water or jelly safely in an elevated head position. However, the patient swallowed jelly safely in the right complete lateral decubitus position. Two months after the initiation of oral intake in the right complete lateral decubitus position, the second FEES revealed that the patient swallowed jelly and food in the form of paste safely in the left complete lateral decubitus position. To relieve the pain of the right shoulder induced by continuous right complete lateral decubitus position, the patient retained oral intake in the left or right complete lateral decubitus position alternately for six months without recurrent aspiration pneumonia. Right and left complete lateral decubitus positions when alternately performed in swallowing training can be useful and safe for a patient with dysphagia and tetraplegia secondary to cervical spinal cord injury.
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Affiliation(s)
- Yoshinori Maki
- Neurosurgery, Hikone Chuo Hospital, Hikone, JPN
- Rehabilitation, Hikari Hospital, Otsu, JPN
| | | | - Akio Goda
- Physical Therapy, Kyoto Tachibana University, Kyoto, JPN
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Cox G, Breen LJ, Cocks N. Being practically, professionally and personally prepared: Supporting people with intellectual disability and dysphagia to eat and drink outside the home. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:256-268. [PMID: 35225105 DOI: 10.1080/17549507.2022.2039765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE Eating and drinking outside the home is important for participation and social inclusion for people with intellectual disability and dysphagia (swallowing difficulties) but is likely to come with additional challenges. This qualitative research aimed to identify the challenges and strategies used by people with intellectual disability and dysphagia and their carers when eating outside the home. METHOD This study used a qualitative research design and reflexive researcher stance following an interpretive phenomenological methodology to understand the nature of the phenomenon "supporting people to eat and drink outside the home". Participants (n = 20) including those with intellectual disability and dysphagia (ages 20-30 years), their support staff and families were interviewed about eating and drinking outside the home. Semi-structured interviews were used. Interviews were analysed thematically. RESULT Three overarching themes were extracted using thematic analysis. These were being fully prepared; being a confident and respectful advocate; and being open to the varied responses of other people. CONCLUSION The findings of this study suggest that there are unique challenges for people with intellectual disability and dysphagia and their carers when eating outside the home. There was a need to be practically, professionally, and personally prepared for eating outside the home. There is a need, therefore, to specifically address the challenges of eating outside the home and sharing the strategies used by others to overcome these challenges.
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Affiliation(s)
- Gillian Cox
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Lauren J Breen
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - Naomi Cocks
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Fernández-Pan I, Merino G, Virseda P, Beriain MJ, Ibañez FC. High hydrostatic pressure processing to replace texturizing agents on a plant product intended for altered deglutition: A concept proof. Lebensm Wiss Technol 2023. [DOI: 10.1016/j.lwt.2023.114702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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A New Screening Tool for Rapid Diagnosis of Functional and Environmental Factors Influencing Adults with Intellectual Disabilities. Diagnostics (Basel) 2022; 12:diagnostics12122991. [PMID: 36552998 PMCID: PMC9776428 DOI: 10.3390/diagnostics12122991] [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: 09/15/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022] Open
Abstract
The dynamic nature of intellectual disability (ID) and its many comorbidities necessitate repeated screening and functional diagnosis. However, the existing scales are lengthy and expensive and cannot be implemented at all levels of ID. During phase one of this study (September 2019-September 2020), the functional screening tool (FST-ID) was validated for adults with ID and then used as a clinical tool to collect data for 76 participants from their direct service providers (DSP). Their age ranged from 21 to 71 years (mean = 37.63, SD ± 14.61), and they were diagnosed with severe/profound (N = 16) and moderate (N = 29), and mild (N = 31) levels of ID. The scale was found to hold high psychometric values. During phase two (September 2020-June 2022), the scale was found to be reliable as a continuous, clinical on-going screening tool, enabling the screening of functional and environmental changes experienced by adults with ID during acute times of the pandemic and regular times alike. All 76 adults experienced changes at the senior's daycare center mostly. The new scale may also help in the future to determine whether those changes only relate to post COVID-19 symptoms or other comorbidities as well.
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Wu C, Zhang K, Ye J, Huang X, Yang H, Yuan L, Wang H, Wang T, Zhong X, Guo J, Yu L, Xiao A. Evaluating the effectiveness of stepwise swallowing training on dysphagia in patients with Alzheimer's disease: study protocol for a randomized controlled trial. Trials 2022; 23:490. [PMID: 35698162 PMCID: PMC9195482 DOI: 10.1186/s13063-022-06446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The high prevalence of dysphagia among Alzheimer's disease (AD) patients has become a public health and economic concern. Therefore, effective and accessible dysphagia treatments are needed. As a fundamental rehabilitation of dysphagia, swallowing muscle exercises have received increased attention. Stepwise swallowing training (SST), integrated with all swallowing organs movement, is expected to improve swallowing dysfunction among AD patients. By using a randomized controlled trial design, we propose a multi-center research to evaluate the effectiveness of SST program among AD patients. METHODS A multi-center exploratory randomized controlled trial, with a 4-week follow-up period, will be conducted in three major public psychiatric hospitals in Guangdong, China. Participants in the control group will be assigned to routine dysphagia care, while participants in the intervention group will undergo the same nursing care and additionally receive the SST program. The SST program includes five sections of swallowing organs training: lip movement, facial movement, tongue movement, mandibular movement, and neck movement. Primary outcomes evaluate the swallowing function, namely, Water Swallowing Test (WTS) and Standard Swallowing Assessment (SSA). Secondary outcomes aim at measuring the improvement of negative impacts of dysphagia, namely eating behavior, ability of daily activity, and nutritional status. Data will be collected at baseline (T1), at 2 weeks (T2, intervention), and 4 weeks after intervention (T3, follow-up). DISCUSSION This study will offer trial-based evidence of the effectiveness of SST in relieving dysphagia among AD patients. SST program is expected to improve both the swallowing function and reduce the negative impacts of dysphagia, with an exploration of acceptability in the SST program. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2200056481 . Prospectively registered on 6 February 2022.
