1
|
Mata S, Blánquez B, Serrano F. The Oropharyngeal Dysphagia Screening Test for Patients and Professionals: Validation in Cognitive Impairment and in Severe Mental Illness. Dysphagia 2024:10.1007/s00455-024-10707-0. [PMID: 38872057 DOI: 10.1007/s00455-024-10707-0] [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: 12/19/2023] [Accepted: 04/08/2024] [Indexed: 06/15/2024]
Abstract
Dysphagia is a symptom that appears with high prevalence in persons diagnosed with dementia, intellectual disability, or severe mental illness. Risk of aspiration pneumonia or even death is very high in these populations. However, screening for dysphagia risk in these patients is complicated by the fact that most of them suffer from cognitive impairments and behavioral manifestations that hinder the assessment process using the existing screening tests. The aim of this study was to validate the Oropharyngeal Dysphagia Screening Test for Patients and Professionals, in patients with cognitive impairment (dementia/intellectual disability) or with severe mental illness (schizophrenia and other psychotic disorders, bipolar disorder, or major depressive disorder). For this purpose, 148 institutionalized patients were evaluated by professionals responsible for their food intake. The Oropharyngeal Dysphagia Screening Test for Patients and Professionals was used to assess its validity in screening for oropharyngeal dysphagia in patients with cognitive impairments and in patients with severe mental illness. Also, the Eating Assessment Tool-10 and the Swallowing Disturbance Questionnaire were used for convergent reliability procedures. Four comparison groups were established: patients with cognitive impairment with and without oropharyngeal dysphagia, and patients with severe mental illness with and without oropharyngeal dysphagia. Results from the Oropharyngeal Dysphagia Screening Test for Patients and Professionals adequately distinguished between groups with and without dysphagia, in addition to presenting adequate levels of convergent validity and reliability. These results were obtained from other-reports (professionals responsible for patients' food intake), using a simple, quickly applied test that does not require the use of food in patients with an altered cognitive state or with severe mental illness. With this study we expand the validity of the Oropharyngeal Dysphagia Screening Test for Patients and Professionals in populations with severe cognitive deficits and mental illness in which there is a great deficiency of oropharyngeal dysphagia screening instruments.
Collapse
Affiliation(s)
- Sara Mata
- The Mind, Brain and Behavior Research Center, University of Granada (CIMCYC-UGR), University of Granada, Granada, Spain
| | - Blas Blánquez
- Benito Menni Mental Health Care complex, SantBoi de Llobregat, Barcelona, Spain
| | - Francisca Serrano
- The Mind, Brain and Behavior Research Center, University of Granada (CIMCYC-UGR), University of Granada, Granada, Spain.
| |
Collapse
|
2
|
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
|
3
|
Roldan-Vasco S, Orozco-Duque A, Suarez-Escudero JC, Orozco-Arroyave JR. Machine learning based analysis of speech dimensions in functional oropharyngeal dysphagia. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 208:106248. [PMID: 34260973 DOI: 10.1016/j.cmpb.2021.106248] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE The normal swallowing process requires a complex coordination of anatomical structures driven by sensory and cranial nerves. Alterations in such coordination cause swallowing malfunctions, namely dysphagia. The dysphagia screening methods are quite subjective and experience dependent. Bearing in mind that the swallowing process and speech production share some anatomical structures and mechanisms of neurological control, this work aims to evaluate the suitability of automatic speech processing and machine learning techniques for screening of functional dysphagia. METHODS Speech recordings were collected from 46 patients with functional oropharyngeal dysphagia produced by neurological causes, and 46 healthy controls. The dimensions of speech including phonation, articulation, and prosody were considered through different speech tasks. Specific features per dimension were extracted and analyzed using statistical tests. Machine learning models were applied per dimension via nested cross-validation. Hyperparameters were selected using the AUC - ROC as optimization criterion. RESULTS The Random Forest in the articulation related speech tasks retrieved the highest performance measures (AUC=0.86±0.10, sensitivity=0.91±0.12) for individual analysis of dimensions. In addition, the combination of speech dimensions with a voting ensemble improved the results, which suggests a contribution of information from different feature sets extracted from speech signals in dysphagia conditions. CONCLUSIONS The proposed approach based on speech related models is suitable for the automatic discrimination between dysphagic and healthy individuals. These findings seem to have potential use in the screening of functional oropharyngeal dysphagia in a non-invasive and inexpensive way.
