1
|
Le HT, Dang AK, Le LTT, Nguyen HTT, Nguyen GT, Nguyen HTT, Phan HBT, Nguyen TA, Robinson L. Nutritional status, dietary quality and eating disturbance issues among people with dementia in Vietnam: evidence of a cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:107. [PMID: 38987853 PMCID: PMC11238499 DOI: 10.1186/s41043-024-00570-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/17/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Due to cognitive impairments, people with dementia (PWD) often have difficulties in eating and drinking. This study aimed to assess the nutritional status, dietary quality and eating disturbance issues among PWD in Vietnam. METHODS We conducted a cross-sectional study at the Vietnamese National Geriatric Hospital from April to December 2022. We used Mini-Mental State Exam (MMSE) to classify the severity levels of dementia. Mini Nutritional Assessment (MNA), 24-hour recall, eating disturbance questionnaires, and anthropometric indicators were used to evaluate the nutritional status, dietary quality, and eating disorders of study subjects. RESULTS Overall, among 63 study participants, 74.6 per cent of PWD were at risk of or having malnutrition. By dementia classification according to MMSE scale, people with moderate and severe dementia accounted for 53.3 per cent of those who met the recommended energy levels, compared to 42.4 per cent of people with mild dementia and normal people. In the above two groups, around three per cent of participants reached the recommended amount of fibre. Calcium (50-70%), vitamin A (80-90%), and D (90%) were found to be the most severe deficiency forms of minerals and vitamins in both male and female participants. The majority of participants (90.5%) had at least one form of eating disorders with the most frequent issue being appetite changes (76.2%) and swallowing issues (50.8%). CONCLUSIONS PWD in our sample frequently experienced malnutrition, a lack of essential nutrients, difficulties swallowing, changes in eating habits and appetite. It is neccesary to early screen and assess nutritional status and swallowing disturbance in PWD, and instruct their caregivers to prepare nutritious meals for them.
Collapse
Affiliation(s)
- Huong Thi Le
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Anh Kim Dang
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, Australia
| | - Linh Thao Thi Le
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam.
| | - Ha Thu Thi Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Giang Thu Nguyen
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, UK
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Hanh Bich Thi Phan
- Faculty of Dentistry, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
2
|
Iwamori H, Magara J, Onuki W, Ita R, Sasa A, Tsujimura T, Inoue M. Effect of carbonation and thickening on voluntary swallow in healthy humans. J Oral Rehabil 2024. [PMID: 38978272 DOI: 10.1111/joor.13793] [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: 07/22/2023] [Revised: 05/21/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Liquid modification is a widely established strategy of treatment for patients with dysphagia. The modification of liquid particularly by thickening or carbonation is a common approach to promote safe swallowing. OBJECTIVE This study sought to investigate how carbonated and/or thickened water modulates swallowing behaviours during swallowing in healthy young individuals. METHODS Thirty-one healthy volunteers (9 men, 22 women; mean age ± standard deviation [SD], 25.7 ± 6.2 years) were instructed to swallow 20 mL of water, carbonated water and carbonated juice with and without added thickening agent. Electromyograms (EMGs) of the suprahyoid (S-hyo) muscles were recorded to evaluate swallowing behaviours. Obtained S-hyo EMG bursts was analysed using the following outcome parameters: onset latency, the time between swallowing que to onset of EMG burst; rising time and falling time, defined as the time between onset and peak, and between peak and offset, respectively; duration, defined as the time between onset and offset of EMG burst; and area integral value under the waveform. RESULTS Effects of thickening demonstrated the extended onset latency, EMG burst duration including falling time and the larger area of EMG in thickened liquid compared to thin liquid, but there was not much difference between thin and thickened carbonated liquids. Carbonation significantly decreased the duration including falling time for thickened but not for thin liquids. CONCLUSION Patients with dysphagia can benefit from use of carbonated or thickened water while the effects on swallowing physiology may differ between carbonation and thickening.
Collapse
Affiliation(s)
- Hajime Iwamori
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Department of Health and Nutrition Faculty of Health Science, Niigata University of Health and Welfare, Niigata, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Unit of Dysphagia Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, Japan
| | - Wakana Onuki
- Unit of Dysphagia Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, Japan
| | - Reiko Ita
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Anna Sasa
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Unit of Dysphagia Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, Japan
| |
Collapse
|
3
|
Krekeler BN, Schieve HJP, Khoury J, Ding L, Haverbusch M, Alwell K, Adeoye O, Ferioloi S, Mackey J, Woo D, Flaherty M, La Rosa FDLR, Demel S, Star M, Coleman E, Walsh K, Slavin S, Jasne A, Mistry E, Kleindorfer D, Kissela B. Health Factors Associated With Development and Severity of Poststroke Dysphagia: An Epidemiological Investigation. J Am Heart Assoc 2024; 13:e033922. [PMID: 38533959 PMCID: PMC11179757 DOI: 10.1161/jaha.123.033922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/31/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Dysphagia after stroke is common and can impact morbidity and death. The purpose of this population-based study was to determine specific epidemiological and health risk factors that impact development of dysphagia after acute stroke. METHODS AND RESULTS Ischemic and hemorrhagic stroke cases from 2010 and 2015 were identified via chart review from the GCNKSS (Greater Cincinnati Northern Kentucky Stroke Study), a representative sample of ≈1.3 million adults from southwestern Ohio and northern Kentucky. Dysphagia status was determined on the basis of clinical assessments and necessity for alternative access to nutrition via nasogastric or percutaneous endoscopic gastrostomy tube placement. Comparisons between patients with and without dysphagia were made to determine differences in baseline characteristics and premorbid conditions. Multivariable logistic regression determined factors associated with increased risk of dysphagia. Dysphagia status was ascertained from 4139 cases (1709 with dysphagia). Logistic regression showed that increased age, Black race, higher National Institutes of Health Stroke Scale score at admission, having a hemorrhagic stroke (versus infarct), and right hemispheric stroke increased the risk of developing dysphagia after stroke. Factors associated with reduced risk included history of high cholesterol, lower prestroke modified Rankin Scale score, and white matter disease. CONCLUSIONS This study replicated previous findings of variables associated with dysphagia (older age, worse stroke, right-sided hemorrhagic lesions), whereas other variables identified were without clear biological rationale (eg, Black race, history of high cholesterol, and presence of white matter disease) and should be investigated in future studies to determine biological relevance and potential influence in stroke recovery.
Collapse
Affiliation(s)
- Brittany N. Krekeler
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Cincinnati College of MedicineCincinnatiOHUSA
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | | | - Jane Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Mary Haverbusch
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Kathleen Alwell
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Opeolu Adeoye
- Department of Emergency MedicineWashington University School of MedicineSt. LouisMOUSA
| | - Simona Ferioloi
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Jason Mackey
- Department of NeurologyIndiana University School of MedicineIndianapolisINUSA
| | - Daniel Woo
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Matthew Flaherty
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Felipe De Los Rios La Rosa
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
- Baptist Health South FloridaMiami Neuroscience InstituteMiamiFLUSA
| | - Stacie Demel
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | | | - Elisheva Coleman
- Department of NeurologyUniversity of Chicago MedicineChicagoILUSA
| | - Kyle Walsh
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Sabreena Slavin
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKSUSA
| | - Adam Jasne
- Department of NeurologyYale School of MedicineNew HavenCTUSA
| | - Eva Mistry
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Dawn Kleindorfer
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
- Department of NeurologyUniversity of MichiganAnn ArborMIUSA
| | - Brett Kissela
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| |
Collapse
|
4
|
Putri AR, Chu YH, Chen R, Chiang KJ, Banda KJ, Liu D, Lin HC, Niu SF, Chou KR. Prevalence of swallowing disorder in different dementia subtypes among older adults: a meta-analysis. Age Ageing 2024; 53:afae037. [PMID: 38536471 DOI: 10.1093/ageing/afae037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Ageing process and abnormal protein accumulation in dementia damage neural pathways affecting the swallowing process and leading to swallowing disorder. OBJECTIVE To estimate the prevalence of swallowing disorder among older adults with different dementia subtypes. METHODS We conducted a systematic search across multiple databases, including PubMed, Embase, Scopus, Web of Science and OVID Medline. The meta-analysis employed R (version 4.0.2) and utilised a generalised linear mixed model with a random-effect approach to estimate the pooled prevalence of swallowing disorder among older adults, considering various dementia subtypes. The quality of included studies was assessed using Hoy's criteria. Heterogeneity was identified through Cochrane's Q and I2 statistics. To further explore heterogeneity, moderator analysis was performed to identify the contributing variables among the included studies. RESULTS Eighteen studies with 12,532 older adults with different dementia subtypes were enrolled in our meta-analysis. The pooled prevalence of swallowing disorder among older adults with dementia was 58%, with 46.5% for Alzheimer's dementia, 34.9% for Parkinson's dementia, 18.8% for vascular dementia, 16.3% for mixed dementia and 12.2% for Lewy body dementia. According to assessment tools, Alzheimer's dementia had the highest prevalence, with 58% in instrumental assessments and 39% in clinical assessments. Medical history, Alzheimer's dementia, moderate-to-severe Clinical Dementia Rating, delayed oral phase, delayed pharyngeal phase and poor tongue motility contributed to the heterogeneity of the included studies. CONCLUSIONS More than half of older adults with dementia demonstrate to have swallowing disorder. Our findings offer valuable insights to healthcare professionals for the identification of swallowing disorder in ageing population with dementia.
Collapse
Affiliation(s)
- Alfiani Rahmi Putri
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
| | - Yu-Hao Chu
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei City 110, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
| | - Kai-Jo Chiang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
- School of Nursing, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Nursing, Tri-Service General Hospital, Taipei City 114202, Taiwan
| | - Kondwani Joseph Banda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
- Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Ministry of Health, Lilongwe, Malawi
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei City 116, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei City 116, Taiwan
| | - Hui-Chen Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei City 116, Taiwan
| | - Shu-Fen Niu
- Department of Nursing, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City 111, Taiwan
- Department of Nursing, Fu Jen Catholic University, New Taipei City 242062, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei City 110, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei City 116, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei City 110, Taiwan
- Research Center for Neuroscience, Taipei Medical University, Taipei City 110, Taiwan
| |
Collapse
|
5
|
Shinagawa S, Hashimoto M, Yamakage H, Toya S, Ikeda M. Eating problems in people with dementia with Lewy bodies: Associations with various symptoms and the physician's understanding. Int Psychogeriatr 2024:1-11. [PMID: 38404021 DOI: 10.1017/s1041610224000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Eating problems frequently occur in people with dementia with Lewy bodies (DLB), but few studies have investigated the clinical background of this phenomenon. This study examined the relationship between eating problems and various symptoms of DLB and the relation between the treatment needs for DLB people with eating problems and the understanding of their eating problems by caregivers and physicians. DESIGN, MEASUREMENTS, AND PARTICIPANTS This was a subanalysis of a cross-sectional, questionnaire-based survey study. Two hundred sixty-one subjects with DLB were divided into subjects with or without eating problems. Logistic or linear regression analysis was used to investigate the factors influencing eating problems. The treatment needs of DLB people for their eating problems and the understanding of these needs by caregivers and physicians were calculated as participant-caregiver and participant-physician kappa coefficient. RESULTS Of the 261 participants, 27% suffered from eating problems. The presence of eating problems in participants with DLB was related to depression (p = 0.01, OR : 2.19, 95% CI: 1.23-3.91) and apathy (p = 0.01, OR 2.15, 95% CI: 1.20-3.87), while the worsening of eating problems was related to dysphagia (β = 0.24, p = 0.03), apathy (β = 0.23, p = 0.05), and nighttime behavior (β = 0.24, p = 0.04). The participant-physician kappa coefficient for physician understanding of constipation, weight loss, dysphagia, weight gain, and increase in appetite was significantly lower than the corresponding participant-caregiver kappa coefficient (p-value of five symptoms < 0.01). CONCLUSIONS Physicians need to pay more attention to eating problems and their neuropsychiatric background in the long-term support and management of DLB subjects.
Collapse
Affiliation(s)
| | - Mamoru Hashimoto
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hajime Yamakage
- Insight Clinical Development Group, 3H Medi Solution Inc, Tokyo, Japan
| | - Shunji Toya
- Medical Science, Sumitomo Pharma Co., Ltd., Tokyo, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
6
|
Krekeler BN, Schieve HJP, Khoury J, Ding L, Haverbusch M, Alwell K, Adeoye O, Ferioloi S, Mackey J, Woo D, Flaherty M, De Los Rios La Rosa F, Demel S, Star M, Coleman E, Walsh K, Slavin S, Jasne A, Mistry E, Kleindorfer D, Kissela B. Health factors associated with development and severity of post-stroke dysphagia: an epidemiological investigation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.29.23294807. [PMID: 37693442 PMCID: PMC10491359 DOI: 10.1101/2023.08.29.23294807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background and Purpose Dysphagia is a common post-stroke occurrence and has been shown to impact patients' morbidity and mortality. The purpose of this study was to use a large population-based dataset to determine specific epidemiological and patient health risk factors that impact development and severity of dysphagia after acute stroke. Methods Using data from the Greater Cincinnati Northern Kentucky Stroke Study, GCNKSS, involving a representative sample of approximately 1.3 million people from Southwest Ohio and Northern Kentucky of adults (age ≥18), ischemic and hemorrhagic stroke cases from 2010 and 2015 were identified via chart review. Dysphagia status was determined based on bedside and clinical assessments, and severity by necessity for alternative access to nutrition via nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tube placement. Comparisons between patients with and without dysphagia were made to determine differences in baseline characteristics and pre-morbid conditions. Multivariable logistic regression was used to determine factors associated with increased risk of developing dysphagia. Results Dysphagia status was ascertained from 4139 cases (1709 with dysphagia). Logistic regression showed: increased age, Black race, higher NIHSS score at admission, having a hemorrhagic stroke (vs infarct), and right hemispheric stroke increased risk of developing dysphagia after stroke. Factors associated with reduced risk included history of high cholesterol, lower pre-stroke mRS score, and white matter disease. Conclusions This study replicated many previous findings of variables associated with dysphagia (older age, worse stroke, right sided hemorrhagic lesions), while other variables identified were without clear biological rationale (e.g. Black race, history of high cholesterol and presence of white matter disease). These factors should be investigated in future, prospective studies to determine biological relevance and potential influence in stroke recovery.
