1
|
Miyagami T, Nishizaki Y, Imada R, Yamaguchi K, Nojima M, Kataoka K, Sakairi M, Aoki N, Furusaka T, Kushiro S, Yang KS, Morikawa T, Tohara H, Naito T. Dental Care to Reduce Aspiration Pneumonia Recurrence: A Prospective Cohort Study. Int Dent J 2024; 74:816-822. [PMID: 38220512 PMCID: PMC11287086 DOI: 10.1016/j.identj.2023.11.010] [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: 09/27/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Aspiration pneumonia has a high recurrence rate, and oral care by dentists has been found effective in preventing its onset; however, this has not been evaluated using prospective studies. Therefore, we conducted a prospective study to evaluate the effectiveness of professional oral care by dentists in reducing aspiration pneumonia recurrence in older adult patients. METHODS In this prospective cohort study, we evaluated a dental oral care intervention, using a historical control group (control group). It was conducted at a single-centre regional core hospital in Japan that serves a large number of patients aged older than 80 years. Patients who were hospitalised for aspiration pneumonia were included in this study. During the study period (1 April 2021 to 31 March 2022), the clinical group received weekly professional cleaning by a dentist and the control group received standard oral care by a nurse as usual from 1 April 2020 to 31 March 2021. The dentist oral care group received weekly professional oral care from a dentist and was followed prospectively for 1 year. A Kaplan-Meier analysis was used to evaluate the timing of recurrent aspiration pneumonia or death. A Cox proportional hazards model was used to obtain a hazard ratio and determine the 95% confidence intervals. RESULTS There were 91 participants in the clinical group and 94 in the control group. The mean age of participants was 85 years, and 75 (40.5%) were female. The recurrence rate was 27.5% in the clinical group and 44.7% in the control group (P = .005). Professional cleaning by a dentist reduced the risk of recurrence of aspiration pneumonia by approximately 50% (adjusted hazard ratio, 0.465; 95% confidence interval, 0.278-0.78). CONCLUSIONS Professional cleaning by a dentist was associated with a lower rate of aspiration pneumonia recurrence than nurse-provided conventional oral care.
Collapse
Affiliation(s)
- Taiju Miyagami
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Yuji Nishizaki
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan; Division of Medical Education, Juntendo University School of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan.
| | - Ryoko Imada
- Dysphagia Rehabilitation, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima Bunkyo-ku, Tokyo, Japan
| | - Kohei Yamaguchi
- Dysphagia Rehabilitation, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima Bunkyo-ku, Tokyo, Japan
| | - Masanori Nojima
- Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Shirokanedai Minato-ku, Tokyo, Japan
| | - Koshi Kataoka
- Division of Medical Education, Juntendo University School of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Mizuki Sakairi
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Nozomi Aoki
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Takayuki Furusaka
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Seiko Kushiro
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Kwang-Seok Yang
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Toru Morikawa
- Department of General Medicine, Nara City Hospital, Higashikideracho, Nara, Japan
| | - Haruka Tohara
- Dysphagia Rehabilitation, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima Bunkyo-ku, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| |
Collapse
|
2
|
Oliveira LD, Marquitti FD, Ramos SCH, Almeida EAD, Nascimento WV, Dantas RO. RELATIONSHIP BETWEEN NUTRITIONAL STATUS, DYSPHAGIA, AND FUNCTIONAL EATING LEVEL IN ADULT PATIENTS WITH CEREBRAL PALSY IN LONG INSTITUTIONAL STAYS. ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:194-200. [PMID: 37556745 DOI: 10.1590/s0004-2803.20230222-149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/11/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Diets with modified consistencies for patients with dysphagia in long term care health institutions may be associated with malnutrition. OBJECTIVE : To assess the nutritional status of adult patients with cerebral palsy and dysphagia hospitalized in a health institution for more than 10 years. METHODS : This prospective investigation was performed in 56 patients with cerebral palsy (ages 25 to 71 years, mean: 44±12 years) and no other neurological diagnosis in hospital stay for more than 10 years had their nutritional status, dysphagia, and food ingestion capacity assessed in two moments with a 12-month interval in between them, respectively using the body mass index, the dysphagia risk assessment protocol (PARD), and the functional oral ingestion scale (FOIS). RESULTS : There were no differences between December 2015 and December 2016 in the patients' weight, nutritional status, diet consistency classification, PARD, and FOIS. The limits of prescribed diet consistency (IDDSI-FDS) and the assessments of dysphagia and functional eating level influenced the nutritional status. More intense dysphagia and greater eating restrictions were associated with a worse nutritional status. CONCLUSION : The nutritional status of adult patients with cerebral palsy hospitalized in a health long term institution who had modified diets according to their swallowing and mastication capacity did not worsen between assessments with a 12-month interval in between them. The severity of dysphagia and diet restrictions interfere with the patients' nutritional status: dysphagia and more intense eating restrictions are associated with a worse nutritional status.