Collapse
Affiliation(s)
- Sebastian Roldan-Vasco
- Faculty of Engineering, Instituto Tecnológico Metropolitano, Medellín, Colombia; Faculty of Engineering, Universidad de Antioquia, Medellín, Colombia.
| | - Andres Orozco-Duque
- Faculty of Pure and Applied Sciences, Instituto Tecnológico Metropolitano, Medellín, Colombia
| | - Juan Camilo Suarez-Escudero
- School of Health Sciences, Faculty of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia; Faculty of Pure and Applied Sciences, Instituto Tecnológico Metropolitano, Medellín, Colombia
| | - Juan Rafael Orozco-Arroyave
- Faculty of Engineering, Universidad de Antioquia, Medellín, Colombia; Pattern Recognition Lab, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany.
| |
Collapse
|
4
|
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
|
5
|
Béseler Soto MR, Montes García J, Máñez Añón I. [Stroke spasticity: Is age a risk factor? Observational study of spasticity in neurovascular patients in a retrospective series of two health sites]. Rev Esp Geriatr Gerontol 2020; 55:258-265. [PMID: 32768255 DOI: 10.1016/j.regg.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Approximately one third of patients who have suffered a stroke develop spasticity. Since clinical observations that spasticity in the elderly population is lower after stroke, and disagreement about risk factors between different authors, an analysis is performed on the variables that influence the development of spasticity. The objective of the study is to determine the how many factors influence spasticity outcome, and the prevalence of spasticity in patients who have suffered a stroke and require intensive rehabilitation treatment. METHOD A retrospective assessment was carried out on a total of 554 patients from two neurorehabilitation centres. A record was made of sociodemographic data, aetiology, type and location of stroke, motor and sensory deficits, language and swallowing impairment, incontinence, cognitive and mood state. Spasticity levels at admission and at the third month were studied in 462 patients using the Ashworth scale. Multivariate regression analyses were used to assess the risk factors for spasticity present at the third month after stroke. RESULTS The mean age of the patients was 67.3 years, of which 67.1% were men, and with ischemic aetiology in 76.5%. On admission 31.4% of patients had spasticity, and this increased to 54.8% at the 3rd month. The absolute risk factor for spasticity was motor index (OR 1.04; 95% CI 1.03-1.05). When this factor was omitted, the variables with predictive ability were: age less than 75 years (OR 0.52; 95% CI 0.30-0.90), sensory impairment (OR 0.66; 95% CI 0.37-1.20), and lower Barthel index score (OR 1.02; 95% CI 1.01-1.03). There was no significant relationship for gender, physiopathological mechanism (ischaemic/haemorrhagic), stroke location, aphasia, or cognitive impairment. CONCLUSION The prevalence of spasticity in stroke at third month of follow-up was 54.8%. Motor index is the independent predictor of spasticity. Patients younger than 75 years old, with sensory impairment and low Barthel index score are more likely to develop spasticity.
Collapse
Affiliation(s)
- M Rosario Béseler Soto
- Servicio de Medicina Física y Rehabilitación, Hospital Universitari Dr. Peset, Valencia, España.
| | - José Montes García
- Departamento de Biometría, Effice Servicios para la Investigación S.L., Madrid, España
| | | |
Collapse
|
6
|
Impact of early nutritional support and presence of diabetes mellitus in patients with acute stroke. NUTR HOSP 2020; 37:233-237. [DOI: 10.20960/nh.02742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
7
|
Quirós S, Serrano F, Mata S. Design and Validation of the Oropharyngeal Dysphagia Screening Test for Patients and Professionals: A Preliminary Study. Dysphagia 2019; 35:52-65. [PMID: 30887116 DOI: 10.1007/s00455-019-09999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
Abstract
Dysphagia is a very common symptom in people of advanced age and with neurological diseases, although it often remains undiagnosed. At present, there are few assessment tools adapted for the Spanish-speaking population; of the few existing, most of them follow a self-reporting format, which requires a well-preserved cognitive state in the patient in order to be tested. Therefore, the main aim of this study was to design and validate an instrument for screening dysphagia without food, which could have a quick application and did not compromise the patient's safety. A secondary aim was to study the test's ability to examine this symptom in people with cognitive disorders. The study was carried out with 206 participants divided into three groups: people with dysphagia and with preserved cognitive abilities, people with dysphagia and with altered cognitive abilities, and people without dysphagia and with preserved cognitive skills (control group). Participants were assessed with the designed Oropharyngeal Dysphagia Screening Test for Patients and Professionals and other dysphagia tests. The results revealed appropriate psychometric features: reliability and validity both for screening dysphagia directly with the patients or if the tester is the professional caregiver responsible for feeding (in cases of altered cognitive abilities). As conclusion, the Oropharyngeal Dysphagia Screening Test for Patients and Professionals is an instrument of easy use and of short duration that has shown adequate results of reliability and validity, thus being useful for the screening of dysphagia in Spanish-speaking populations.