Collapse
|
7
|
Wang JY, Yang YW, Liu CH, Chang KC, Lin YT, Liu CC. Emergency department visits and associated factors among people with dementia residing in nursing homes in Taiwan: a one-year cohort study. BMC Geriatr 2023; 23:503. [PMID: 37605133 PMCID: PMC10441757 DOI: 10.1186/s12877-023-04221-5] [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: 02/20/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Residing in a nursing home (NH) may increase emergency department (ED) utilization in patients with dementia; however, evidence regarding the status of and predictors for ED utilization of NH residents with dementia remains unclear, especially in Asia. This study aimed to assess the incidence density of ED visits and associated factors for the risk of ED utilization among NH residents with dementia. METHODS This one-year cohort study followed 6595 NH residents with dementia aged ≧ 40 years from Taiwan's National Health Insurance Research Database between 2012 and 2014. The Andersen-Gill extension of Cox regression analysis with death as a competing risk was applied to investigate the association of the risk of all causes and the most common causes of ED utilization with the predisposing, enabling, and need factors as defined by the Andersen model. RESULTS All participants encountered 9254 emergency visits in the 5371.49 person-years observed, representing incidence densities of ED visits of 1722.80 per 1000 person-years. Among them, respiratory disease was the most common cause of ED visits. The significant predictors for the risk of all-cause and respiratory-cause ED visits included: (1) predisposing factors (i.e., age and gender); (2) enabling factors (i.e., regional variables); and (3) need factors (i.e., prolonged ventilator dependence and comorbidity status). CONCLUSIONS Predisposing, enabling, and need factors could influence ED visits among studies patients. NH providers should consider these factors to develop strategies for reducing ED utilization.
Collapse
Affiliation(s)
- Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Wan Yang
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chien-Hui Liu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Division of Emergency Medical Service, New Taipei City Fire Department, New Taipei, Taiwan
| | - Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Lin
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan
| | - Chih-Ching Liu
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan.
| |
Collapse
|
8
|
Moreira VS, Chaves MLF, de Castilhos RM, Olchik MR. Caregiver burden related to feeding process in Alzheimer's disease. Dement Neuropsychol 2023; 17:e20220092. [PMID: 37533596 PMCID: PMC10392878 DOI: 10.1590/1980-5764-dn-2022-0092] [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: 11/09/2022] [Revised: 03/16/2023] [Accepted: 04/16/2023] [Indexed: 08/04/2023] Open
Abstract
Difficulties in the feeding process, such as aversive feeding behaviors and dysphagia, are common in patients with Alzheimer's disease (AD) and can often overload their caregivers. Although dysphagia is already established as a factor contributing to caregiver burden, the impact of aversive behaviors is less studied. Objectives Evaluate the relationship between the feeding process in individuals with AD and their caregiver's burden. Methods Dyads of individuals with AD and their caregivers were recruited for a cross-sectional study. The Edinburgh Feeding Evaluation in Dementia (EdFED) scale, the Zarit Burden Interview (ZBI), the mini-mental state examination (MMSE), the Functional Activities Questionnaire (FAQ), and the Functional Oral Intake scale (FOIS) were performed. Results We included 60 AD individuals-caregivers dyads. The median (IQR) age of caregivers was 57 (19-81) years, and the most were females (70%). The individuals with AD had a median MMSE of 12 (6-15), and the disease duration was 4 (2-6) years. The mean (SD) Zarit score was 20.95 (6.51). In the multivariate linear regression, the EdFED score (95% CI 0.368-1.465) and time as a caregiver (95% CI 0.133-1.355) were associated with the caregiver's burden. Conclusions Aversive behaviors were associated with the caregiver burden of individuals with AD, even with a short duration of the disease. These findings show the importance of education for caregivers regarding the feeding process, as these measures have great potential to minimize the caregiver's burden.
Collapse
Affiliation(s)
- Verônica Salazar Moreira
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina, Ciências Médicas, Porto Alegre RS, Brazil
| | - Márcia Lorena Fagundes Chaves
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina, Ciências Médicas, Porto Alegre RS, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Medicina Interna, Porto Alegre RS, Brazil
| | - Raphael Machado de Castilhos
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina, Ciências Médicas, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil
| | - Maira Rozenfeld Olchik
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina, Ciências Médicas, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Odontologia, Curso de Fonoaudiologia, Departamento de Cirurgia e Ortopedia, Porto Alegre RS, Brazil
| |
Collapse
|
9
|
Calles M, Wirth R, Labeit B, Muhle P, Suntrup-Krueger S, Dziewas R, Lueg G, Trampisch US. Sarcopenic Dysphagia Revisited: A Cross-Sectional Study in Hospitalized Geriatric Patients. Nutrients 2023; 15:2662. [PMID: 37375566 PMCID: PMC10302961 DOI: 10.3390/nu15122662] [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: 05/08/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Oropharyngeal dysphagia (OD) is a frequent finding in older patients with potentially lethal complications such as aspiration pneumonia, malnutrition, and dehydration. Recent studies describe sarcopenia as a causative factor for OD, which is occasionally referred to as "sarcopenic dysphagia" in the absence of a neurogenic etiology. In most of the previous studies on sarcopenic dysphagia, the diagnosis was based only on clinical assessment. In this study, flexible endoscopic evaluation of swallowing (FEES) was used as an objective method to evaluate the presence of OD, its association with sarcopenia, and the presence of pure sarcopenic dysphagia. In this retrospective cross-sectional study, 109 acute care geriatric hospital patients with suspected OD received FEES examination and bioimpedance analysis (BIA) in clinical routine. 95% of patients had at least one neurological disease, 70% fulfilled the criteria for sarcopenia, and 45% displayed moderate or severe OD. Although the prevalence of sarcopenia and OD was high, there was no significant association between OD and sarcopenia. Considering these results, both the association between sarcopenia and OD and pure sarcopenic dysphagia appear questionable. Further prospective studies are needed to elucidate if sarcopenia is merely an epiphenomenon of severe disease or whether it plays a causative role in the development of OD.
Collapse
Affiliation(s)
- Marcel Calles
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, 44625 Herne, Germany; (M.C.); (R.W.); (G.L.)
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, 44625 Herne, Germany; (M.C.); (R.W.); (G.L.)
| | - Bendix Labeit
- Department of Neurology, University Hospital Münster, 48149 Münster, Germany (P.M.); (S.S.-K.)
| | - Paul Muhle
- Department of Neurology, University Hospital Münster, 48149 Münster, Germany (P.M.); (S.S.-K.)
| | - Sonja Suntrup-Krueger
- Department of Neurology, University Hospital Münster, 48149 Münster, Germany (P.M.); (S.S.-K.)
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrück, 49076 Osnabrück, Germany;
| | - Gero Lueg
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, 44625 Herne, Germany; (M.C.); (R.W.); (G.L.)
| | - Ulrike Sonja Trampisch
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, 44625 Herne, Germany; (M.C.); (R.W.); (G.L.)
| |
Collapse
|
10
|
Yamada Y, Yokogawa N, Kato S, Sasagawa T, Tsuchiya H, Nakashima H, Segi N, Ito S, Funayama T, Eto F, Yamaji A, Yamane J, Nori S, Furuya T, Yunde A, Nakajima H, Yamada T, Hasegawa T, Terashima Y, Hirota R, Suzuki H, Imajo Y, Ikegami S, Uehara M, Tonomura H, Sakata M, Hashimoto K, Onoda Y, Kawaguchi K, Haruta Y, Suzuki N, Kato K, Uei H, Sawada H, Nakanishi K, Misaki K, Terai H, Tamai K, Kuroda A, Inoue G, Kakutani K, Kakiuchi Y, Kiyasu K, Tominaga H, Tokumoto H, Iizuka Y, Takasawa E, Akeda K, Takegami N, Funao H, Oshima Y, Kaito T, Sakai D, Yoshii T, Ohba T, Otsuki B, Seki S, Miyazaki M, Ishihara M, Okada S, Imagama S, Watanabe K. Effects of Dementia on Outcomes after Cervical Spine Injuries in Elderly Patients: Evaluation of 1512 Cases in a Nationwide Multicenter Study in Japan. J Clin Med 2023; 12:jcm12051867. [PMID: 36902654 PMCID: PMC10003092 DOI: 10.3390/jcm12051867] [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: 12/25/2022] [Revised: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
We aimed to retrospectively investigate the demographic characteristics and short-term outcomes of traumatic cervical spine injuries in patients with dementia. We enrolled 1512 patients aged ≥ 65 years with traumatic cervical injuries registered in a multicenter study database. Patients were divided into two groups according to the presence of dementia, and 95 patients (6.3%) had dementia. Univariate analysis revealed that the dementia group comprised patients who were older and predominantly female and had lower body mass index, higher modified 5-item frailty index (mFI-5), lower pre-injury activities of daily living (ADLs), and a larger number of comorbidities than patients without dementia. Furthermore, 61 patient pairs were selected through propensity score matching with adjustments for age, sex, pre-injury ADLs, American Spinal Injury Association Impairment Scale score at the time of injury, and the administration of surgical treatment. In the univariate analysis of the matched groups, patients with dementia had significantly lower ADLs at 6 months and a higher incidence of dysphagia up to 6 months than patients without dementia. Kaplan-Meier analysis revealed that patients with dementia had a higher mortality than those without dementia until the last follow-up. Dementia was associated with poor ADLs and higher mortality rates after traumatic cervical spine injuries in elderly patients.
Collapse
Affiliation(s)
- Yohei Yamada
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
| | - Noriaki Yokogawa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
| | - Satoshi Kato
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
- Correspondence: ; Tel.: +81-76-265-2374
| | - Takeshi Sasagawa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
- Department of Orthopedic Surgery, Toyama Prefectural Central Hospital, Toyama 930-8550, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Toru Funayama
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
| | - Fumihiko Eto
- Department of Orthopedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki 305-8575, Japan
| | - Akihiro Yamaji
- Department of Orthopedic Surgery, Ibaraki Seinan Medical Center Hospital, Ibaraki 306-0433, Japan
| | - Junichi Yamane
- Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo 208-0011, Japan
| | - Satoshi Nori
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo 160-8582, Japan
| | - Takeo Furuya
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Atsushi Yunde
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Hideaki Nakajima
- Department of Orthopedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Fukui 910-1193, Japan
| | - Tomohiro Yamada
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan
- Department of Orthopedic Surgery, Nagoya Kyoritsu Hospital, Aichi 454-0933, Japan
| | - Tomohiko Hasegawa
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan
| | - Yoshinori Terashima
- Department of Orthopedic Surgery, Sapporo Medical University, Sapporo 060-8543, Japan
- Department of Orthopedic Surgery, Matsuda Orthopedic Memorial Hospital, Sapporo 001-0018, Japan
| | - Ryosuke Hirota
- Department of Orthopedic Surgery, Sapporo Medical University, Sapporo 060-8543, Japan
| | - Hidenori Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan
| | - Yasuaki Imajo
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan
| | - Shota Ikegami
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano 390-8621, Japan
| | - Masashi Uehara
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano 390-8621, Japan
| | - Hitoshi Tonomura
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kyoto 602-8566, Japan
| | - Munehiro Sakata
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kyoto 602-8566, Japan
- Department of Orthopedics, Saiseikai Shiga Hospital, Shiga 520-3046, Japan
| | - Ko Hashimoto
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Miyagi 980-8574, Japan
| | - Yoshito Onoda
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Miyagi 980-8574, Japan
| | - Kenichi Kawaguchi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yohei Haruta
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Nobuyuki Suzuki
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Kenji Kato
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hiroshi Uei
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo 101-8393, Japan
- Department of Orthopedic Surgery, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Hirokatsu Sawada
- Department of Orthopedic Surgery, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Kazuo Nakanishi
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama 701-0192, Japan
| | - Kosuke Misaki
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama 701-0192, Japan
| | - Hidetomi Terai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Koji Tamai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Akiyoshi Kuroda
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1, Kanagawa 252-0374, Japan
| | - Gen Inoue
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1, Kanagawa 252-0374, Japan
| | - Kenichiro Kakutani
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yuji Kakiuchi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Katsuhito Kiyasu
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku 783-8505, Japan
| | - Hiroyuki Tominaga
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Hiroto Tokumoto
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Yoichi Iizuka
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi 371-8511, Japan
| | - Eiji Takasawa
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi 371-8511, Japan
| | - Koji Akeda
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Mie 514-8507, Japan
| | - Norihiko Takegami
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Mie 514-8507, Japan
| | - Haruki Funao
- Department of Orthopedic Surgery, School of Medicine, International University of Health and Welfare, Chiba 286-0124, Japan
- Department of Orthopedic Surgery, International University of Health and Welfare Narita Hospital, Chiba 286-0124, Japan
- Department of Orthopedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Yasushi Oshima
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Daisuke Sakai
- Department of Orthopedics Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa 259-1193, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Yushima 113-8519, Japan
| | - Tetsuro Ohba
- Department of Orthopedic Surgery, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Bungo Otsuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
| | - Shoji Seki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Masashi Miyazaki
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan
| | - Masayuki Ishihara
- Department of Orthopedic Surgery, Kansai Medical University Hospital, Osaka 573-1191, Japan
| | - Seiji Okada
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo 160-8582, Japan
| |
Collapse
|
11
|
van Buuren CP, van der Steen JT, Olthof-Nefkens M, Bakker C, Koopmans RTCM, Perry M, Kalf JG. The Complexity of Nutritional Problems in Persons with Dementia: Expanding a Theoretical Model. J Alzheimers Dis 2023; 96:183-192. [PMID: 37742638 PMCID: PMC10657712 DOI: 10.3233/jad-230135] [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] [Accepted: 08/14/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Persons with dementia are at risk of developing nutritional problems. Theoretical models on nutritional problems have been developed, but have not been evaluated with healthcare professionals. OBJECTIVE This study aimed to explore the comprehensiveness and applicability of a theoretical model of nutritional problems in persons with dementia for daily nursing home practice. METHODS A qualitative design employing a combined deductive and inductive approach was used. Healthcare professionals were eligible to participate if they 1) had expert knowledge of and experience with nutritional problems related to dementia, and 2) worked in a nursing home affiliated with an academic network covering the east and south of the Netherlands. Three focus group interviews with 20 healthcare professionals from seven professions were held. We conducted thematic analysis and we compared themes with existing theoretical models from the literature. RESULTS We identified six themes, four of which corresponded with the existing models (observing and analysing nutritional problems; consequences of nutritional problems; functioning of the person with dementia; environmental factors). Interprofessional collaboration and ethical factors were identified as new themes. The analyses indicated interactions within each theme, between themes, and a bidirectional connection between themes. CONCLUSIONS This study demonstrated the relevance of interprofessional collaboration and ethical considerations in nutritional problems related to dementia. It uncovered complex bidirectional relations within and between factors regarding nutritional problems. All aspects should be taken into account to minimize the consequences of nutritional problems for persons with dementia.