Collapse
Affiliation(s)
| | | | | | | | | | - Roberto Oliveira Dantas
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| |
Collapse
|
3
|
Koyama M, Ueha R, Sato T, Goto T, Yamauchi A, Kaneoka A, Suzuki S, Nito T, Yamasoba T. Aspiration Prevention Surgery: Clinical Factors Associated With Improvements in Oral Status Intake and Suction Frequency. Otolaryngol Head Neck Surg 2023; 168:1146-1155. [PMID: 36939382 DOI: 10.1002/ohn.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE In recent years, the use of aspiration prevention surgery (APS) for the treatment of severe dysphagia has been on the rise. However, relevant clinical studies have included small samples, and the frequency of, and risk factors for postoperative complications have not been clarified. We investigated the clinical features of patients undergoing APS and whether oral-intake status and suction frequency could be reduced. STUDY DESIGN A case series. SETTING Single-institution academic center. METHODS We retrospectively evaluated medical charts generated from 2010 to 2021. The clinical characteristics of patients undergoing APS, changes in the oral-intake status (Functional Oral Intake Scale, FOIS), suction frequency before and after surgery, risk factors for postoperative complications, and factors contributing to improvements in postoperative oral-intake status were retrieved. RESULTS We included the data of 100 patients (median age: 65 years, 72 men). Amyotrophic lateral sclerosis was the most common primary disease (28%), and glottis closure was the most common APS (69%). Postoperatively, 78% of patients showed improvements in the FOIS score, and suction frequency decreased in 85% of cases. Postoperative complications were observed in 10 patients (10%), wound infection in 6, and bleeding in 4; all improved. Higher preoperative FOIS scores were significantly associated with postoperative complications (p = 0.02). CONCLUSION APS contributed to improving the FOIS score and helped reduce the suction frequency in most cases. APS can be performed safely with proper perioperative management, even in patients with poor preoperative general conditions and nutritional status.
Collapse
Affiliation(s)
- Misaki Koyama
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.,Swallowing Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Asako Kaneoka
- Swallowing Center, The University of Tokyo Hospital, Tokyo, Japan.,Rehabilitation Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Sayaka Suzuki
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takaharu Nito
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
4
|
Hsiao SY, Yao CT, Lin YT, Huang ST, Chiou CC, Huang CY, Huang SS, Yen CW, Liu HY. Relationship between Aspiration Pneumonia and Feeding Care among Home Care Patients with an In-Dwelling Nasogastric Tube in Taiwan: A Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095419. [PMID: 35564813 PMCID: PMC9104070 DOI: 10.3390/ijerph19095419] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022]
Abstract
Home care patients have swallowing dysfunction and rely on an in-dwelling nasogastric tube (NGT) to complement oral food intake, supplement their diet, and maintain adequate nutritional status. This study explored the relationship between aspiration pneumonia (AP) and feeding care among home care patients with an in-dwelling NGT. This preliminary study employed a cross-sectional design. There were 35 patients who relied on an in-dwelling NGT to complement their oral intake of food (NGT-oral feeding) and their primary caregivers participated in this study. All of them developed AP in the past year. Factors involving food intake performance during mealtime of the home care patients and feeding care provided by the caregivers were simultaneously observed and recorded. Among the six risk factors univariately correlated with the incidence of AP, feeding in a noisy environment, using a large spoon to feed the participants, more than 5 mL of food per mouthful, food intake duration lasting > 30 min, swallowing twice for each mouthful of food, and coughing at least once every day remained significant in the logistic regression model (all p < 0.05). Four risk factors for AP were correlated with feeding care; the adjusted risk ratio ranged from 6.17 to 14.96 (all p < 0.05). In addition to each individual’s food intake ability, improper feeding assistance was related to the risk factors for AP among home care patients with NGT-oral feeding. Thus, home caregivers should receive safe oral feeding education and training.
Collapse
Affiliation(s)
- Szu-Yu Hsiao
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan; (S.-Y.H.); (Y.-T.L.)
- Division of Pediatric and Special Needs Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan; (S.-T.H.); (C.-Y.H.); (S.-S.H.); (C.-W.Y.)
| | - Ching-Teng Yao
- Master Program of Long-Term Care in Aging, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Yi-Ting Lin
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan; (S.-Y.H.); (Y.-T.L.)
- Division of Pediatric and Special Needs Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan; (S.-T.H.); (C.-Y.H.); (S.-S.H.); (C.-W.Y.)
| | - Shun-Te Huang
- Division of Pediatric and Special Needs Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan; (S.-T.H.); (C.-Y.H.); (S.-S.H.); (C.-W.Y.)
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
| | - Chi-Chen Chiou
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
- Chi-Mei Medical Center, Tainan 710402, Taiwan
| | - Ching-Yu Huang
- Division of Pediatric and Special Needs Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan; (S.-T.H.); (C.-Y.H.); (S.-S.H.); (C.-W.Y.)
| | - Shan-Shan Huang
- Division of Pediatric and Special Needs Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan; (S.-T.H.); (C.-Y.H.); (S.-S.H.); (C.-W.Y.)
| | - Cheng-Wei Yen
- Division of Pediatric and Special Needs Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan; (S.-T.H.); (C.-Y.H.); (S.-S.H.); (C.-W.Y.)
| | - Hsiu-Yueh Liu
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Correspondence:
| |
Collapse
|