Collapse
Affiliation(s)
- Sandra Quirós
- The Mind, Brain and Behavior Research Center (CIMCYC-UGR), Faculty of Psychology, University of Granada, Campus Cartuja S/N, 18071, Granada, Spain
| | - Francisca Serrano
- The Mind, Brain and Behavior Research Center (CIMCYC-UGR), Faculty of Psychology, University of Granada, Campus Cartuja S/N, 18071, Granada, Spain.
| | - Sara Mata
- The Mind, Brain and Behavior Research Center (CIMCYC-UGR), Faculty of Psychology, University of Granada, Campus Cartuja S/N, 18071, Granada, Spain
| |
Collapse
|
8
|
Saucedo Figueredo MC, Morilla Herrera JC, San Alberto Giraldos M, López Leiva I, León Campos Á, Martí García C, García Mayor S, Kaknani Uttumchandani S, Morales Asencio JM. Validation of the Spanish version of the Edinburgh Feeding Evaluation in Dementia Scale for older people with dementia. PLoS One 2018; 13:e0192690. [PMID: 29486002 PMCID: PMC5828442 DOI: 10.1371/journal.pone.0192690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/29/2018] [Indexed: 01/30/2023] Open
Abstract
AIMS To adapt the Edinburgh Feeding Evaluation in Dementia Scale (EdFED) for use in a Spanish-speaking population and to assess its validity and reliability in patients with dementia. METHOD A cross-sectional study was carried out in two stages: 1. Cross-cultural adaptation (translation, back-translation, review by committee of experts, pilot test and weighting of results); 2. Clinimetric validation comprising interobserver reliability assessment, test-retest reliability and internal consistency. To determine construct validity, confirmatory factorial analysis and principal components analysis were performed by oblique rotations. Criteria validity was analysed using the Pearson correlation (p<0.05) with the BMI, MNA and analytical values of albumin, transferrin, cholesterol, absolute lymphocytes and total proteins. Data collection was carried out for six months in 2016 in nursing homes and Alzheimer's day centers in the province of Málaga (Spain), at nine centers, with 262 patients (aged over 60 years and presenting feeding difficulties), 20 nurses, 20 professional caregivers and 103 family caregivers. RESULTS A version of EdFED culturally adapted to Spanish was obtained. The sample presented the following characteristics: 76.3% women, mean age 82.3 years (SD: 7.9); MNA 18.73 (SD: 4.44); BMI 23.99 (SD: 4.72); serum albumin 3.79 mg/dl (SD: 0.36). A Cronbach's alpha of 0.88 was obtained, with an inter-item global correlation of 0.43 and a homogeneity index ranging from 0.42 to 0.73. The exploratory factor analysis reproduced the three-factor model identified by the original authors, explaining 62.32% of the total variance. The criterion validity showed a good inverse correlation with MNA and a moderate one with albumin, total proteins, transferrin and BMI. DISCUSSION The Spanish version of EdFED is reliable and valid for use in elderly people with dementia. The most appropriate for our environment is the three-factor model, which maintains the original factors, with a slight redistribution of the items.