Collapse
Affiliation(s)
- Cornelia Pieternella van Buuren
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- ‘Joachim en Anna’, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Jenny Theodora van der Steen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Olthof-Nefkens
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
- Zorggroep Maas & Waal, Beneden-Leeuwen, The Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Groenhuysen, Center for Geriatric Care, Roosendaal, The Netherlands
| | - Raymond Theodorus Catherina Maria Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- ‘Joachim en Anna’, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Marieke Perry
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- General Medical Practice, Velp, The Netherlands
| | - Johanna Gezina Kalf
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| |
Collapse
|
12
|
Factors Associated with Food Form in Long-Term Care Insurance Facilities. Dysphagia 2022; 37:1757-1768. [PMID: 35415813 DOI: 10.1007/s00455-022-10440-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
We examined factors related to dietary intake status (food form) of long-term care facility (LTCF) residents to identify factors related to proper food form choice for older individuals requiring nursing care. We surveyed 888 residents from 37 LTCFs in Japan. We evaluated basic information (age, sex, body mass index [BMI]), food form (swallowing-adjusted diet class), Barthel Index (BI), Clinical Dementia Rating (CDR), simply evaluated eating and swallowing functions, the number of present/functional teeth, oral diadochokinesis, repetitive saliva swallowing test (RSST), and modified water swallowing test. To clarify factors associated with food form, participants who had good nutrition by oral intake were categorized into the dysphagic diet (DD) and normal diet (ND) groups. Multi-level analyses were used to detect oral functions associated with food form status. Among objective assessments, BMI (odds ratio [OR] 0.979, 95% confidence interval [CI] - 0.022- to 0.006, p = 0.001), BI (OR 0.993, 95% CI - 0.007 to - 0.004, p < 0.001), CDR 3.0 (OR 1.002, 95% CI 0.002‒0.236, p = 0.046), present teeth (OR 0.993, 95% CI - 0.007 to - 0.001, p = 0.011), functional teeth (OR 0.989, 95% CI - 0.011 to - 0.005, p < 0.001), and RSST (OR 0.960, 95% CI - 0.041 to - 0.007, p = 0.006) were significantly associated with DD vs ND discrimination. Simple evaluations of coughing (OR 1.056, 0.054‒0.198, p = 0.001) and rinsing (OR 1.010, 0.010‒0.174, p = 0.029) could also discriminate food form status. These simple evaluations provide insight into the discrepancies between food form status and eating abilities of LTCF residents. Periodic evaluations by the nursing caregiver may help to prevent aspiration by older individuals with dysphagia.
Collapse
|
13
|
Li CH, Hsieh SW, Huang P, Liu HY, Chen CH, Hung CH. Pharmacological Management of Dysphagia in Patients with Alzheimer's Disease: A Narrative Review. Curr Alzheimer Res 2022; 19:CAR-EPUB-127915. [PMID: 36453507 DOI: 10.2174/1567205020666221130091507] [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: 08/20/2022] [Revised: 10/07/2022] [Accepted: 11/02/2022] [Indexed: 12/03/2022]
Abstract
Alzheimer's disease (AD) and dysphagia are important health and socioeconomic problems in the aging population. Currently, the medical treatment of dysphagia in AD patients remains insufficient, and there are significant gaps in the management and clinical needs to postpone tube feeding. Literatures published over the last 30 years were searched in the PubMed and Embase databases. All relevant and promising pharmacological management studies were included. Because of the heterogeneity in design and methodology, only narrative reports were mentioned. Nine studies were included with two case reports, two case series, and two observational and three randomized controlled trials. The key approaches and clinical problems related to dysphagia include onset pattern, dementia stage, review of offending drugs and polypharmacy, and comorbidities (cerebrovascular disease, hypertension, parkinsonism, depression, and anorexia). The corresponding strategies of pharmacological treatments are further proposed and discussed comprehensively, with transient receptor potential channel modulators as promising treatment. With the integration of adequate and potential pharmacomanagement, AD patients with dysphagia can achieve a good prognosis and postpone tube feeding to maintain a better quality of life. More rigorous studies are needed to verify the effectiveness of innovative strategies and develop targets for neurostimulation.
Collapse
Affiliation(s)
- Chien-Hsun Li
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Integrated Center of Healthy and Long-term Care, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
| | - Sun-Wung Hsieh
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Poyin Huang
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hsiu-Yueh Liu
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chun-Hung Chen
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chih-Hsing Hung
- Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Center of Teaching and Research, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Pediatrics, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| |
Collapse
|
14
|
Guarín Navas EG, García Morales OM. Broncoaspiración en el anciano: reflejo de la disfagia como síndrome geriátrico. UNIVERSITAS MÉDICA 2022. [DOI: 10.11144/javeriana.umed63-4.bard] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Mujer de 86 años con enfermedad de Alzheimer, ingresa al hospital por síntomas respiratorios; estudio de imagen con lesión redondeada obstructiva a nivel del bronquio intermediario atribuido a broncoaspiración de cuerpo extraño (arveja). Se exhibe la asociación entre un síndrome geriátrico y una complicación respiratoria prevenible con rehabilitación y educación.
Collapse
|
15
|
Bayne DF, Shune SE. A Biopsychosocial Model of Mealtime Management in Persons with Dementia, an Asset-Based Approach to Patient-Centered Care. Geriatrics (Basel) 2022; 7:geriatrics7050112. [PMID: 36286215 PMCID: PMC9601353 DOI: 10.3390/geriatrics7050112] [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: 09/14/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 01/24/2023] Open
Abstract
Considering the rapid increase in the population over the age of 65, there is increasing need to consider models of care for persons with dementia (PWD). One common deficit associated with dementia progression is difficulty with successful participation in mealtimes. Difficulty participating in mealtimes in PWD is not the result of one factor, but rather a confluence of biological, psychological, and social characteristics common in dementia. Factors leading to mealtime difficulties for PWD may include changes in cognitive status, altered sensorimotor functioning, and increased reliance on caregiver support. The complex nature of biological, psychological, and social factors leading to mealtime difficulty highlights the need for a pragmatic model that caregivers can utilize to successfully support PWD during mealtimes. Existing models of dementia and mealtime management were reviewed and collated to create a model of mealtime management that considers this complex interplay. The Biopsychosocial Model of Mealtime Management builds on past research around patient-centered care and introduces an asset-based approach to capitalize on a PWD's retained capabilities as opposed to compensating for disabilities associated with dementia. We hope this model will provide a framework for caregivers to understand what factors impact mealtime participation in PWD and provide appropriate means on intervention.
Collapse
|
16
|
Otsuka R. Diet, nutrition, and cognitive function: A narrative review of Japanese longitudinal studies. Geriatr Gerontol Int 2022; 22:825-831. [PMID: 36002912 PMCID: PMC9805113 DOI: 10.1111/ggi.14463] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/19/2022] [Accepted: 07/20/2022] [Indexed: 01/09/2023]
Abstract
In aging societies, the number of older people with cognitive decline and dementia is increasing. Proper nutrition is a key factor that can help in the prevention of these age-related impairments. This narrative review of longitudinal studies in Japan outlines the relationship between nutrition and the brain and focuses on Japanese nutritional epidemiologic studies. The results of Japanese cohort studies suggest that rather than a single food or nutrient, a nutritionally balanced diet that integrates a variety of foods and nutrients can contribute to the maintenance of brain function and be effective in preventing dementia. In addition, this review considers a nutritional approach to reducing the severity of cognitive decline in individuals with mild cognitive impairment and dementia, and suggests lifelong strategies for the prevention of cognitive decline. It is important that we consider the practice of eating not only as a way to obtain nutrients, but also as an important lifestyle habit to maintain our physical and mental health. Geriatr Gerontol Int 2022; 22: 825-831.
Collapse
Affiliation(s)
- Rei Otsuka
- Department of Epidemiology of Aging, Center for Gerontology and Social Science, Research InstituteNational Center for Geriatrics and GerontologyAichiJapan
| |
Collapse
|
17
|
Kim M, Park SJ, Choi S, Chang J, Kim SM, Jeong S, Park YJ, Lee G, Son JS, Ahn JC, Park SM. Association between antibiotics and dementia risk: A retrospective cohort study. Front Pharmacol 2022; 13:888333. [PMID: 36225572 PMCID: PMC9548656 DOI: 10.3389/fphar.2022.888333] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background: The possible relation between antibiotic exposure and the alteration of gut microbiota, which may affect dementia risk, has been revealed. However, the association between antibiotics and dementia incidence has rarely been studied. We aimed to determine the association between antibiotic exposure and the risk of dementia. Methods: This population-based retrospective cohort study used data from the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) in South Korea. Exposure was the cumulative days of antibiotic prescription from 2002 to 2005. Newly diagnosed overall dementia, Alzheimer’s disease (AD), and vascular dementia (VD) were identified based on diagnostic codes and prescriptions for dementia-related drugs. The follow-up investigation was carried out from 1 January 2006 to 31 December 2013. The Cox proportional hazards regression was used to assess the association between cumulative antibiotic prescription days and dementia incidence. Results: A total of 313,161 participants were analyzed in this study. Compared to antibiotic non-users, the participants who used antibiotics for 91 or more days had an increased risk of overall dementia [adjusted hazard ratio (aHR), 1.44; 95% confidence interval (CI), 1.19–1.74], AD (aHR, 1.46; 95% CI, 1.17–1.81), and VD (aHR, 1.38; 95% CI, 0.83–2.30). Those who used five or more antibiotic classes had higher risks of overall dementia (aHR, 1.28; 95% CI, 1.00–1.66) and AD (aHR, 1.34; 95% CI, 1.00–1.78) than antibiotic non-users. Conclusion: Antibiotic exposure may increase the risk of dementia in a cumulative duration-dependent manner among adult participants. Future studies are needed to assess the causality between the long-term prescription of antibiotics and dementia risk.
Collapse
Affiliation(s)
- Minseo Kim
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- College of Medicine, Jeonbuk National University, Jeonju, South Korea
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jooyoung Chang
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Min Kim
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seogsong Jeong
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam, South Korea
| | - Young Jun Park
- Medical Research Center, Genomic Medicine Institute, Seoul National University, Seoul, South Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Joung Sik Son
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Joseph C. Ahn
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, NY, United States
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- *Correspondence: Sang Min Park,
| |
Collapse
|
18
|
Topal F, Ertas B, Guler E, Gurbuz F, Ozcan GS, Aydemir O, Bocekci VG, Duruksu G, Sahin Cam C, Yazir Y, Gunduz O, Cam ME. A novel multi-target strategy for Alzheimer's disease treatment via sublingual route: Donepezil/memantine/curcumin-loaded nanofibers. BIOMATERIALS ADVANCES 2022; 138:212870. [PMID: 35913251 DOI: 10.1016/j.bioadv.2022.212870] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/07/2022] [Accepted: 05/14/2022] [Indexed: 06/15/2023]
Abstract
Drug delivery systems that not only show efficacy through multiple therapeutic pathways but also facilitate patient drug use and exhibit a high bioavailability profile represent a promising strategy in the treatment of Alzheimer's disease (AD). Here, donepezil (DO)/memantine (MM)/curcumin (CUR)-loaded electrospun nanofibers (NFs) were produced for the treatment of AD. DSC, XRD, and FT-IR studies demonstrated the complete incorporation of the drug into PVA/PVP NFs. The disintegration profile was improved by loading the drugs in PVA/PVP with fast wetting (less than 1 s), the start of disintegration (21 s), and dispersion in 110 s. The desired properties for sublingual application were achieved with the dissolution of NFs in 240 s. The cell viability in DO/MM/CUR-loaded NFs was similar to the control group after 48 h in the cell culture. DO/MM/CUR-loaded NFs enhanced the expressions of BDNF (13.5-fold), TUBB3 (8.9-fold), Neurog2 (5.6-fold), NeuroD1 (5.8-fold), Nestin (166-fold), and GFAP (115-fold). DO/MM/CUR-loaded NFs and powder of these drugs contained in these fibers were daily administered sublingually to intracerebroventricular-streptozotocin (icv-STZ) treated rats. DO/MM/CUR-loaded NFs treatment improved the short-term memory damage and enhanced memory, learning ability, and spatial exploration talent. Results indicated that the levels of Aβ, Tau protein, APP, GSK-3β, AChE, and TNF-α were significantly decreased, and BDNF was increased by DO/MM/CUR-loaded NFs treatment compared to the AD group. In the histopathological analysis of the hippocampus and cortex, neuritic plaques and neurofibrillary nodes were not observed in the rats treated with DO/MM/CUR-loaded NFs. Taken together, the sublingual route delivery of DO/MM/CUR-loaded NFs supports potential clinical applications for AD.
