The association between eating difficulties and biliary sludge in the gallbladder in older adults with advanced dementia, at end of life

Chewing and Swallowing Abilities of Persons Living With Dementia: A Systematic Review of Psychometric Properties of Instruments

Background and Objectives

It is critical to use validated instruments to diagnose and manage chewing and swallowing problems of persons living with dementia. The study aimed to synthesize the characteristics and psychometric quality of instruments that assess the chewing and swallowing abilities of persons living with dementia.

Research Design and Methods

The systematic review was used to conduct this study. We searched 5 electric databases for records published from January 1, 1980, to July 8, 2022. Records were eligible if they included any instrument to assess chewing ability or swallowing ability in the dementia population. Eight characteristics of eligible instruments were extracted from the records: (1) development process, (2) operationalized concept/construct, (3) sample and setting, (4) administration method, (5) items, (6) scoring format/interpretation, (7) reliability, and (8) validity. The psychometric assessment for self-report and observational tool was used to evaluate 12 psychometric properties of eligible instruments.

Results

In total, 11,074 records were reviewed. Thirty-five eligible instruments, including observational tools, self-report questionnaires, and physiological instruments, were identified from 60 records. All 8 instruments assessing chewing ability were evaluated as having low psychometric quality, and only 3 out of 27 instruments assessing swallowing ability were evaluated as having moderate psychometric quality. Fifteen instruments were tested for only 1 type of psychometric property, limiting the overall evaluation of psychometric evidence.

Discussion and Implications

The study findings inform the use and adaptation of appropriate instruments for practice and research. All existing instruments warrant further validation in larger samples to expand use in diverse care settings. This review described and evaluated current instruments measuring chewing and swallowing abilities and potential use in research and clinical practice to plan for and evaluate the effectiveness of mealtime and oral care practice and reduce health-related negative outcomes of persons living with dementia.

Diagnostic Point-of-Care Ultrasound (POCUS) for Abdominal Pain: A Case of Tumefactive Sludge

Biliary sludge is an extremely viscous sediment, consisting essentially of calcium bilirubinate granules and cholesterol crystals, which, due to its high viscosity, has poor and slow movement, leading to a mass-like configuration called tumefactive biliary sludge. Tumefactive sludge was first described with the advent of ultrasonography in the 1970s and is an uncommon intraluminal lesion of the gallbladder (GB). The differential diagnoses for an echogenic mass in the GB lumen include GB carcinoma, tumefactive sludge, and gangrenous cholecystitis. Ultrasonography is the election method for the screening of GB diseases, with diagnostic accuracy exceeding 90%. The point-of-care ultrasound (POCUS) has shown a major improvement in the evaluation of hepatobiliary diseases. POCUS allows the detection of GB wall thickness, pericholestatic fluid, sonographic Murphy's sign, and dilatation of the common bile duct. The authors present a case of abdominal pain caused by the presence of tumefactive sludge in the GB, in which POCUS helped establish the diagnosis and therapeutic guidance.

Risk factors for gallstone disease onset in Japan: Findings from the Shizuoka Study, a population-based cohort study

In the research literature on factors associated with gallstones, large population-based cohort studies are rare. We carried out a study of this type to explore risk factors for the onset of gallstones. This study included Japanese participants aged 40-107 years who were followed prospectively from January 2012 to September 2020 using a dataset composed of two individually linked databases, one containing annual health checkup records and the other containing medical claims for beneficiaries of the National Health Insurance System and the Medical Care System for Elderly in the Latter Stage of Life in Shizuoka Prefecture, Japan. Among the 611,930 participants in the analysis set, 23,843 (3.9%) were diagnosed with gallstones during the observational period (median [max]: 5.68 [7.5] years). Multivariate analysis revealed that risk of gallstone disease was increased by male sex, cerebrovascular disease, any malignancy, dementia, rheumatic disease, chronic pulmonary disease, hypertension, and H. pylori-infected gastritis. These findings provide essential insights into the etiology of cholelithiasis and may contribute to efforts to reduce the incidence of the disease.

Comprehensive Approaches to Aspiration Pneumonia and Dysphagia in the Elderly on the Disease Time-Axis

Pneumonia in the elderly has been increasing on an annual basis. To a greater or lesser extent, aspiration is a major contributor to the development of pneumonia in the elderly. Antimicrobials alone are not sufficient for the treatment of pneumonia, and the condition may become intractable or even recur repeatedly. In addition, some patients with pneumonia may have no problems with eating, while others are unable to receive the necessary nutrition due to severe dysphagia. It has recently been found that pneumonia decreases both the muscle mass and strength of the swallowing and respiratory muscles, a condition named pneumonia-associated sarcopenia. This contributes to a pathophysiological time-axis of aspiration pneumonia and dysphagia in the elderly, in which silent aspiration leads to the development of pneumonia, and further to dysphagia, malnutrition, and low immunity. Therefore, it is recommended that the treatment and prevention of developing pneumonia should also differ according to an individual’s placement in the disease time-axis. In particular, approaches for preventing aspiration based on scientific findings are able to be implemented at home.

Medical aromatherapy in geriatric syndrome

Geriatric syndromes are symptoms and signs, such as falls, incontinence, delirium, pressure ulcers, dysphagia and so on, that often threaten the independence of older adults, rather than the disease itself. Although the syndromes are very common in older people, it is difficult to treat those by modern medicine due to their complexity. To mitigate the intractable geriatric symptoms, we review the efficacy of aromatherapy, especially for dysphagia, dyspnea, cognitive dysfunction and falls in geriatric syndrome. Olfactory stimulation using a volatile black pepper oil on institutional residents improved the swallowing reflex, which is a crucial risk factor of aspiration pneumonia. Brain imaging study showed that olfactory stimulation using volatile black pepper oil activated cerebral regions of the anterior cingulate and the insular cortex, which play a role in controlling appetite and swallowing. Also, aromatherapy with volatile l-menthol decreased the sense of dyspnea and improved the efficacy of exercise therapy. The fragrance of the combination of rosemary and lemon oils in the morning, and the combination of lavender and orange oils in the night-time were reported to improve cognition and behavioural and psychological symptoms of dementia, respectively. Also, the combination of lavender and lemon balm oils was reported to be effective for irritability-related agitation in older adults. Furthermore, aromatherapy with lavender fragrance could improve both static and dynamic balance, resulting in a reduction in the number of fallers and the incidence rate in older people. Thus, aromatherapy is a promising remedy for geriatric syndrome. Geriatr Gerontol Int 2021; 21: 377-385.