Collapse
Affiliation(s)
| | - Juan Carlos Morilla Herrera
- Nursing Home Unit Málaga-Guadalhorce, Primary Health Care District, Málaga, Spain; Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | | | | | | | - Celia Martí García
- Department of Nursing, Faculty of Health Sciences University of Málaga, Málaga, Spain
| | - Silvia García Mayor
- Department of Nursing, Faculty of Health Sciences University of Málaga, Málaga, Spain
| | | | | |
Collapse
|
9
|
Nursing interventions in adult patients with oropharyngeal dysphagia: a systematic review. Eur Geriatr Med 2018; 9:5-21. [PMID: 34654278 DOI: 10.1007/s41999-017-0009-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/09/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Oropharyngeal dysphagia is a geriatric syndrome of high prevalence. It requires screening, diagnosis and specific care to avoid possible complications. The objective of this study is to perform a systematic review of the literature to know what interventions are performed by nursing professionals in the care of adult patients with OD. METHODS A systematic literature review was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration guideline. Included are observational and analytical scientific studies on the interventions nurses made in the assessment and screening of OD secondary to age and/or neurodegenerative diseases, as well as nursing interventions in patient's care and diagnosis in the electronic databases of Medline, SCOPUS and CINALH. RESULTS A total of 51 articles were included: 10 observational studies, 29 experimental studies and 12 systematic reviews. 66.7% studies talked about the interventions to patients with OD secondary to ICTUS. 82.05% was performed in a hospital setting. In 49.01% of the articles, nurses are mentioned as participants in the interventions. CONCLUSION Screening and clinical assessment of OD for an early diagnosis are the interventions performed by the most prevalent nursing professionals found in the literature, mainly in the OD, due to ICTUS and in the hospital setting. Further research on interventions by nursing professionals is needed in this area.
Collapse
|
10
|
Effects of Sensory Neuromuscular Electrical Stimulation on Swallowing in the Elderly Affected by Stroke. TOPICS IN GERIATRIC REHABILITATION 2018. [DOI: 10.1097/tgr.0000000000000176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
11
|
Baijens LW, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016. [PMID: 27785002 DOI: 10.2147/cia.s107750.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
Collapse
Affiliation(s)
- Laura Wj Baijens
- Department of Otorhinolaryngology - Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró; CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | | | - Gerald F Kolb
- Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany
| | | | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró; CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - David G Smithard
- Clinical Gerontology, Princess Royal University Hospital, King's College Hospital Foundation Trust, London, UK
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
12
|
Baijens LWJ, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016; 11:1403-1428. [PMID: 27785002 PMCID: PMC5063605 DOI: 10.2147/cia.s107750] [Citation(s) in RCA: 372] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
Collapse
Affiliation(s)
- Laura WJ Baijens
- Department of Otorhinolaryngology – Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | | | - Gerald F Kolb
- Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany
| | | | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - David G Smithard
- Clinical Gerontology, Princess Royal University Hospital, King’s College Hospital Foundation Trust, London, UK
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
13
|
Saucedo Figueredo MC, Morilla Herrera JC, Ramos Gil R, Arjona Gómez MN, García Dillana F, Martínez Blanco J, Morales Asencio JM. Validation of the Spanish version of the Edinburgh feeding evaluation in dementia scale applied to institutionalized older persons with dementia: a study protocol. Nurs Open 2016; 3:236-242. [PMID: 27708835 PMCID: PMC5050548 DOI: 10.1002/nop2.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 02/08/2016] [Indexed: 11/11/2022] Open
Abstract
Aim The aim of this study was to obtain a Spanish version of the Edinburgh Feeding Evaluation in Dementia Scale version, to assess its reliability for use by medical staff and caregivers at residential care homes, to evaluate by confirmatory methods its construct validity. A further aim was to determine the criterion validity with respect to biochemical markers of malnutrition such as serum albumin, transferrin, cholesterol and lymphocytes, the body mass index and the mini nutritional assessment. Design Clinimetric cross‐validation study. Methods Institutionalized subjects with dementia will be observed while consuming meals and evaluated with the instrument independently by nurses and caregivers.
Collapse
Affiliation(s)
| | - Juan Carlos Morilla Herrera
- Nursing Home Unit Málaga-Gualdalhorce Primary Health Care District Málaga Spain; Faculty of Health Sciences University of Málaga Málaga Spain
| | - Roberto Ramos Gil
- Nursing Home Unit Costa del Sol Primary Health Care District Málaga Spain
| | | | | | | | | |
Collapse
|
14
|
Herrera C, Quilez R, Castro ME, Canovas C. [Dysphagia in the elderly]. Rev Esp Geriatr Gerontol 2014; 49:243-4. [PMID: 24998640 DOI: 10.1016/j.regg.2014.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 02/03/2014] [Indexed: 11/25/2022]
Affiliation(s)
- C Herrera
- Servicio de Geriatría, Hospital Nuestra Señora de Gracia, Zaragoza, España.
