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Burdick R, Bayne D, Hitchcock M, Gilmore-Bykovskyi A, Shune S, Rogus-Pulia N. The Impact of Modifiable Preoral Factors on Swallowing and Nutritional Outcomes in Healthy Adults: A Scoping Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4860-4895. [PMID: 37931134 DOI: 10.1044/2023_jslhr-23-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PURPOSE Swallowing has previously been characterized as consisting of four phases; however, it has become apparent that these four phases are not truly discrete and may be influenced by factors occurring prior to bolus entrance into the oral cavity (i.e., preoral factors). Still, the relationship between these factors and swallowing remains poorly understood. The aim of this review was to synthesize and characterize the literature pertaining to the influence of preoral factors on swallowing and nutritional outcomes in healthy individuals. METHOD We performed a scoping review, searching the databases of PubMed, CINAHL, Cochrane, and Scopus. Search terms included those related to swallowing, experience of preoral factors, and exclusionary terminology to reduce animal and pediatric literature. Our initial search revealed 5,560 unique articles, of which 153 met our inclusionary criteria and were accepted into the review. RESULTS Of the accepted articles, 78% were focused exclusively on nutritional outcomes, 17% were focused on both swallowing and nutritional outcomes, and 5% were focused on solely swallowing outcomes. Of the preoral factors examined, 99% were exteroceptive in nature (17% olfactory, 44% visual, 21% auditory, 7% tactile, 11% other), while 1% were proprioceptive in nature. CONCLUSIONS This review supports the influence of preoral factors on swallowing and nutritional outcomes. However, there is a large emphasis on the visual modality and on nutritional outcomes. Nearly none of the literature found in this review directly measured swallowing safety, efficiency, or physiology. Future work will benefit from a larger focus on proprioceptive preoral factors as they relate to swallowing outcomes.
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Affiliation(s)
- Ryan Burdick
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
- Geriatric Research Education and Clinical Center, William S. Middleton Veterans' Hospital, Madison, WI
| | - David Bayne
- Communication Disorders and Sciences Program, University of Oregon, Eugene
| | | | - Andrea Gilmore-Bykovskyi
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Samantha Shune
- Communication Disorders and Sciences Program, University of Oregon, Eugene
| | - Nicole Rogus-Pulia
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
- Geriatric Research Education and Clinical Center, William S. Middleton Veterans' Hospital, Madison, WI
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Frith J. New horizons in the diagnosis and management of dehydration. Age Ageing 2023; 52:afad193. [PMID: 37847795 PMCID: PMC10581537 DOI: 10.1093/ageing/afad193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Indexed: 10/19/2023] Open
Abstract
Hydration is a fundamental aspect of clinical practice and yet it is an under-researched topic, particularly in older people, leading to many areas of uncertainty. There are two types of dehydration; hypertonic, which is a water deficit, and isotonic, which is a deficit of both water and salt. Individual clinical signs and bedside tests are poor diagnostic tools, making dehydration difficult to identify. However, the diagnostic value of a holistic clinical approach is not known. The gold-standard clinical test for dehydration is serum osmolality, but this cannot diagnose isotonic dehydration and may delay diagnosis in acute situations. Salivary osmolality point-of-care testing is a promising and rapid new diagnostic test capable of detecting both hypertonic and isotonic dehydration in older people, but further evidence to support its clinical utility is needed. Daily fluid requirements may be less than previously thought in adults, but the evidence specific to older people remains limited. Hydration via the subcutaneous route is safer and easier to initiate than the intravenous route but is limited by infusion speed and volume. Prompting older adults more frequently to drink, offering a wider selection of drinks and using drinking vessels with particular features can result in small increases in oral intake in the short-term. The ongoing clinically-assisted hydration at end of life (CHELsea II) trial will hopefully provide more evidence for the emotive issue of hydration at the end of life.