Collapse
Affiliation(s)
- Fadime Topal
- Department of Pharmacology, Faculty of Pharmacy, Marmara University, Istanbul 34854, Turkey; Center for Nanotechnology and Biomaterials Application and Research, Marmara University, Istanbul 34722, Turkey
| | - Busra Ertas
- Department of Pharmacology, Faculty of Pharmacy, Marmara University, Istanbul 34854, Turkey
| | - Ece Guler
- Department of Pharmacology, Faculty of Pharmacy, Marmara University, Istanbul 34854, Turkey; Center for Nanotechnology and Biomaterials Application and Research, Marmara University, Istanbul 34722, Turkey
| | - Fatmanur Gurbuz
- Department of Pharmacology, Faculty of Pharmacy, Marmara University, Istanbul 34854, Turkey
| | - Gul Sinemcan Ozcan
- Stem Cell and Gene Therapies Research and Applied Center, Medical Faculty, Kocaeli University, Kocaeli 41380, Turkey
| | - Oguzhan Aydemir
- Department of Research & Development, Joker Food Industry International Domestic and Foreign Trade Company, Istanbul 34885, Turkey
| | - Veysel Gokhan Bocekci
- Department of Electrical and Electronics Engineering, Faculty of Technology, Marmara University, Istanbul 34722, Turkey
| | - Gokhan Duruksu
- Stem Cell and Gene Therapies Research and Applied Center, Medical Faculty, Kocaeli University, Kocaeli 41380, Turkey
| | - Cansun Sahin Cam
- Department of Psychiatry, Faculty of Medicine, Marmara University, Istanbul 34854, Turkey
| | - Yusufhan Yazir
- Stem Cell and Gene Therapies Research and Applied Center, Medical Faculty, Kocaeli University, Kocaeli 41380, Turkey
| | - Oguzhan Gunduz
- Center for Nanotechnology and Biomaterials Application and Research, Marmara University, Istanbul 34722, Turkey; Department of Metallurgy and Material Engineering, Faculty of Technology, Marmara University, Istanbul 34722, Turkey
| | - Muhammet Emin Cam
- Department of Pharmacology, Faculty of Pharmacy, Marmara University, Istanbul 34854, Turkey; Center for Nanotechnology and Biomaterials Application and Research, Marmara University, Istanbul 34722, Turkey.
| |
Collapse
|
19
|
Mira A, Gonçalves R, Rodrigues IT. Dysphagia in Alzheimer's disease: a systematic review. Dement Neuropsychol 2022; 16:261-269. [PMID: 36619845 PMCID: PMC9762388 DOI: 10.1590/1980-5764-dn-2021-0073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/03/2021] [Accepted: 11/12/2021] [Indexed: 11/02/2023] Open
Abstract
Dysphagia is described as a highly relevant comorbidity of Alzheimer's disease (AD). However, there is a scarcity of studies aiming at the characteristics and progression of dysphagia. OBJECTIVE The objective of this study was to identify the specific characteristics, progression, and prevalence of dysphagia in AD. METHODS Publications were searched in the PubMed (MEDLINE), EBSCO, ScienceDirect, and BASE databases. Critical appraisal and evidence-level analysis were conducted using the Joanna Briggs Institute and Effective Public Health Practice Project's (EPHPP) tools. RESULTS A total of 26 studies were reviewed. Symptoms begin in the early stage of AD, as oral phase impairments, and progress to pharyngeal symptoms and swallowing apraxia in the later stages of AD. Dysphagia progresses, as AD, along a continuum, with severity depending on individual variability. There were no studies found on prevalence. CONCLUSIONS Dysphagia is a complex and important comorbidity in AD that impacts the quality of life. No recent publications on prevalence may imply that is not being coded as a potential cause for pneumonia deaths in AD.
Collapse
Affiliation(s)
- Ana Mira
- Escola Superior de Saúde do Alcoitão, Alcabideche,
Portugal
- Centro Hospitalar Universitário do Algarve, Centro de Medicina
de Reabilitação do Sul, São Brás de Alportel, Portugal
| | - Rita Gonçalves
- Centro Hospitalar Universitário do Algarve, Centro de Medicina
de Reabilitação do Sul, São Brás de Alportel, Portugal
| | - Inês Tello Rodrigues
- Escola Superior de Saúde do Alcoitão, Alcabideche,
Portugal
- Center for Innovative Care and Health Technology, Instituto
Politécnico de Leiria, Leiria, Portugal
| |
Collapse
|
20
|
Takeda M, Watanabe Y, Matsushita T, Taira K, Miura K, Ohara Y, Iwasaki M, Ito K, Nakajima J, Iwasa Y, Itoda M, Nishi Y, Furuya J, Watanabe Y, Umemoto G, Kishima M, Hirano H, Sato Y, Yoshida M, Yamazaki Y. Observational Variables for Considering a Switch from a Normal to a Dysphagia Diet among Older Adults Requiring Long-Term Care: A One-Year Multicenter Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116586. [PMID: 35682168 PMCID: PMC9180175 DOI: 10.3390/ijerph19116586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023]
Abstract
This one-year multicenter longitudinal study aimed to assess whether older adult residents of long-term care facilities should switch from a normal to a dysphagia diet. Using the results of our previous cross-sectional study as baseline, older adults were subdivided into those who maintained a normal diet and those who switched to a dysphagia diet. The explanatory variables were age, sex, body mass index (BMI), Barthel Index, clinical dementia rating (CDR), and 13 simple and 5 objective oral assessments (remaining teeth, functional teeth, oral diadochokinesis, modified water swallowing test, and repetitive saliva swallowing test), which were used in binomial logistic regression analysis. Between-group comparison showed a significantly different BMI, Barthel Index, and CDR. Significant differences were also observed in simple assessments for language, drooling, tongue movement, perioral muscle function, and rinsing and in objective assessments. In multi-level analysis, switching from a normal to a dysphagia diet was significantly associated with simple assessments of tongue movement, perioral muscle function, and rinsing and with the objective assessment of the number of functional teeth. The results suggest that simple assessments can be performed regularly to screen for early signs of discrepancies between food form and eating/swallowing functions, which could lead to the provision of more appropriate food forms.
Collapse
Affiliation(s)
- Maaya Takeda
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan; (M.T.); (T.M.); (K.T.); (K.M.); (Y.Y.)
| | - Yutaka Watanabe
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan; (M.T.); (T.M.); (K.T.); (K.M.); (Y.Y.)
- Correspondence: ; Tel.: +81-11-706-4582
| | - Takae Matsushita
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan; (M.T.); (T.M.); (K.T.); (K.M.); (Y.Y.)
| | - Kenshu Taira
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan; (M.T.); (T.M.); (K.T.); (K.M.); (Y.Y.)
| | - Kazuhito Miura
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan; (M.T.); (T.M.); (K.T.); (K.M.); (Y.Y.)
| | - Yuki Ohara
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Masanori Iwasaki
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Kayoko Ito
- Oral Rehabilitation, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan;
| | - Junko Nakajima
- Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, Tokyo 272-8513, Japan;
| | - Yasuyuki Iwasa
- Department of Dentistry, Haradoi Hospital, Fukuoka 813-8588, Japan;
| | - Masataka Itoda
- Department of Oral Rehabilitation, Osaka Dental University Hospital, Osaka 573-1144, Japan;
| | - Yasuhiro Nishi
- Department of Oral and Maxillofacial Prosthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan;
| | - Junichi Furuya
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo 145-8515, Japan; (J.F.); sato-@dent.showa-u.ac.jp (Y.S.)
| | - Yoshihiko Watanabe
- Department of Healthcare Management, Tohoku Fukushi University, Sendai 981-8522, Japan;
| | - George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka 814-0180, Japan;
| | - Masako Kishima
- Wakakusa-Tatsuma Rehabilitation Hospital, Daito 574-0012, Japan;
| | - Hirohiko Hirano
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Yuji Sato
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo 145-8515, Japan; (J.F.); sato-@dent.showa-u.ac.jp (Y.S.)
| | - Mitsuyoshi Yoshida
- Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Dengakugakubo, 1-98, Kutsukake-cho, Toyoake 470-1192, Japan;
| | - Yutaka Yamazaki
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan; (M.T.); (T.M.); (K.T.); (K.M.); (Y.Y.)
| |
Collapse
|
21
|
Sasegbon A, Hammerbeck U, Michou E, Cheng I, Zhang M, James C, Hamdy S. A feasibility pilot study of the effects of neurostimulation on swallowing function in Parkinson’s Disease. AMRC OPEN RESEARCH 2022; 3:19. [PMID: 35726231 PMCID: PMC7612876 DOI: 10.12688/amrcopenres.13007.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction Dysphagia often occurs during Parkinson’s disease (PD) and can have severe consequences. Recently, neuromodulatory techniques have been used to treat neurogenic dysphagia. Here we aimed to compare the neurophysiological and swallowing effects of three different types of neurostimulation, 5 Hertz (Hz) repetitive transcranial magnetic stimulation (rTMS), 1 Hz rTMS and pharyngeal electrical stimulation (PES) in patients with PD. Method 12 PD patients with dysphagia were randomised to receive either 5 Hz rTMS, 1 Hz rTMS, or PES. In a cross-over design, patients were assigned to one intervention and received both real and sham stimulation. Patients received a baseline videofluoroscopic (VFS) assessment of their swallowing, enabling penetration aspiration scores (PAS) to be calculated for: thin fluids, paste, solids and cup drinking. Swallowing timing measurements were also performed on thin fluid swallows only. They then had baseline recordings of motor evoked potentials (MEPs) from both pharyngeal and (as a control) abductor pollicis brevis (APB) cortical areas using single-pulse TMS. Subsequently, the intervention was administered and post interventional TMS recordings were taken at 0 and 30 minutes followed by a repeat VFS within 60 minutes of intervention. Results All interventions were well tolerated. Due to lower than expected recruitment, statistical analysis of the data was not undertaken. However, with respect to PAS swallowing timings and MEP amplitudes, there was small but visible difference in the outcomes between active and sham. Conclusion PES, 5 Hz rTMS and 1 Hz rTMS are tolerable interventions in PD related dysphagia. Due to small patient numbers no definitive conclusions could be drawn from the data with respect to individual interventions improving swallowing function and comparative effectiveness between interventions. Larger future studies are needed to further explore the efficacy of these neuromodulatory treatments in Parkinson’s Disease associated dysphagia.
Collapse
Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, Greater Manchester, Stott Lane, Salford M6 8HD, UK
| | - Ulrike Hammerbeck
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, Greater Manchester, Stott Lane, Salford M6 8HD, UK
| | - Emilia Michou
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, Greater Manchester, Stott Lane, Salford M6 8HD, UK
- Department of Speech and Language Therapy, University of Patras, Patras, Greece
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, Greater Manchester, Stott Lane, Salford M6 8HD, UK
| | - Mengqing Zhang
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, Greater Manchester, Stott Lane, Salford M6 8HD, UK
| | - Charlotte James
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, Greater Manchester, Stott Lane, Salford M6 8HD, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, Greater Manchester, Stott Lane, Salford M6 8HD, UK
| |
Collapse
|
22
|
Mushero N, Demers LB, Chippendale R. An Interactive Workshop on Managing Dysphagia in Older Adults With Dementia. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11223. [PMID: 35309254 PMCID: PMC8888763 DOI: 10.15766/mep_2374-8265.11223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Nearly six million American adults live with dementia, and dysphagia is a common comorbidity impacting their nutrition and quality of life. There is a shortfall in the number of geriatricians available to care for older adults. Thus, primary care physicians should be equipped with the knowledge to adequately care for the geriatric population. Modified diets are routinely prescribed for patients with dementia despite limited evidence that they protect patients from the sequelae of dysphagia and some suggestion of poor side-effect profiles. METHODS We created a onetime, interactive, case-based session to educate medical residents on how to evaluate and treat dementia-associated dysphagia and address the discrepancy between the limited evidence for dietary modifications and their routine use. The session had a mixture of small-group discussion and didactic learning as well as a participatory component during which learners were able to sample thickened liquids. RESULTS The session was implemented in an established primary care curriculum. Based on survey responses, which were obtained from 15 out of 17 participants, the session significantly improved participants' knowledge of dysphagia-associated dementia and increased their comfort with caring for patients with dysphagia. DISCUSSION Dementia-associated dysphagia, although an increasingly common clinical problem, remains an underexamined area of medicine. We successfully implemented a session on this topic for internal medicine residents on the primary care track. Limitations included generalizability due to the small number of residents in the course and inability to gather sufficient data to see if knowledge learned was sustained over time.
Collapse
Affiliation(s)
- Nicole Mushero
- Assistant Professor, Section of Geriatrics, Department of Medicine, Boston University School of Medicine; Physician, Department of Geriatrics, Boston Medical Center
| | - Lindsay B. Demers
- Assistant Professor, Section of Geriatrics, Department of Medicine, Boston University School of Medicine
| | - Ryan Chippendale
- Assistant Professor, Section of Geriatrics, Department of Medicine, Boston University School of Medicine; Physician, Department of Geriatrics, Boston Medical Center
| |
Collapse
|
23
|
Palmer PM, Padilla AH. Risk of an Adverse Event in Individuals Who Aspirate: A Review of Current Literature on Host Defenses and Individual Differences. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:148-162. [PMID: 34731584 DOI: 10.1044/2021_ajslp-20-00375] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The presence of oropharyngeal dysphagia increases the likelihood of prandial aspiration, and aspiration increases the likelihood of a dysphagia-related pulmonary sequelae such as aspiration pneumonia, acute respiratory distress syndrome, pulmonary fibrosis, and even death. Although these outcomes are unfortunate, it is important to point out that these consequences are not solely determined by the presence of aspiration. The purpose of this tutorial is to provide current information on pulmonary defenses and the variables that increase risk of an adverse outcome in individuals who aspirate. METHOD This tutorial reviews the basics of lung defenses and summarizes the literature to make the case that the host is a central theme in dysphagia management. Case studies are employed to highlight the key variables. RESULTS Based on a literature review, a series of questions are proposed for consideration in dysphagia management. These questions, which take the focus away from the presence of aspiration and toward the associated risks within an individual, are then applied to two case studies. CONCLUSIONS A guiding framework is proposed to encourage clinicians to assess more than the presence of aspiration and consider the individual's ability to cope with the aspirated material. In the presence of aspiration, clinicians are urged to focus on the risk factors that can lead to a negative consequence, identify which factors are modifiable, and determine when a level of risk is acceptable.