| | - Raquel Quilez
- Servicio de Geriatría, Hospital Nuestra Señora de Gracia, Zaragoza, España
| | - Maria E Castro
- Servicio de Geriatría, Hospital Nuestra Señora de Gracia, Zaragoza, España
| | - Carmen Canovas
- Servicio de Geriatría, Hospital Nuestra Señora de Gracia, Zaragoza, España
| |
Collapse
|
15
|
José Luis Bacco R, Fanny Araya C, Esteban Flores G, Natalia Peña J. Trastornos de la alimentación y deglución en niños y jóvenes portadores de parálisis cerebral: abordaje multidisciplinario. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70044-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
16
|
Galán Sánchez-Heredero MJ, Santander Vaquero C, Cortázar Sáez M, de la Morena López F, Susi García R, Martínez Rincón MDC. [Relationship between dysphagia and malnutritition in patients over 65 years of age]. ENFERMERIA CLINICA 2014; 24:183-90. [PMID: 24560979 DOI: 10.1016/j.enfcli.2013.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/15/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
Abstract
AIMS The main objective of this study was to understand the relationship between oropharyngeal dysphagia, nutritional risk factors and functional impairment in the elderly (>65y) admitted to a medical-surgical hospital unit. Secondary objectives were to determine the prevalence of oropharyngeal dysphagia, the nutritional status and their functional capacity. METHODS A cross-sectional observational study was performed. It included patients over 65 years of age admitted to the Gastroenterology-Urology Department in La Princesa University Hospital (Madrid, Spain) during the months of February and March. The following variables were recorded: age, sex, body mass index, family support, diagnosis, comorbidity, oropharyngeal dysphagia (EAT-10 and volume-viscosity evaluation method), malnutrition (Mininutritional Assessment) and functional capacity (Barthel index). RESULTS A total of 167 patients were recruited, with 30.8% and 15.4% prevalence of dysphagia and malnutrition, respectively. Prevalence of malnutrition increased to 75% in patients with oropharyngeal dysphagia. The logistic regression analysis showed how conditions as low score on the Barthel index (OR 0.97 [95% CI, 0.95-0.99]), comorbidity (OR 7.98 [CI 95%, 3.09-20.61]) and dysphagia (OR 4.07 [CI 95%, 1.57-10.52]) were associated with a greater likelihood of suffering malnutrition. DISCUSSION Oropharyngeal dysphagia is one of the most underdiagnosed and underestimated conditions among elderly patients and one that has a greater effect on their nutritional status. Accordingly, we suggest using established diagnostic methods with a multidisciplinary team collaboration for its early detection.
Collapse
Affiliation(s)
| | | | - Milagros Cortázar Sáez
- Unidad de Aparato Digestivo y Urología, Hospital Universitario de La Princesa, Madrid, España
| | | | - Rosario Susi García
- Departamento de Estadística e Investigación Operativa III, Facultad de Estudios Estadísticos, Universidad Complutense, Madrid, España
| | | |
Collapse
|
17
|
Güell MR, Antón A, Rojas-García R, Puy C, Pradas J. Comprehensive Care of Amyotrophic Lateral Sclerosis Patients: A Care Model. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2013.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
18
|
Guidelines for the Management of Respiratory Complications in Patients With Neuromuscular Disease. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2013.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
19
|
Güell MR, Antón A, Rojas-García R, Puy C, Pradas J. Comprehensive care of amyotrophic lateral sclerosis patients: a care model. Arch Bronconeumol 2013; 49:529-33. [PMID: 23540596 DOI: 10.1016/j.arbres.2013.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/22/2013] [Accepted: 01/28/2013] [Indexed: 12/13/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that presents with muscle weakness, causing progressive difficulty in movement, communication, eating and ultimately, breathing, creating a growing dependence on family members and other carers. The ideal way to address the problems associated with the disease, and the decisions that must be taken, is through multidisciplinary teams. The key objectives of these teams are to optimise medical care, facilitate communication between team members, and thus to improve the quality of care. In our centre, we have extensive experience in the care of patients with ALS through an interdisciplinary team whose aim is to ensure proper patient care from the hospital to the home setting. In this article, we describe the components of the team, their roles and our way of working.