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Affiliation(s)
- James Frith
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Shune S, Barewal R. Redefining the value of snacks for nursing home residents: Bridging psychosocial and nutritional needs. Geriatr Nurs 2022; 44:39-47. [DOI: 10.1016/j.gerinurse.2021.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 01/11/2023]
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Keller H, Wei C, Slaughter S, Yoon MN, Lengyel C, Namasivayam-Macdonald A, Martin L, Heckman G, Gaspar P, Mentes J, Syed S. Qualitative analysis of a virtual research meeting summarises expert-based strategies to promote hydration in residential care during COVID-19 and beyond. BMJ Open 2022; 12:e055457. [PMID: 35135772 PMCID: PMC8829846 DOI: 10.1136/bmjopen-2021-055457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Poor fluid intake is a complex and long-standing issue in residential care, further exacerbated by COVID-19 infection control procedures. There is no consensus on how best to prevent dehydration in residents who vary in their primary reasons for insufficient fluid intake for a variety of reasons. The objectives of this research were to determine expert and provider perspectives on: (1) how COVID-19 procedures impacted hydration in residential care and potential solutions to mitigate these challenges and (2) strategies that could target five types of residents based on an oral hydration typology focused on root causes of low fluid intake. DESIGN Qualitative study based on virtual group discussion. The discussion was audiorecorded with supplementary field notes. Qualitative content analysis was completed. SETTING Residential care. PARTICIPANTS 27 invited researcher and provider experts. RESULTS Challenges that have potentially impacted hydration of residents because of COVID-19 procedures were categorised as resident (eg, apathy), staff (eg, new staff) and home-related (eg, physical distancing in dining rooms). Potential solutions were offered, such as fun opportunities (eg, popsicle) for distanced interactions; training new staff on how to approach specific residents and encourage drinking; and automatically providing water at meals. Several strategies were mapped to the typology of five types of residents with low intake (eg, sipper) and categorised as: supplies (eg, vessels with graduated markings), timing (eg, identify best time of day for drinking), facility context (eg, identify preferred beverages), socialisation (eg, promote drinking as a social activity) and education (eg, educate cognitively well on water consumption goals). CONCLUSIONS COVID-19 has necessitated new procedures and routines in residential care, some of which can be optimised to promote hydration. A variety of strategies to meet the hydration needs of different subgroups of residents can be compiled into multicomponent interventions for future research.
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Affiliation(s)
- Heather Keller
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Cindy Wei
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan Slaughter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Minn N Yoon
- School of Dentistry, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Christina Lengyel
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Laurel Martin
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - George Heckman
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Janet Mentes
- School of Nursing, University of California Los Angeles, Los Angeles, California, USA
| | - Safura Syed
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Keller H, Wei C, Namasivayam-MacDonald A, Syed S, Lengyel C, Yoon MN, Slaughter SE, Gaspar PM, Heckman GA, Mentes J. Feasibility and Acceptability Testing of Evidence-Based Hydration Strategies for Residential Care. Res Gerontol Nurs 2022; 15:27-38. [PMID: 35044865 DOI: 10.3928/19404921-20211209-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study examined stakeholder perspectives on the perceived effectiveness, feasibility, and acceptability of 20 evidence-based strategies appropriate for residential care via an online survey (N = 162). Most participants worked in long-term care (83%), were direct care providers (62%), worked in food/nutrition roles (55%), and identified as female (94%). Strategies that were rated as effective, feasible, and likely to be used in the future were social drinking events, increased drink options at meals, and pre-thickened drinks. Participants also listed their top strategies for inclusion in a multicomponent intervention. Responses to open-ended questions provided insight on implementation, compliance, and budget constraints. Participant perspectives provide insight into developing a multicomponent intervention. Strategies prioritized for such an intervention include: staff education, social drinking opportunities, drinks trolley, volunteer support, improved beverage availability, hydration reminders, offering preferred beverages, and prompting residents to drink using various cues. [Research in Gerontological Nursing, 15(1), 27-38.].
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Burdick R, Lin TF, Shune SE. Visual Modeling: A Socialization-Based Intervention to Improve Nutritional Intake Among Nursing Home Residents. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2202-2213. [PMID: 34463561 DOI: 10.1044/2021_ajslp-21-00097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Malnutrition is a widespread, dangerous, and costly condition among institutionalized older adults and can be both a contributor to and consequence of dysphagia for individuals with cognitive impairment. However, interventions to maximize intake in individuals with dementia are limited and frequently problematic, with negative implications for independence and quality of life. The goal of this study was to examine a novel, socialization-grounded intervention based on visual modeling, utilizing the theoretical underpinnings of motor resonance and mimicry. Method To examine the impact of environment on intake, data were collected from four nursing home residents (M age = 83.5 years, SD = 4.2; three women) with dementia. Weight of food and liquid intake was measured across 15 meals and three different mealtime conditions: the "baseline condition" in which the individual ate alone, the "watch condition" in which the individual ate in the company of a "mealtime buddy," and the "eat" condition in which the individual consumed a meal while the "mealtime buddy" did the same. Results Data visualization supported a weak functional relation between eating environment and amount of intake consumed across participants. Log response ratio estimates suggested a trend for increased weight of food consumed during the eat condition as compared to baseline and the eat condition as compared to the watch condition for some participants. Conclusions These results preliminarily support the benefit of a visual model for increased consumption in some individuals with dementia. The presence and magnitude of the effect across conditions varied based on individual-level factors, such as cognitive status, which has implications for implementation. Overall, this study provides initial proof of concept regarding the use of visual modeling as an intervention approach, laying the foundation for larger scale future studies.
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Affiliation(s)
- Ryan Burdick
- Genesis Rehab Services, Kennett Square, PA
- Swallowing and Salivary Bioscience Lab, Department of Medicine, University of Wisconsin-Madison
| | - Ting-fen Lin
- Communication Disorders and Sciences, University of Oregon,Eugene
- Department of Communicative Sciences and Deaf Studies, California State University, Fresno
| | - Samantha E Shune
- Communication Disorders and Sciences, University of Oregon,Eugene
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