Collapse
Affiliation(s)
- Phyllis M Palmer
- Department of Speech and Hearing Sciences, The University of New Mexico, Albuquerque
| | | |
Collapse
|
24
|
Rie K, Yokoi T, Miyoshi Y, Watanabe H, Fukuda T. Eating Behavior and Environments of Severe Alzheimer's Disease Patients With Loss of Language Skills. Gerontol Geriatr Med 2022; 8:23337214221113848. [PMID: 35874433 PMCID: PMC9301107 DOI: 10.1177/23337214221113848] [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: 03/05/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background: As Alzheimer’s disease (AD) progresses, AD patients
become more and more dependent on the environment. To prevent the patients from
being distracted from eating, it is necessary to pay attention to the
environment. Purpose: Five severe AD patients with loss of language
skills were observed closely to identify the environments that interfered with
their eating behaviors and environments that encouraged them to eat.
Methods: The author, a certified care worker, recorded the
behaviors of five severe AD patients while providing care for the overall
aspects of their daily lives. From these records, the author extracted the
situations in which the subjects exhibited self-eating behavior and situations
in which they were distracted from eating, and organized the meanings of these
environments for the subjects. Results: Eating behavior was
interrupted: (1) when staff members started conversations nearby a subject, or
when a caregiver attempted to stop a subject’s behavior in order to get her to
eat; (2) by physical environmental changes, such as phone ringing and reflection
of artificial light on their table. Conclusion: By organizing the
meanings of the environments surrounding each individual, we can identify the
environments that encourage a patient to start eating and environments that
interfere with a patient’s eating behavior.
Collapse
Affiliation(s)
- Ketu Rie
- University of Kochi, Kochi City, Japan
| | | | | | | | | |
Collapse
|
25
|
Moncayo-Hernández BA, Herrera-Guerrero JA, Vinazco S, Ocampo-Chaparro JM, Reyes-Ortiz CA. Sarcopenic dysphagia in institutionalised older adults. ENDOCRINOL DIAB NUTR 2021; 68:602-611. [PMID: 34906340 DOI: 10.1016/j.endien.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/20/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Sarcopenic dysphagia, defined as dysphagia caused by sarcopenia, is a swallowing disorder of great interest to the medical community. The objective of our study was to evaluate the prevalence and factors associated with sarcopenic dysphagia in institutionalised older adults. MATERIAL AND METHODS An observational, analytical, cross-sectional study was conducted in a nursing home between September and December 2017, with 100 participants. The presence of dysphagia was assessed using the volume-viscosity clinical examination method, and the diagnostic algorithm for sarcopenic dysphagia was followed. The participants' grip strength, gait speed, calf circumference, nutritional assessment (Mini Nutritional Assessment), Barthel Index, cognitive assessment (Mini-Mental State Examination) and Charlson Comorbidity Index were evaluated. Bivariate and multivariate logistic regression analyses were performed. RESULTS The median age was 84 years, and 55% were women; 48% had functional dependence, 49% had positive screening for malnutrition and 64% had some degree of dysphagia. The prevalence of sarcopenic dysphagia was 45%, and the main factors related to less sarcopenic dysphagia were a good nutritional status (OR 0.85, 95% CI, 0.72-0.99) and a better functional performance status (OR 0.98, 95% CI 0.97-0.98). CONCLUSION Sarcopenic dysphagia has a high prevalence in institutionalised older adults; and functional dependence and poor nutritional status were associated with sarcopenic dysphagia.
Collapse
Affiliation(s)
| | | | - Steven Vinazco
- Programa de Medicina Familiar, Universidad del Valle, Cali, Colombia
| | - José Mauricio Ocampo-Chaparro
- Departamento de Medicina Interna, Grupo Interinstitucional de Medicina Interna (GIMI 1), Universidad Libre, Cali, Colombia; Departamento de Medicina Familiar, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Carlos A Reyes-Ortiz
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A & M University, Tallahassee, FL, United States.
| |
Collapse
|
26
|
Hsieh SW, Chuang HY, Hung CH, Chen CH. Cognitive Deficits Associated With Dysphagia in Patients With Dementia. J Neurogastroenterol Motil 2021; 27:650-652. [PMID: 34642286 PMCID: PMC8521476 DOI: 10.5056/jnm21027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sun-Wung Hsieh
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Yu Chuang
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Hsing Hung
- Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Hung Chen
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
27
|
Donohue C, Khalifa Y, Mao S, Perera S, Sejdić E, Coyle JL. Characterizing Swallows From People With Neurodegenerative Diseases Using High-Resolution Cervical Auscultation Signals and Temporal and Spatial Swallow Kinematic Measurements. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3416-3431. [PMID: 34428093 PMCID: PMC8642099 DOI: 10.1044/2021_jslhr-21-00134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/21/2021] [Accepted: 05/21/2021] [Indexed: 06/13/2023]
Abstract
Purpose The prevalence of dysphagia in patients with neurodegenerative diseases (ND) is alarmingly high and frequently results in morbidity and accelerated mortality due to subsequent adverse events (e.g., aspiration pneumonia). Swallowing in patients with ND should be continuously monitored due to the progressive disease nature. Access to instrumental swallow evaluations can be challenging, and limited studies have quantified changes in temporal/spatial swallow kinematic measures in patients with ND. High-resolution cervical auscultation (HRCA), a dysphagia screening method, has accurately differentiated between safe and unsafe swallows, identified swallow kinematic events (e.g., laryngeal vestibule closure [LVC]), and classified swallows between healthy adults and patients with ND. This study aimed to (a) compare temporal/spatial swallow kinematic measures between patients with ND and healthy adults and (b) investigate HRCA's ability to annotate swallow kinematic events in patients with ND. We hypothesized there would be significant differences in temporal/spatial swallow measurements between groups and that HRCA would accurately annotate swallow kinematic events in patients with ND. Method Participants underwent videofluoroscopic swallowing studies with concurrent HRCA. We used linear mixed models to compare temporal/spatial swallow measurements (n = 170 ND patient swallows, n = 171 healthy adult swallows) and deep learning machine-learning algorithms to annotate specific temporal and spatial kinematic events in swallows from patients with ND. Results Differences (p < .05) were found between groups for several temporal and spatial swallow kinematic measures. HRCA signal features were used as input to machine-learning algorithms and annotated upper esophageal sphincter (UES) opening, UES closure, LVC, laryngeal vestibule reopening, and hyoid bone displacement with 66.25%, 85%, 68.18%, 70.45%, and 44.6% accuracy, respectively, compared to human judges' measurements. Conclusion This study demonstrates HRCA's potential in characterizing swallow function in patients with ND and other patient populations.
Collapse
Affiliation(s)
- Cara Donohue
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
| | - Yassin Khalifa
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, PA
| | - Shitong Mao
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, PA
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, PA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, PA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, PA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, PA
- Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, PA
| | - James L. Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
- Department of Otolaryngology, School of Medicine, University of Pittsburgh Medical Center, PA
| |
Collapse
|
28
|
Parlak MM, Babademez MA, Alicura Tokgöz S, Bizpınar Ö, Saylam G. Evaluation of Swallowing Function according to the Stage of Alzheimer's Disease. Folia Phoniatr Logop 2021; 74:186-194. [PMID: 34469898 DOI: 10.1159/000519263] [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: 04/26/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is a progressive neurodegenerative disease, and swallowing difficulties may occur as the disease progresses. Dysphagia has many consequences, such as aspiration and pneumonia. In particular, in the advanced stage, approximately 70% of the causes of death in AD involve aspiration pneumonia. Therefore, it is vital to assess the presence or absence of dysphagia in AD. OBJECTIVE This study aims to describe swallowing difficulty across the stages of AD. METHODS Thirty-five AD patients were evaluated. The Mini-Mental State Examination was conducted. A bedside water swallow test (BWST) and the Eating Assessment Tool (EAT-10) were administered. Finally, fiberoptic endoscopic evaluation of swallowing was used to evaluate residual, aspiration and penetration conditions. RESULTS EAT-10 scores, BWST results, and penetration-aspiration status were statistically significantly different according to AD stage (p < 0.05). Among all patients, 74.3% had residue, 25.7% had penetration, and 2.9% had aspiration. CONCLUSIONS This study has demonstrated that swallowing dysfunction begins at a mild stage and progressively worsens toward the advanced stage in patients with AD. At all stages of AD, residue was observed, and this poses a risk for the development of penetration-aspiration. Therefore, it is necessary to evaluate the early dysphagia of individuals.
Collapse
Affiliation(s)
- Mümüne Merve Parlak
- Department of Speech and Language Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Mehmet Ali Babademez
- Department of Otolaryngology, Faculty of Medicine, Yıldırım Beyazıt Unıversıty, Ankara, Turkey
| | - Sibel Alicura Tokgöz
- Department of Otolaryngolgy, Dışkapı Research and Training Hospital, Ankara, Turkey
| | - Özlem Bizpınar
- Department of Neurology, Dışkapı Research and Training Hospital, Ankara, Turkey
| | - Güleser Saylam
- Department of Otolaryngolgy, Dışkapı Research and Training Hospital, Ankara, Turkey
| |
Collapse
|
29
|
Deguigne M, Cellier M, Hamon Y, Legay M, Descatha A. Poisoning exposure from non-pharmaceutical products in residents of structured living facilities. Clin Toxicol (Phila) 2021; 60:371-378. [PMID: 34409905 DOI: 10.1080/15563650.2021.1965158] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objectives of this study were to describe poisonings occurring in older or disabled patients residing in structured living facilities, identify risk factors, and propose preventive measures. METHOD This was a prospective and observational study, covering all cases of poisoning occurring in structured living facilities in the Brittany region of France. All calls were received at the Grand Ouest Poison Control Centre (PCC) of Angers and were recorded from 1 February 2019 to 31 January 2020. The clinical severity of the poisonings was assessed using the Poisoning Severity Score (PSS). Clinical severity was compared by univariate and multivariate analyses using the following dependent variables: PSS score < 2 and PSS ≥ 2. RESULTS This study included 158 residents with a median age of 83 years (5-116 years old). The average number of residents supervised by a member of the supervisory staff was 11 (+/-10.7). The substance ingested was a personal hygiene product or a cleaning product in 48% and 25% of cases, respectively. The most frequently ingested product was a bar of soap (n = 20). All moderate to severe cases (4.6%, n = 8 including one death) occurred in residents with dementia living in nursing homes for elderly patients, and 9% of residents required hospital treatment. In more than 50% of cases (n = 83), the product was provided by the facility and in 23% (n = 40), it was brought in by the family. Ingestion of a bar of soap or a product brought in by the family was significantly associated with higher poisoning severity (PSS ≥ 2). After adjustment for age, sex and the number of residents per supervisor, the severity of poisoning was significantly greater after ingestion of a bar of soap (OR = 12.33, CI95 [2.12, 71.63], p = 0.005). CONCLUSION Older adults residing in medical facilities who have a history of dementia and/or cognitive impairment are more at risk of non-medicinal product poisoning. Clinical severity and the hospitalisation rate were greater when bar soap was ingested.
Collapse
Affiliation(s)
- Marie Deguigne
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Morgane Cellier
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Yveline Hamon
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Marion Legay
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France
| | - Alexis Descatha
- Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, Angers, France.,Univ Angers, CHU Angers, Univ Rennes, Inserm, Ehesp, Irset (Institut de recherche en santé, environnement et travail - Research Institute for Environmental and Occupational Health), Angers, France
| |
Collapse
|
30
|
Namasivayam-MacDonald AM, Alomari N, Attner L, Benjamin RD, Chill A, Doka S, Guastella R, Marchese J, Oppedisano S, Ressa K, Rider BE, Sandoval GK, Soyfer A, Thompson R, Walshe CM, Riquelme LF. A Retrospective Analysis of Swallowing Function and Physiology in Patients Living with Dementia. Dysphagia 2021; 37:900-908. [PMID: 34374860 DOI: 10.1007/s00455-021-10350-z] [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: 01/07/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Dysphagia is commonly diagnosed in patients living with dementia, but we lack understanding of changes in swallowing physiology and the resulting relationship to impairments of safety and efficiency. The purpose of this study was to describe the pathophysiology of dysphagia in a retrospective sample of patients living with dementia. Videofluoroscopy data from 106 adults (mean age: 84) diagnosed with dementia were scored by blinded raters. Raters analyzed 412 thin liquid swallows for safety [Penetration-Aspiration Scale (PAS)], efficiency [% of (C2-C4)2], timing [Pharyngeal Transit Time (PTT), Swallow Reaction Time (SRT), Laryngeal Vestibule Closure Reaction Time (LVCrt), Upper Esophageal Sphincter Opening Duration (UESO)], and kinematics (pharyngeal constriction). Impairment thresholds from existing literature were used to characterize swallowing. Chi-square tests and Pearson's correlations were used to determine associations between swallowing physiology and function. Compared to published norms, we identified significant differences in PTT, SRT, LVCrt, UESO, and degree of maximum pharyngeal constriction. Unsafe swallowing (PAS > 2) was seen in 17% of swallows. Clinically significant residue (i.e., % of (C2-C4)2 > 0.54 vallecular; > 0.34 pyriforms) was seen in most patients. Chi-square tests revealed significant associations between LVCrt and unsafe swallowing. There was a weak positive association between post-swallow residue in the pyriforms and poor pharyngeal constriction. Detailed analysis of swallowing physiology in this sample provides insight into the pathophysiological mechanisms associated with dysphagia in patients living with dementia. Further work is needed to explore additional bolus consistencies and to identify how physiology changes based on type and severity of dementia diagnosis.