Collapse
Affiliation(s)
- Maria Rosa Güell
- Departamento de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | | | | | | | | | | |
Collapse
|
20
|
Farrero E, Antón A, Egea CJ, Almaraz MJ, Masa JF, Utrabo I, Calle M, Verea H, Servera E, Jara L, Barrot E, Casolivé V. Guidelines for the management of respiratory complications in patients with neuromuscular disease. Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Arch Bronconeumol 2013; 49:306-13. [PMID: 23410743 DOI: 10.1016/j.arbres.2012.12.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/05/2012] [Accepted: 12/11/2012] [Indexed: 12/13/2022]
Affiliation(s)
- Eva Farrero
- Unidad Funcional Interdisciplinaria Sociosanitaria (UFISS) Respiratoria, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Cricopharyngeal Myotomy in the Treatment of Oculopharyngeal Muscular Dystrophy. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012. [DOI: 10.1016/j.otoeng.2012.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
22
|
Cricopharyngeal myotomy in the treatment of oculopharyngeal muscular dystrophy. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 63:465-9. [PMID: 22898142 DOI: 10.1016/j.otorri.2012.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 05/30/2012] [Accepted: 06/04/2012] [Indexed: 11/22/2022]
Abstract
Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant myopathic disease which provokes oropharyngeal dysphagia, palpabral ptosis and proximal limb weakness. It is the abnormal expression of the GCG triplet in the PABPN1 gene on chromosome 14 that causes this disease. The study of the oropharyngeal dysphagia that these patients suffer from should include upper gastrointestinal endoscopy, barium video-radiology and oesophageal manometry. Genetic study confirms the diagnosis. We report 6 patients (3 of whom were siblings) referred to our department with a confirmed diagnosis of OPMD, who underwent cricopharyngeal myotomy to achieve normal swallowing.
Collapse
|
23
|
Ferrero López MI, García Gollarte JF, Botella Trelis JJ, Juan Vidal O. [Detection of dysphagia in the institutionalised elderly]. Rev Esp Geriatr Gerontol 2012; 47:143-147. [PMID: 22264749 DOI: 10.1016/j.regg.2011.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 08/31/2011] [Accepted: 09/06/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To determine the prevalence of dysphagia in a population of institutionalised elderly people, and the effectiveness of a clinical method for its detection. METHODOLOGY A prospective study was conducted on a random sample of elderly residents. A clinical evaluation along with an assessment with different volumes and viscosities (MECVV) were used. Specific care and follow up was arranged following this assessment. RESULTS Forty residents were studied. The prevalence of unrecognised dysphagia was 42.5%. Following assessment by the MECVV, the prevalence rose from 22.5% to 65% (P=.012). Dysphagia detected by MECVV was related to nutritional risk, as measured by the Mini-Nutritional Assessment (MNA) (P=.007), and to the diagnosis of dementia (P=.028). CONCLUSIONS The diagnosis of dysphagia in this sample of institutionalised elderly people increases when applying a clinical method for detection, reaching a prevalence similar to other studies.
Collapse
|
24
|
Complications of Oropharyngeal Dysphagia: Malnutrition and Aspiration Pneumonia. Dysphagia 2011. [DOI: 10.1007/174_2011_348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
25
|
Diagnosis and management of oropharyngeal Dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterol Res Pract 2010; 2011. [PMID: 20811545 PMCID: PMC2929516 DOI: 10.1155/2011/818979] [Citation(s) in RCA: 216] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 04/13/2010] [Indexed: 11/17/2022] Open
Abstract
Oropharyngeal dysphagia is a major complaint among older people. Dysphagia may cause two types of complications in these patients: (a) a decrease in the efficacy of deglutition leading to malnutrition and dehydration, (b) a decrease in deglutition safety, leading to tracheobronchial aspiration which results in aspiration pneumonia and can lead to death. Clinical screening methods should be used to identify older people with oropharyngeal dysphagia and to identify those patients who are at risk of aspiration. Videofluoroscopy (VFS) is the gold standard to study the oral and pharyngeal mechanisms of dysphagia in older patients. Up to 30% of older patients with dysphagia present aspiration-half of them without cough, and 45%, oropharyngeal residue; and 55% older patients with dysphagia are at risk of malnutrition. Treatment with dietetic changes in bolus volume and viscosity, as well as rehabilitation procedures can improve deglutition and prevent nutritional and respiratory complications in older patients. Diagnosis and management of oropharyngeal dysphagia need a multidisciplinary approach.