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Affiliation(s)
- Chenxin Wu
- Geriatric Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China.,Nursing School, Guangzhou Medical University, 195 Dongfeng West Road, Yuexiu District, Guangzhou, China
| | - Kun Zhang
- School of Public Health and Management, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, China
| | - Junrong Ye
- Geriatric Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China
| | - Xingxiao Huang
- Geriatric Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China
| | - Hang Yang
- Geriatric Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China
| | - Lexin Yuan
- Geriatric Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China.,Nursing Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China
| | - Haoyun Wang
- Nursing School, Guangzhou Medical University, 195 Dongfeng West Road, Yuexiu District, Guangzhou, China
| | - Ting Wang
- Nursing School, Guangzhou Medical University, 195 Dongfeng West Road, Yuexiu District, Guangzhou, China
| | - Xiaomei Zhong
- Geriatric Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China
| | - Jianxiong Guo
- Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China.
| | - Lin Yu
- TCM Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China.
| | - Aixiang Xiao
- Geriatric Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China. .,Nursing School, Guangzhou Medical University, 195 Dongfeng West Road, Yuexiu District, Guangzhou, China. .,School of Public Health and Management, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, China.
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Ben-David N, Lotan M, Moran DS. Development and validation of a functional screening tool for adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1281-1296. [PMID: 35606683 DOI: 10.1111/jar.13004] [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: 08/10/2021] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The dynamic nature of intellectual disability necessitates repeated screening. METHOD The functional screening tool (FST-ID) for individuals with intellectual disabilities was carefully constructed intellectual disabilities. RESULTS The FST-ID General Adaptive Composite score (GAC) runs between 0 and 68 points. Criterion validity-high-positive correlations were found between FST-ID and ABAS-II (Gold standard), and between the severity of the intellectual disability and the FST-ID (r = 0.78, p < .001). The scale holds high-internal consistency, intra and inter-rater reliability values. The cut-off point between mild and moderate disability is 50.4 (Sensitivity: 87%, Specificity 86%, p < .001) and 29.4 between moderate to severe-profound (Sensitivity: 96%, Specificity 94%, p < .001). CONCLUSIONS The FST-ID presents high-psychometric properties and requires less than 5 min to complete. Using this tool may support efficient screening practices and improved supports for adults with intellectual disability.
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Affiliation(s)
- Nophar Ben-David
- Health Administration Department, Health Sciences Faculty, University of Ariel, Ariel, Israel.,Amichai Non-profit Organization, Hod Hasharon, Israel
| | - Meir Lotan
- Physical Therapy Department, Health Sciences Faculty, University of Ariel, Ariel, Israel
| | - Daniel Sender Moran
- Health Administration Department, Health Sciences Faculty, University of Ariel, Ariel, Israel
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Parisius KG, Wartewig E, Schoonmade LJ, Aarab G, Gobbens R, Lobbezoo F. Oral frailty dissected and conceptualized: A scoping review. Arch Gerontol Geriatr 2022; 100:104653. [DOI: 10.1016/j.archger.2022.104653] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/26/2022] [Accepted: 02/04/2022] [Indexed: 01/28/2023]
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Dishes Adapted to Dysphagia: Sensory Characteristics and Their Relationship to Hedonic Acceptance. Foods 2021; 10:foods10020480. [PMID: 33672336 PMCID: PMC7926527 DOI: 10.3390/foods10020480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/27/2022] Open
Abstract
Dishes whose texture has been modified for dysphagia undergo changes in other sensory characteristics as well. Therefore, it is necessary to identify these characteristics in adapted dishes and their relationship to hedonic acceptance. In the present work, the sensory characteristics of five dishes adapted to dysphagia associated with cerebral palsy were investigated using the check-all-that-apply method. A hedonic evaluation with a panel of non-dysphagic judges was performed to relate the degree of acceptance with the sensory characteristics of the adapted dishes. The identification of the original non-adapted dish as well as the relationship between the hedonic evaluation by non-dysphagic judges and dysphagic judges were explored. The main attributes of the dishes adapted to dysphagia were "homogeneity" and "easy-to-swallow". Attributes that increased the hedonic evaluation were "flavorful", "flavor of the original dish", "soft texture", "easy-to-swallow", and "odor of the original dish". The attributes that decreased the hedonic evaluation were "thick mash" and "bland". The fish dish was the only one correctly identified more than 62.5% of the time. The adapted dishes received scores above 4.7 out of 9.0 in the hedonic evaluation. The most accepted dishes were the chicken stew and the chickpea stew. Except for the pasta dish, the test yielded similar results to those obtained with dysphagic judges. The texture-modified dishes were correctly characterized and accepted. This study shows that all the sensory characteristics of the adapted dishes are crucial for acceptance and identification.
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