Collapse
Affiliation(s)
- Ashwini M Namasivayam-MacDonald
- School of Rehabilitation Science, McMaster University, 1280 Main St. West, IAHS 420, Hamilton, ON, L8S 4L8, Canada. .,Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA.
| | - Naga Alomari
- Speech-Language Pathology, New York Medical College, Valhalla, NY, USA.,NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Lauren Attner
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Rebecca D Benjamin
- Speech-Language Pathology, New York Medical College, Valhalla, NY, USA.,NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Alexandra Chill
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Samantha Doka
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Rebekah Guastella
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Jena Marchese
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Stefania Oppedisano
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Kathryn Ressa
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Brianna E Rider
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Gracelynn K Sandoval
- Speech-Language Pathology, New York Medical College, Valhalla, NY, USA.,NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Alexandra Soyfer
- Speech-Language Pathology, New York Medical College, Valhalla, NY, USA.,NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Riesa Thompson
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Caitlin M Walshe
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Luis F Riquelme
- Speech-Language Pathology, New York Medical College, Valhalla, NY, USA.,NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| |
Collapse
|
31
|
Borda MG, Bani Hassan E, Weon J, Wakabayashi H, Tovar-Rios DA, Oppedal K, Aarsland D, Duque G. Muscle volume and intramuscular fat of the tongue evaluated with MRI predict malnutrition in people living with dementia: a five-year follow-up study. J Gerontol A Biol Sci Med Sci 2021; 77:228-234. [PMID: 34338751 DOI: 10.1093/gerona/glab224] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 11/12/2022] Open
Abstract
Malnutrition is highly prevalent in older persons with dementia. Therefore, strong predictors of malnutrition in this population are crucial to initiating early interventions. This study evaluates the association between the probability of having malnutrition with the muscle volume and intramuscular fat (iMAT) of the masseter and the tongue in magnetic resonance images (MRI) of community-dwelling older persons diagnosed with mild dementia followed for five years. This is a longitudinal study conducted in the western part of Norway. Muscle volume and iMAT of the tongue and masseter were computed from structural head MRIs obtained from 65 participants of The Dementia Study of Western Norway (DemVest) using Slice-O-Matic software for segmentation. Malnutrition was assessed using the glim index. Linear mix models were conducted. Having malnutrition at baseline was associated with lower muscle volume (OR 0.60 SE 0.20 p=0.010) and higher iMAT (OR 3.31 SE 0.46 p=0.010) in the tongue. At five years follow-up, those with lower muscle volume (OR 0.55, SE 0.20 p=0.002) and higher iMAT (OR 2.52, SE 0.40 p=0.022) in the tongue had a higher probability of presenting malnutrition. The masseter iMAT and volume were not associated with malnutrition in any of the adjusted models.In people diagnosed with mild dementia, tongue muscle volume and iMAT were associated with baseline malnutrition and the probability of developing malnutrition in a 5-year trajectory. In the masseter, there were no significant associations after adjustments.
Collapse
Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway.,Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana.Bogotá, Colombia.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Ebrahim Bani Hassan
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Geroscience and Osteosarcopenia Research Program, The University of Melbourne and Western Health, St. Albans, Melbourne, Victoria, Australia
| | - JangHo Weon
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Geroscience and Osteosarcopenia Research Program, The University of Melbourne and Western Health, St. Albans, Melbourne, Victoria, Australia
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Diego Alejandro Tovar-Rios
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway.,Universidad del Valle, School of Statistics, Santiago de Cali, Colombia
| | - Ketil Oppedal
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway.,Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway.,Department of Electrical Engineering & Computer Science, University of Stavanger, Stavanger, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Gustavo Duque
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Geroscience and Osteosarcopenia Research Program, The University of Melbourne and Western Health, St. Albans, Melbourne, Victoria, Australia
| |
Collapse
|
32
|
Moncayo-Hernández BA, Herrera-Guerrero JA, Vinazco S, Ocampo-Chaparro JM, Reyes-Ortiz CA. Sarcopenic dysphagia in institutionalised older adults. ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(21)00146-4. [PMID: 34219050 PMCID: PMC8720107 DOI: 10.1016/j.endinu.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Sarcopenic dysphagia, defined as dysphagia caused by sarcopenia, is a swallowing disorder of great interest to the medical community. The objective of our study was to evaluate the prevalence and factors associated with sarcopenic dysphagia in institutionalised older adults. MATERIAL AND METHODS An observational, analytical, cross-sectional study was conducted in a nursing home between September and December 2017, with 100 participants. The presence of dysphagia was assessed using the volume-viscosity clinical examination method, and the diagnostic algorithm for sarcopenic dysphagia was followed. The participants' grip strength, gait speed, calf circumference, nutritional assessment (Mini Nutritional Assessment), Barthel Index, cognitive assessment (Mini-Mental State Examination) and Charlson Comorbidity Index were evaluated. Bivariate and multivariate logistic regression analyses were performed. RESULTS The median age was 84 years, and 55% were women; 48% had functional dependence, 49% had positive screening for malnutrition and 64% had some degree of dysphagia. The prevalence of sarcopenic dysphagia was 45%, and the main factors related to less sarcopenic dysphagia were a good nutritional status (OR 0.85, 95% CI, 0.72-0.99) and a better functional performance status (OR 0.98, 95% CI 0.97-0.98). CONCLUSION Sarcopenic dysphagia has a high prevalence in institutionalised older adults; and functional dependence and poor nutritional status were associated with sarcopenic dysphagia.
Collapse
Affiliation(s)
| | | | - Steven Vinazco
- Programa de Medicina Familiar, Universidad del Valle, Cali, Colombia
| | - José Mauricio Ocampo-Chaparro
- Departamento de Medicina Interna, Grupo Interinstitucional de Medicina Interna (GIMI 1), Universidad Libre, Cali, Colombia; Departamento de Medicina Familiar, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Carlos A Reyes-Ortiz
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A & M University, Tallahassee, Florida, EE. UU..
| |
Collapse
|
33
|
Küppers L, Ritz-Timme S, Hartung B. [Died from or with dementia? The relationship between dementia and cause of death]. Dtsch Med Wochenschr 2021; 146:677-682. [PMID: 33957690 DOI: 10.1055/a-1380-1436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Specifying a singular specific cause of death or an appropriate causal chain in the death certificate can be challenging, especially in cases of elderly, multimorbid deceased persons.The German cause of death statistics suggest that mental illnesses, including dementia, are beneath the most frequent causes of death. But when looking at death certificates in the context of dementia considerable information gaps and a lack of plausibility in the causal chain can be observed quite regularly.In this article we give recommendations for the correct designation of the cause of death and underlying diseases in the death certificate. These recommendations are not only to be seen against an academic background. The correct registration of dementia in the causes of death statistics may be a basis for decision making in health politics and is hence in the interest of optimal patient care.
Collapse
Affiliation(s)
- Lisa Küppers
- Institut für Rechtsmedizin, Universitätsklinikum Düsseldorf, Düsseldorf
| | | | - Benno Hartung
- Institut für Rechtsmedizin, Universitätsklinikum Düsseldorf, Düsseldorf
| |
Collapse
|
34
|
Abstract
The global population of 80 years and older is predicted to reach 437
million by 2050. As overall brain structure and function progressively degrades,
older and younger adults show differences in sensorimotor performance and brain
activity in the sensorimotor regions. Oral sensorimotor functions are an
important area of focus in natural aging and Alzheimer’s Disease (AD)
because oral health issues are commonly found in both elderly and AD
populations. While human behavioral studies on changes in oral sensorimotor
functions abound, very little is known about their neuronal correlates in normal
and pathological aging.
Collapse
|
35
|
Crary MA. Adult Neurologic Disorders. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00004-4] [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]
|
36
|
Velasco LC, Imamura R, Rêgo APV, Alves PR, da Silva Peixoto LP, de Oliveira Siqueira J. Sensitivity and Specificity of Bedside Screening Tests for Detection of Aspiration in Patients Admitted to a Public Rehabilitation Hospital. Dysphagia 2020; 36:821-830. [PMID: 33052481 DOI: 10.1007/s00455-020-10198-9] [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: 02/26/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
Early detection of dysphagia and specifically aspiration is essential to prevent and reduce complications of hospitalized patients in rehabilitation centers. Bedside screening test are often used to evaluate swallowing disorders, but their results may be questionable due to insufficient and inconsistent sensitivity and specificity. To compare the sensitivity and specificity of various bedside screening tests for detecting aspiration in hospitalized rehabilitation patients. A prospective observational study was performed in 150 consecutive patients of a tertiary rehabilitation hospital. Patients were evaluated regarding clinical predictors for aspiration, maximum phonation time (MPT), Eating Assessment Tool 10 (EAT-10) questionnaire, tongue strength and endurance (Iowa Oral Performance Instrument [IOPI]) and a swallowing test (Volume-Viscosity Swallow Test [V-VST]). Flexible Endoscopic Evaluation of Swallowing (FEES) was the reference test. Of the 144 patients included, 22% aspirated on FEES. Previous history of pneumonia, dysarthria, wet voice, and abnormal cough reflex were significantly associated with aspiration. The sensitivity, specificity and accuracy for V-VST (83.3%, 72.6%, 74.8%, respectively) and EAT-10 (82.8%, 57.7%, 62.8%, respectively) to detect aspiration were superior than those of other methods. Maximum tongue strength on IOPI and MPT presented high sensitivity but low specificity to detect aspiration. Clinical predictors of aspiration (previous history of pneumonia, dysarthria, wet voice, and abnormal cough reflex) associated with either V-VST or EAT-10 may be good screening methods to detect aspiration in patients hospitalized in a rehabilitation center.
Collapse
Affiliation(s)
- Leandro Castro Velasco
- Department of Otorhinolaryngology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Rua T-14, número 1529, apartamento 2301, bloco Monet, Goiânia, GO, CEP 74230-130, Brasil.
| | - Rui Imamura
- Department of Otorhinolaryngology, School of Medicine, University of São Paulo, Avenida Padre Pereira de Andrade, 545, apto 153-F, Boacava, São Paulo, 05469-000, Brazil
| | - Ana Paula Valeriano Rêgo
- Department of Otorhinolaryngology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Avenida T-4, número 550, Condomínio Ilhas Do Caribe, apartamento 1303, Bloco A, Setor Bueno, Goiânia, Goiás, 74230030, Brazil
| | - Priscilla Rabelo Alves
- Department of Speech-Language Pathology and Audiology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Rua 230, número 978, Condomínio Quinta Vila Boa, apartamento 303, Bloco C, Setor Vila Jaraguá, Goiânia, Goiás, 74655130, Brazil
| | - Lorena Pacheco da Silva Peixoto
- Department of Speech-Language Pathology and Audiology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Rua Vitória, número 265, Residencial Veneza, apartamento 601, Setor Alto da Glória, Goiânia, Goiás, 74815745, Brazil
| | - José de Oliveira Siqueira
- Department of Pathology, School of Medicine, University of São Paulo, Rua Catuaba, número 595, Vila Alpina, São Paulo, 03208000, Brazil
| |
Collapse
|
37
|
Li Y, Sun D, Zhang X, Li H, Zhao Y, Ma D, Li Z, Sun J. Informal dementia caregivers' experiences and perceptions about mealtime care: A qualitative evidence synthesis. J Adv Nurs 2020; 76:3317-3328. [PMID: 32996617 DOI: 10.1111/jan.14550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022]
Abstract
AIMS To systematically identify, evaluate and synthesize the available qualitative evidence on the mealtime care experiences of informal caregivers of people with dementia. DESIGN A qualitative evidence synthesis using the Thomas and Harden method. DATA SOURCES All qualitative and mixed-method studies in English and Chinese were retrieved from PubMed, Web of Science, Embase, Cochrane, CINAHL, CNKI, WanFang, and Vip from the inception of each database until November 2019. REVIEW METHODS Two researchers independently selected the studies using qualitative assessment and review instruments for quality evaluation and thematic synthesis for the data analysis. RESULTS Ten studies were chosen for this review. The analytical themes identified included injecting a new element, moving forward in the challenge and external supports facilitating better coping. CONCLUSION Community nurses should effectively use resources to provide food-related information and services to families with dementia. Future research should combine informal caregiver experiences and clinical skills to develop high-quality interventions to improve the quality of mealtimes. IMPACT The findings established that informal caregivers experienced not only changes in their roles and concerns but also emotional changes. Informal caregivers develop different coping strategies to adapt to feeding issues without professional support. Although informal caregivers attach great importance to mealtimes and nutrition issues, they experience a lack of information and support services. Community nurses can provide more economical, practical, and accessible information resources based on informal caregivers' perceptions of mealtime care. Future interventions need to be more aware of the importance of dyad or family-centred support services.