Collapse
|
26
|
Barroso J. [Oropharyngeal dysphagia and aspiration]. Rev Esp Geriatr Gerontol 2009; 44 Suppl 2:22-8. [PMID: 19913946 DOI: 10.1016/j.regg.2009.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 06/15/2009] [Indexed: 10/20/2022]
Abstract
Oropharyngeal dysphagia, or inability to swallow liquids and/or solids, is one of the less well known geriatric syndromes, despite its enormous impact on functional ability, quality of life and health in affected individuals. The origin of oropharyngeal dysphagia can be structural or functional. Patients with neurodegenerative or cerebrovascular diseases and the frail elderly are the most vulnerable. The complications of oropharyngeal dysphagia are malnutrition, dehydration and aspiration, all of which are serious and provoke high morbidity and mortality. Oropharyngeal aspiration causes frequent respiratory infections and aspiration pneumonias. Antibiotic therapy must cover the usual microorganisms of the oropharyngeal flora. Oropharyngeal dysphagia should be identified early in risk groups through the use of screening methods involving clinical examination of swallowing and diagnostic confirmation methods. The simplest and most effective therapeutic intervention is adaptation of the texture of the solid and the viscosity of the liquid.
Collapse
Affiliation(s)
- Julia Barroso
- Servicio de Medicina Interna, Hospital Txagorritxu, Vitoria-Gasteiz, Alava-Araba, Spain.
| |
Collapse
|
27
|
Gómez-Busto F, Andia V, Ruiz de Alegria L, Francés I. [Approach to dysphagia in advanced dementia]. Rev Esp Geriatr Gerontol 2009; 44 Suppl 2:29-36. [PMID: 19800150 DOI: 10.1016/j.regg.2008.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 06/15/2009] [Indexed: 11/19/2022]
Abstract
From the onset, dementia affects the patient's nutritional status, producing anorexia, weight loss, feeding apraxia and dysphagia. Distinct strategies are required in each of the stages of this disease, starting with awareness and knowledge of the problem and its prompt detection. In dementia, dysphagia usually appears in advanced phases, when the patient is often institutionalized. When dysphagia is suspected, the patient's tolerance must be evaluated by the volume/viscosity test, environmental and postural strategies should be introduced, and the texture of the diet should be modified. This is a complex task requiring the involvement of a properly trained interdisciplinary team, able to provide information and alternatives and integrate the family environment in the patient's care. The adapted diet should be based on the traditional diet that can also be combined with artificial supplements to provide a varied diet that increases patients', caregivers' and relatives' satisfaction. Tube feeding has shown no nutritional benefits in patients with advanced dementia. Therefore, we propose assisted oral feeding as the most natural and appropriate form of feeding in these patients, always respecting their previously expressed wishes.
Collapse
Affiliation(s)
- Fernando Gómez-Busto
- Centro integral de atención a mayores San Prudencio, Ayuntamiento de Vitoria-Gasteiz, Vitoria-Gasteiz, Spain.
| | | | | | | |
Collapse
|
28
|
Martínez-Ramos D. [Retrospective analysis of the use of the Spanish words severo and severidad in CIRUGIA ESPANOLA during 2007]. Cir Esp 2008; 84:328-32. [PMID: 19087779 DOI: 10.1016/s0009-739x(08)75044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The Spanish words severo (severe) and severidad (severity) are usually used as a synonyms of grave (serious) and gravedad (seriousness), although the Spanish Royal Academy of Language (Real Academia Española [RAE]) specifically recommends not to use them in this sense. A retrospective analysis to evaluate the use of the words severo and severidad in Cirugía Española during 2007 was performed. MATERIAL AND METHOD All the articles published in Cirugía Española during 2007 were reviewed. The articles in which severo and/or severidad were present were selected. For each article, the month of publication, the type of article, the geographic origin and the exact sentence containing these words were analyzed. Correctness and incorrectness of their use was studied according to the RAE normative. RESULTS A total of 33 articles were selected. Every month (except for January) had, at least, 2 articles. Thirty-one of the articles were from Spain whereas 2 were from Hispano-America. Eleven cases were original articles, 7 reviews, 6 case reports, 3 editorials, 3 special articles and 3 letters to the editor. CONCLUSIONS The Spanish words severo and severidad are inadequately used too often in scientific texts. It must be avoided using them as a synonym of grave, importante or serio, incorrect translations of the English word severe.
Collapse
Affiliation(s)
- David Martínez-Ramos
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General de Castellón, Castellón de la Plana, Avda. Benicàssim s/n, Castellón, Spain.
| |
Collapse
|