Collapse
Affiliation(s)
- Yijing Li
- School of Nursing, Jilin University, Changchun, Jilin, People's Republic of China
| | - Dan Sun
- China-Japan Union Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Xu Zhang
- School of Nursing, Jilin University, Changchun, Jilin, People's Republic of China
| | - Huanhuan Li
- School of Nursing, Jilin University, Changchun, Jilin, People's Republic of China
| | - Yingnan Zhao
- School of Nursing, Jilin University, Changchun, Jilin, People's Republic of China
| | - Dongfei Ma
- School of Nursing, Jilin University, Changchun, Jilin, People's Republic of China
| | - Zehui Li
- School of Nursing, Jilin University, Changchun, Jilin, People's Republic of China
| | - Jiao Sun
- School of Nursing, Jilin University, Changchun, Jilin, People's Republic of China
| |
Collapse
|
38
|
Chen S, Cui Y, Ding Y, Sun C, Xing Y, Zhou R, Liu G. Prevalence and risk factors of dysphagia among nursing home residents in eastern China: a cross-sectional study. BMC Geriatr 2020; 20:352. [PMID: 32943011 PMCID: PMC7495827 DOI: 10.1186/s12877-020-01752-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background Dysphagia is a common health care problem and poses significant risks including mortality and hospitalization. China has many unsolved long-term care problems, as it is a developing country with the largest ageing population in the world. The present study aimed to identify the prevalence and risk factors of dysphagia among nursing home residents in China to direct caregivers towards preventative and corrective actions. Methods Data were collected from 18 public or private nursing homes in 9 districts of Nanjing, China. A total of 775 older adults (aged 60 ~ 105 years old; 60.6% female) were recruited. Each participant underwent a standardized face-to-face interview by at least 2 investigators. The presence of risk of dysphagia was assessed using the Chinese version of the EAT-10 scale. The Barthel Index (BI) was used to evaluate functional status. Additionally, demographic and health-related characteristics were collected from the participants and their medical files. Univariate analyses were first used to find out candidate risk factors, followed by binary logistic regression analyses to determine reliable impact factors after adjusting for confounders. Results Out of 775 older adults, the prevalence of dysphagia risk was calculated to be 31.1%. A total of 85.0% of the older adults reported at least one chronic disease, and diseases with the highest prevalence were hypertension (49.5%), stroke (40.4%), diabetes (25.5%) and dementia (18.2%). Approximately 11.9% of participants received tube feeding. The mean BI score was 56.2 (SD = 38.3). Risk factors for dysphagia were texture of diet (OR = 2.978, p ≤ 0.01), BI level (OR = 1.418, p ≤ 0.01), history of aspiration, pneumonia and heart attack (OR = 22.962, 4.909, 3.804, respectively, p ≤ 0.01), types of oral medication (OR = 1.723, p ≤ 0.05) and Parkinson disease (OR = 2.566, p ≤ 0.05). Conclusions A serious risk of dysphagia was observed among Chinese nursing home residents. Overall, nursing home residents were moderately dependent, according to the BI level. The risk for dysphagia increased with thinner diet texture, worse functional status, history of aspiration, pneumonia and heart attack, more oral medications and Parkinson disease. The findings of our study may serve to urge nursing home staff to pay more attention to the swallowing function of all residents and to take more actions in advance to prevent or reduce dysphagia.
Collapse
Affiliation(s)
- Shen Chen
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, Jiangsu Province, China
| | - Yan Cui
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, Jiangsu Province, China.
| | - Yaping Ding
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, Jiangsu Province, China
| | - Changxian Sun
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, Jiangsu Province, China.,Jiangsu Vocational Institute of Commerce, 180 Longmian Avenue, Nanjing, 211168, China
| | - Ying Xing
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, Jiangsu Province, China
| | - Rong Zhou
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, Jiangsu Province, China
| | - Guohua Liu
- JORU QingHe Senior Care Center, 70 Youyi Street, Nanjing, 210041, China
| |
Collapse
|
39
|
Dimech J, Agius E, Hughes JC, Bartolo P. Challenges faced by patients, relatives and clinicians in end-stage dementia decision-making: a qualitative study of swallowing problems. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106222. [PMID: 32747524 DOI: 10.1136/medethics-2020-106222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Decision-making in end-stage dementia (ESD) is a complex process involving medical, social, legal and ethical issues. In ESD, the person suffers from severe cognitive problems leading to a loss of capacity to decide matters regarding health and end-of-life issues. The decisional responsibility is usually passed to clinicians and relatives who can face significant difficulty in making moral decisions, particularly in the presence of life-threatening swallowing problems. AIM This study aimed to understand the decision-making processes of clinical teams and relatives in addressing life-threatening swallowing difficulties in ESD in long-term care in Malta. METHOD The study followed a qualitative approach where six case studies, involving six different teams and relatives of six different patients, were interviewed retrospectively to understand their decision-making in connection with the management of swallowing difficulties in ESD. Data were collected through semistructured interviews with each stakeholder. All data were transcribed and subjected to thematic analysis. RESULTS Four themes were identified: the vulnerability of patients in dementia decision-making; the difficult role of relatives in decision-making; the decisional conflict between aggressive care through tube feeding versus oral comfort feeding; a consensus-building decision-making process as ideal to facilitate agreement and respect for patient's dignity. CONCLUSION Decision-making to manage swallowing difficulties in ESD is a challenging process, which involves an interpretation of personal values, beliefs, patient preferences, care needs and clinical practice. Better communication between clinicians and relatives in dementia helps promote agreement between stakeholders leading to a care plan that respects the dignity of patients at their end of life.
Collapse
Affiliation(s)
- Joseph Dimech
- Government of Malta, Ministry for the Family and Social Solidarity, Valletta, Malta
- Barts and The London School of Medicine and Dentistry, QMUL, Malta Campus, Gozo, Malta
| | - Emmanuel Agius
- Department of Moral Theology, University of Malta, Msida, Malta
- European Group of Ethics in Science and New Technologies, European Commission, Brussels, Belgium
| | - Julian C Hughes
- University of Bristol, Bristol, UK
- Policy, Ethics and Life Sciences Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Paul Bartolo
- Department of Psychology, Faculty for Social Wellbeing, University of Malta, Msida, Malta
| |
Collapse
|
40
|
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
|
41
|
Zhang M, Li C, Zhang F, Han X, Yang Q, Lin T, Zhou H, Tang M, Zhou J, Shi H, Hui Y, Xiong M, Pang L, Wang B, Feng Z, Li Z, Cao C, Lu X, Ding Y, Shen S, Xu Z, Yu F, Chen C, Meng L, Liao G, Zhang J, Sasegbon A, Dou Z. Prevalence of Dysphagia in China: An Epidemiological Survey of 5943 Participants. Dysphagia 2020; 36:339-350. [PMID: 32458145 DOI: 10.1007/s00455-020-10138-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/16/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prevalence of dysphagia among an older population and patients with stroke, head and neck cancers (HNCs) or neurodegenerative diseases (NDDs) in China, to identify the factors associated with this condition, and to explore the relationship between dysphagia and nutritional status. METHODS This study included participants 65 years and older living in the community or in nursing homes and patients who had sustained a stroke, HNC, or NDD also recruited in hospitals from 14 provinces of China. The presence of dysphagia was determined by use of a questionnaire, water swallowing test, and/or a videofluoroscopic swallowing study. Logistic regression analysis was used to assess the possible associated risk factors. Body mass index was assessed as an indicator of malnutrition. RESULTS A total of 5943 persons met the inclusion criteria and 2341 (39.4%) were identified with dysphagia, including the following: 51.14% of patients with stroke, 34.4% in HNCs, 48.3% in NDDs, and 19.2% of otherwise healthy older adults. The elderly with comorbidity (OR = 2.90, p < 0.01) and stroke patients (OR = 2.27, p < 0.01) were significantly more likely to exhibit signs of dysphagia. Dysphagic participants were at significantly greater risk of malnutrition (OR = 1.91, p < 0.01) compared to those without dysphagia. CONCLUSION Dysphagia is prevalent in China among older individuals and people who have suffered a stroke, HNCs, or NDDs. The prevalence of dysphagia increases steadily with increasing age and presence of comorbid disease. People with dysphagia are more likely to suffer from malnutrition.
Collapse
Affiliation(s)
- Mengqing Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Chao Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Fang Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Xiaoxiao Han
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Qinglu Yang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Tuo Lin
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Huichang Zhou
- Department of Rehabilitation Medicine, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Min Tang
- Department of Neurological Rehabilitation Medicine, Ningbo Rehabilitation Hospital, Ningbo, Zhejiang, China
| | - Jungui Zhou
- Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangzhou, Guangdong, China
| | - Hongling Shi
- Department of Rehabilitation Medicine, Third People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Yanping Hui
- Department of Rehabilitation Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shanxi, China
| | - Mingfeng Xiong
- Department of Rehabilitation Medicine, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Ling Pang
- Department of Rehabilitation Medicine, China-Japan Union Hospital of Jilin University, Jilin, Changchun, China
| | - Baolan Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Xinjiang University and Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhen Feng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhanfei Li
- Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Changbing Cao
- Department of Rehabilitation Medicine, Fujian Longyan Longgang Hospital, Longyan, Fujian, China
| | - Xiao Lu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuanyuan Ding
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shukun Shen
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengyue Xu
- Department of Rehabilitation Medicine, Qinghai Provincial People's Hospital, Xining, Qinghai, China
| | - Fan Yu
- Department of Rehabilitation Medicine, Shanghai General Hospital, Shanghai, China
| | - Chen Chen
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Ling Meng
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guiqing Liao
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jinxin Zhang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, Centre for Gastrointestinal Sciences, School of Medical Sciences, The University of Manchester, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, Guangdong, China.
| |
Collapse
|
42
|
A Brief Intervention for Malnutrition among Older Adults: Stepping Up Your Nutrition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103590. [PMID: 32443789 PMCID: PMC7277589 DOI: 10.3390/ijerph17103590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/16/2020] [Accepted: 05/17/2020] [Indexed: 12/19/2022]
Abstract
Despite a multitude of nutritional risk factors among older adults, there is a lack of community-based programs and activities that screen for malnutrition and address modifiable risk among this vulnerable population. Given the known association of protein and fluid consumption with fall-related risk among older adults and the high prevalence of falls among Americans age 65 years and older each year, a brief intervention was created. Stepping Up Your Nutrition (SUYN) is a 2.5 h workshop developed through a public/private partnership to motivate older adults to reduce their malnutrition risk. The purposes of this naturalistic workshop dissemination were to: (1) describe the SUYN brief intervention; (2) identify participant characteristics associated with malnutrition risk; and (3) identify participant characteristics associated with subsequent participation in Stepping On (SO), an evidence-based fall prevention program. Data were analyzed from 429 SUYN participants, of which 38% (n = 163) subsequently attended SO. As measured by the SCREEN II®, high and moderate malnutrition risk scores were reported among approximately 71% and 20% of SUYN participants, respectively. Of the SUYN participants with high malnutrition risk, a significantly larger proportion attended a subsequent SO workshop (79.1%) compared to SUYN participants who did not proceed to SO (65.8%) (χ2 = 8.73, p = 0.013). Findings suggest SUYN may help to identify malnutrition risk among community-dwelling older adults and link them to needed services like evidence-based programs. Efforts are needed to expand the delivery infrastructure of SUYN to reach more at-risk older adults.
Collapse
|
43
|
Ahmadi N, Mbuagbaw L, Hanna WC, Finley C, Agzarian J, Wen CK, Coret M, Schieman C, Shargall Y. Development of a clinical score to distinguish malignant from benign esophageal disease in an undiagnosed patient population referred to an esophageal diagnostic assessment program. J Thorac Dis 2020; 12:191-198. [PMID: 32274084 PMCID: PMC7139012 DOI: 10.21037/jtd.2020.02.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Esophageal cancer is associated with poor prognosis. Diagnosis is often delayed, resulting in presentation with advanced disease. We developed a clinical score to predict the risk of a malignant diagnosis in symptomatic patients prior to any diagnostic tests. Methods We analyzed data from patients referred to a regional esophageal diagnostic assessment program between May 2013 and August 2016. Logistic regression was performed to identify predictors of malignancy based on patient characteristics and symptoms. Predicted probabilities were used to develop a score from 0 to 10 which was weighted according to beta coefficients for predictors in the model. Score accuracy was evaluated using a receiver operating characteristic (ROC) curve and internally validated using bootstrapping techniques. Patients were classified into low (0–2 points), medium (3–6 points), and high (7–10 points) risk groups based on their scores. Pathologic tissue diagnosis was used to assess the effectiveness of the developed score in predicting the risk of malignancy in each group. Results Of 530 patients, 363 (68%) were diagnosed with malignancy. Factors predictive of malignancy included male sex, family history of cancer and esophageal cancer, fatigue, chest/throat/back pain, melena and weight loss. These factors were allocated 1–2 points each for a total of 10 points. Low-risk patients had 70% lower chance of malignancy (RR =0.28, 95% CI: 0.21–0.38), medium-risk had 50% higher chance of malignancy (RR =1.5, 95% CI: 1.26–1.77), and high-risk patients were 8 times more likely to be diagnosed with malignancy (RR =8.2, 95% CI: 2.60–25.86). The area under the ROC curve for malignancy was 0.82 (95% CI: 0.77–0.87). Conclusions A simple score using patient characteristics and symptoms reliably distinguished malignant from benign diagnoses in a population of patients with upper gastrointestinal symptoms. This score might be useful in expediting investigations, referrals and eventual diagnosis of malignancy.
Collapse
Affiliation(s)
- Negar Ahmadi
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Centre for the Development of Best Practices in Health, Yaoundé, Cameroon
| | - Waël C Hanna
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Christian Finley
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - John Agzarian
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Chuck K Wen
- Division of Thoracic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Michal Coret
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Colin Schieman
- Section of Thoracic Surgery, University of Calgary, Calgary, AB, Canada
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| |
Collapse
|
44
|
Miyazaki A, Mori H. Frequent Karaoke Training Improves Frontal Executive Cognitive Skills, Tongue Pressure, and Respiratory Function in Elderly People: Pilot Study from a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1459. [PMID: 32102472 PMCID: PMC7068312 DOI: 10.3390/ijerph17041459] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 12/14/2022]
Abstract
We tested whether karaoke training improves cognitive skills and reduces the risk of physical function impairments. We conducted a single-blinded randomized controlled trial in 26 elderly participants at residential care facilities, who were generally healthy or required the lowest level of care. Participants were near the threshold for mild cognitive impairment with the Montreal Cognitive Assessment (MoCA) and close to the sarcopenia cut-off with the skeletal muscle mass index. Pulmonary function as measured with spirometry and tongue strength were used as markers for physical functions affected by sarcopenia. Karaoke training occurred once a week for two hours, with an hour of homework assigned weekly. Karaoke training significantly improved the Frontal Assessment Battery at bedside (FAB) compared with an active control group receiving scratch art training (F = 8.04, permutation p-value = 0.013). Subscore improved with inhibitory control (F = 7.63, permutation p-value = 0.015) and sensitivity to interference (F = 11.98, permutation p-value = 0.001). We observed improved tongue pressure (F = 4.49, permutation p-value = 0.040) and pulmonary function by a greater increase in FIV1 (F = 5.22, permutation p-value = 0.047). Engaging elderly people, especially those in care homes, with karaoke training exercises that are moderately physically challenging may be a key to slowing cognitive decline and preventing dysphagia by sarcopenia.
Collapse
Affiliation(s)
- Atsuko Miyazaki
- Technology and Innovation Hub, Cluster for Science, RIKEN, Saitama 351-0198, Japan;
| | | |
Collapse
|
45
|
Impact of the Consistency of Food Substances on Health and Related Factors of Residents in Welfare Facilities for Seniors in Japan. Dent J (Basel) 2020; 8:dj8010009. [PMID: 31947641 PMCID: PMC7175262 DOI: 10.3390/dj8010009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 12/14/2022] Open
Abstract
The aim of this study is to determine the effect of food consistency on health and related factors among residents in welfare facilities for seniors (n = 227; mean age, 86.2 ± 8.0 years; 78.9% female). Residents who ate regular food had a lower incidence of fever during the 3-month period (p < 0.001) and consumed more calories (1325.97 ± 220.2 kcal) than those who ate chopped (1125.0 ± 256.8 kcal), paste (1122.0 ± 288.5 kcal), and gastric tube food (812.5 ± 150.7 kcal) (p < 0.001). Modifying a resident’s food by making it softer and finer did not reduce the incidence of choking. Logistic regression analysis (backward elimination method) revealed four factors related to eating regular food: vitality index, appetite, number of remaining teeth, and choking frequency. Causal relationships were not obtained because this was a cross-sectional study. The findings of this study suggest that a regular consistency of food positively influences the health of older individuals.
Collapse
|
46
|
Lages DRP, Fonseca LC, Tedrus GMAS, Oliveira IBD. The relationship between dysphagia and clinical and cognitive aspects in elderly patients presented with dementia. REVISTA CEFAC 2020. [DOI: 10.1590/1982-0216/20202225719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
47
|
Bartier S, Bodez D, Kharoubi M, Canouï-Poitrine F, Chatelin V, Henrion C, Coste A, Damy T, Béquignon E. Pharyngo-laryngeal involvement in systemic amyloidosis with cardiac involvement: a prospective observational study. Amyloid 2019; 26:216-224. [PMID: 31364411 DOI: 10.1080/13506129.2019.1646639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: Systemic amyloidosis with cardiac involvement (CA) is a severe disease caused by the aggregation of misfolded proteins infiltrating organs and tissues and leading to their dysfunction. No study has yet focused on potential pharyngo-laryngeal impairments associated to CA. Our objective was to define its prevalence and describe pharyngo-laryngeal involvement patterns in a population with CA (light chain: AL, wild-type transthyretin: ATTRwt, variant transthyretin: ATTRv). Methods: Consecutive patients with a confirmed diagnosis of CA were prospectively investigated for pharyngo-laryngeal involvement. This included questionnaires on symptoms of dysphonia/dysphagia and quality of life Voice Handicap Index (VHI). In cases of dysphonia, a nasofibroscopy was performed to evaluate potential laryngeal organic lesions of amyloid infiltration and induced laryngeal dysfunction (mobility, glottic air leak). In cases of dysphagia, Video Endoscopy Swallowing Study (VESS) was performed to evaluate the presence of hypopharyngeal pooling at rest and during swallowing and the time of swallowing 80 ml of water. Results: Ninety-five CA patients were enrolled, of whom 19 were ATTRv, 36 AL and 40 ATTRwt. Their mean age was 73.8 ± 9.2 years and the sex ratio was 2.6 in favor of men. Dysphagia was reported in 17% of the patients and 40% had more specific oropharyngeal symptoms (food sticking, regurgitation, change in dietary habits), preceding the CA diagnosis by 7 (0-24) months. Recent weight loss was reported in 60% of the patients (mean loss of 10 ± 6.3 kg). VESS showed functional swallowing impairment in only 4 patients without any macroscopic organic lesion. Dysphonia was reported in 36% of the patients (44% and 47% in AL and ATTRv sub-groups, respectively) of whom 40% had functional or organic laryngeal abnormality (14% of vocal fold mobility dysfunction and 26% of abnormal mucosa) without any macroscopic-specific lesions of amyloid infiltration in these patients. Conclusions: This prospective study suggests, for the first time, that amyloid associated with CA could infiltrate the various anatomical structures of the pharyngo-larynx, responsible for functional impairment and potential nutritional depletion and poor quality of life.
Collapse
Affiliation(s)
- Sophie Bartier
- Department of Oto-rhino-laryngo Surgery, Centre Hospitalier Intercommunal de Créteil , Créteil , France.,Referral Center for Cardiac Amyloidosis, Filière Cardiogen and GRC Amyloid Research Institute , Créteil , France.,Henri Mondor Teaching Hospital, Mondor Amyloidosis Network , Créteil , France.,Department of Oto-rhino-laryngology, AP-HP, Henri Mondor Teaching Hospital , Créteil , France
| | - Diane Bodez
- Referral Center for Cardiac Amyloidosis, Filière Cardiogen and GRC Amyloid Research Institute , Créteil , France.,Henri Mondor Teaching Hospital, Mondor Amyloidosis Network , Créteil , France.,School of Medicine, University Paris-Est Creteil (UPEC) , Créteil , France.,INSERM U955 - Institut Mondor de Recherche Biomedicale , Créteil , France.,Department of Cardiology, AP-HPHenri Mondor Teaching Hospital , Créteil , France
| | - Mounira Kharoubi
- Referral Center for Cardiac Amyloidosis, Filière Cardiogen and GRC Amyloid Research Institute , Créteil , France.,Henri Mondor Teaching Hospital, Mondor Amyloidosis Network , Créteil , France.,School of Medicine, University Paris-Est Creteil (UPEC) , Créteil , France.,Department of Cardiology, AP-HPHenri Mondor Teaching Hospital , Créteil , France
| | - Florence Canouï-Poitrine
- School of Medicine, University Paris-Est Creteil (UPEC) , Créteil , France.,Department of Epidemiology and Biostatistics, AP-HPHenri Mondor Teaching Hospital , Créteil , France
| | - Véronique Chatelin
- Department of Oto-rhino-laryngology, AP-HP, Henri Mondor Teaching Hospital , Créteil , France
| | - Carole Henrion
- Referral Center for Cardiac Amyloidosis, Filière Cardiogen and GRC Amyloid Research Institute , Créteil , France.,Henri Mondor Teaching Hospital, Mondor Amyloidosis Network , Créteil , France.,School of Medicine, University Paris-Est Creteil (UPEC) , Créteil , France.,Department of Cardiology, AP-HPHenri Mondor Teaching Hospital , Créteil , France
| | - André Coste
- Department of Oto-rhino-laryngo Surgery, Centre Hospitalier Intercommunal de Créteil , Créteil , France.,Department of Oto-rhino-laryngology, AP-HP, Henri Mondor Teaching Hospital , Créteil , France.,School of Medicine, University Paris-Est Creteil (UPEC) , Créteil , France.,INSERM U955 - Institut Mondor de Recherche Biomedicale , Créteil , France.,CNRS ERL 7240 , Créteil , France
| | - Thibaud Damy
- Referral Center for Cardiac Amyloidosis, Filière Cardiogen and GRC Amyloid Research Institute , Créteil , France.,Henri Mondor Teaching Hospital, Mondor Amyloidosis Network , Créteil , France.,School of Medicine, University Paris-Est Creteil (UPEC) , Créteil , France.,Department of Cardiology, AP-HPHenri Mondor Teaching Hospital , Créteil , France
| | - Emilie Béquignon
- Department of Oto-rhino-laryngo Surgery, Centre Hospitalier Intercommunal de Créteil , Créteil , France.,Department of Oto-rhino-laryngology, AP-HP, Henri Mondor Teaching Hospital , Créteil , France.,School of Medicine, University Paris-Est Creteil (UPEC) , Créteil , France.,INSERM U955 - Institut Mondor de Recherche Biomedicale , Créteil , France.,CNRS ERL 7240 , Créteil , France
| |
Collapse
|
48
|
Miarons M, Clavé P, Wijngaard R, Ortega O, Arreola V, Nascimento W, Rofes L. Pathophysiology of Oropharyngeal Dysphagia Assessed by Videofluoroscopy in Patients with Dementia Taking Antipsychotics. J Am Med Dir Assoc 2019; 19:812.e1-812.e10. [PMID: 30149844 DOI: 10.1016/j.jamda.2018.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/19/2018] [Accepted: 04/21/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The objective of this study was to assess the pathophysiology of oropharyngeal dysphagia (OD) in patients with dementia, specifically in those taking antipsychotics (APs). DESIGN A cross-sectional study was performed from January 2011 to May 2017 in a general hospital. SETTING AND PARTICIPANTS We included 114 patients with dementia, of which 39 (34.2%) were taking APs (82.5 ± 7.8 years, Barthel Index 52.28 ± 30.42) and 29 patients without dementia (82.4 ± 6.7 years, Barthel Index 77.71 ± 24.7) and OD confirmed by a videofluoroscopy. MEASURES Demographical and clinical factors as well as swallowing function of patients with dementia with OD were compared with older patients without dementia with OD. We also compared patients with dementia taking and not taking APs. Impaired efficacy during videofluoroscopy was defined as the presence of oral and/or pharyngeal residue, and impaired safety (unsafe swallow) was defined as aspiration or penetration. Receiver operating characteristic curves were drawn for laryngeal vestibule closure (LVC) time to predict unsafe swallow. RESULTS 87.7% of patients with dementia presented impaired efficacy of swallow and 74.6% impaired safety [penetration-aspiration scale (PAS) 3.94 ± 1.94]. 86.2% of patients without dementia presented impaired efficacy and 44.8% impaired safety (PAS 2.21 ± 1.92). Time to LVC was significantly delayed in patients with dementia taking APs in comparison with patients without dementia (LVC 0.377 ± 0.093 vs 0.305 ± 0.026, P = .003). In contrast, there were no differences in the PAS and LVC time in patients with dementia taking and not taking APs (PAS 3.96 ± 0.26 vs 3.88 ± 0.22, LVC 0.398 ± 0.117 vs 0.376 ± 0.115, NS). LVC time ≥0.340 seconds predicted unsafe swallow in patients with dementia with an accuracy of 0.71. CONCLUSIONS/IMPLICATIONS Patients with dementia presented high prevalence and severity of videofluoroscopy signs of impaired efficacy and safety of swallow and a more severe impairment in airway protection mechanisms (higher PAS and LVC delay). Clinical practice should implement specific protocols to prevent OD and its complications in these patients. AP treatment did not significantly worsen swallowing impairments.
Collapse
Affiliation(s)
- Marta Miarons
- Pharmacy Department, Hospital de Mataró, Mataró, Spain.
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Viridiana Arreola
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain
| | - Weslania Nascimento
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain
| | - Laia Rofes
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
49
|
Ramos Reis D, de Carvalho RF, Farias Pontes AE, de Oliveira Bello Corrêa F, Rabelo CC. Occlusal device with extraoral retention: An occlusal technique for patients with Down syndrome. J Prosthet Dent 2019; 124:1-4. [PMID: 31757441 DOI: 10.1016/j.prosdent.2019.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 11/15/2022]
Abstract
Temporomandibular disorders associated with bruxism have a high prevalence rate in the overall population, including individuals with Down syndrome (DS). Occlusal devices have been prescribed for the treatment of temporomandibular disorders and prevention of tooth wear due to bruxism. Patients with DS have restrictions concerning treatment with occlusal devices, with an increased risk of swallowing and asphyxia, because of limitations with cognitive ability and motor deficiency. Therefore, an occlusal device with extraoral retention was developed to improve the safety for a patient with DS. An extraoral transverse rod was connected to the occlusal device to prevent it from being swallowed. The patient used the device safely for 4 weeks.
Collapse
Affiliation(s)
- Daiandara Ramos Reis
- Undergraduate research student, School of Dentistry, Federal University of Juiz de Fora (UFJF), Governador Valadares Campus, Governador Valadares, Brazil
| | - Rodrigo Furtado de Carvalho
- Adjunct Professor, Department of Prosthodontics, School of Dentistry, Federal University of Juiz de Fora (UFJF), Governador Valadares Campus, Governador Valadares, Brazil
| | - Ana Emília Farias Pontes
- Adjunct Professor, Department of Periodontics, School of Dentistry, Federal University of Juiz de Fora (UFJF), Governador Valadares Campus, Governador Valadares, Brazil
| | - Fernanda de Oliveira Bello Corrêa
- Associate Professor, Department of Periodontics, School of Dentistry, Federal University of Juiz de Fora (UFJF), Governador Valadares Campus, Governador Valadares, Brazil
| | - Cleverton Corrêa Rabelo
- Adjunct Professor, Department of Periodontics, School of Dentistry, Federal University of Juiz de Fora (UFJF), Governador Valadares Campus, Governador Valadares, Brazil.
| |
Collapse
|
50
|
Factors Contributing to the Preferred Method of Feeding in End-Stage Dementia: A Scoping Review. Dysphagia 2019; 35:616-629. [DOI: 10.1007/s00455-019-10072-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
|