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Volkert D, Beck AM, Faxén-Irving G, Frühwald T, Hooper L, Keller H, Porter J, Rothenberg E, Suominen M, Wirth R, Chourdakis M. ESPEN guideline on nutrition and hydration in dementia - Update 2024. Clin Nutr 2024; 43:1599-1626. [PMID: 38772068 DOI: 10.1016/j.clnu.2024.04.039] [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: 04/02/2024] [Revised: 04/16/2024] [Accepted: 04/30/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND & AIMS Dementia is accompanied by a variety of changes that result in an increased risk of malnutrition and low-intake dehydration. This guideline update aims to give evidence-based recommendations for nutritional care of persons with dementia in order to prevent and treat these syndromes. METHODS The previous guideline version was reviewed and expanded in accordance with the standard operating procedure for ESPEN guidelines. Based on a systematic search in three databases, strength of evidence of appropriate literature was graded by use of the SIGN system. The original recommendations were reviewed and reformulated, and new recommendations were added, which all then underwent a consensus process. RESULTS 40 recommendations for nutritional care of older persons with dementia were developed and agreed, seven at institutional level and 33 at individual level. As a prerequisite for good nutritional care, organizations caring for persons with dementia are recommended to employ sufficient qualified staff and offer attractive food and drinks with choice in a functional and appealing environment. Nutritional care should be based on a written care concept with standardized operating procedures. At the individual level, routine screening for malnutrition and dehydration, nutritional assessment and close monitoring are unquestionable. Oral nutrition may be supported by eliminating potential causes of malnutrition and dehydration, and adequate social and nursing support (including assistance, utensils, training and oral care). Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Routine use of dementia-specific ONS, ketogenic diet, omega-3 fatty acid supplementation and appetite stimulating agents is not recommended. Enteral and parenteral nutrition and hydration are temporary options in patients with mild or moderate dementia, but not in severe dementia or in the terminal phase of life. In all stages of the disease, supporting food and drink intake and maintaining or improving nutrition and hydration status requires an individualized, comprehensive approach. Due to a lack of appropriate studies, most recommendations are good practice points. CONCLUSION Nutritional care should be an integral part of dementia management. Numerous interventions are available that should be implemented in daily practice. Future high-quality studies are needed to clarify the evidence.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Gerd Faxén-Irving
- Division of Clinical Geriatrics, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frühwald
- Department of Geriatric Acute Care, Hietzing Municipal Hospital, Vienna, Austria
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Heather Keller
- Department of Kinesiology & Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - Judi Porter
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Elisabet Rothenberg
- Department of Nursing and Integrated Health Sciences, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Merja Suominen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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Cheng H, Song S, Tang Y, Yuan S, Huang X, Ling Y, Wang Z, Tian X, Lyu J. Does ICU admission dysphagia independently contribute to delirium risk in ischemic stroke patients? Results from a cohort study. BMC Psychiatry 2024; 24:65. [PMID: 38263028 PMCID: PMC10804594 DOI: 10.1186/s12888-024-05520-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Delirium is prevalent in ischemic stroke patients, particularly those in the intensive care unit (ICU), and it poses a significant burden on patients and caregivers, leading to increased mortality rates, prolonged hospital stays, and impaired cognitive function. Dysphagia, a common symptom in critically ill patients with ischemic stroke, further complicates their condition. However, the association between dysphagia and delirium in this context remains unclear. The objective of this study was to investigate the correlation between dysphagia and delirium in ICU patients with ischemic stroke. METHODS A retrospective analysis was conducted on adult patients diagnosed with ischemic stroke at a medical center in Boston. Ischemic stroke cases were identified using the ninth and tenth revisions of the International Classification of Diseases. Dysphagia was defined as a positive bedside swallowing screen performed by medical staff on the day of ICU admission, while delirium was assessed using the ICU Confusion Assessment Method and review of nursing notes. Logistic regression models were used to explore the association between dysphagia and delirium. Causal mediation analysis was employed to identify potential mediating variables. RESULTS The study comprised 1838 participants, with a median age of approximately 70 years, and 50.5% were female. Among the total study population, the prevalence of delirium was 43.4%, with a higher prevalence observed in the dysphagia group (60.7% vs. 40.8%, p < 0.001) compared to the non-dysphagia group. After adjusting for confounding factors including age, sex, race, dementia, depression, sedative medications, history of falls, visual or hearing deficit, sequential organ failure score, and Glasgow coma score, multifactorial logistic regression analysis demonstrated a significant association between dysphagia and an increased likelihood of delirium (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.07-2.05; p = 0.018; E-value = 1.73). Causal mediation analysis revealed that serum albumin levels partially mediated the association between dysphagia and delirium in critically ill patients with ischemic stroke (average causal mediated effect [ACME]: 0.02, 95% CI: 0.01 to 0.03; p < 0.001). CONCLUSION ICU admission dysphagia may independently contribute to the risk of delirium in patients with ischemic stroke. Early identification and intervention in ischemic stroke patients with dysphagia may help mitigate the risk of delirium and improve patient prognosis.
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Affiliation(s)
- Hongtao Cheng
- School of Nursing, Jinan University, Guangzhou, China
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Simeng Song
- School of Nursing, Jinan University, Guangzhou, China
| | - Yonglan Tang
- School of Nursing, Jinan University, Guangzhou, China
| | - Shiqi Yuan
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaxuan Huang
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yitong Ling
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zichen Wang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaoying Tian
- School of Nursing, Jinan University, Guangzhou, China.
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China.
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Zhong L, Lewis JR, Sim M, Bondonno CP, Wahlqvist ML, Mugera A, Purchase S, Siddique KHM, Considine MJ, Johnson SK, Devine A, Hodgson JM. Three-dimensional food printing: its readiness for a food and nutrition insecure world. Proc Nutr Soc 2023; 82:468-477. [PMID: 37288524 DOI: 10.1017/s0029665123003002] [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] [Indexed: 06/09/2023]
Abstract
Three-dimensional (3D) food printing is a rapidly emerging technology offering unprecedented potential for customised food design and personalised nutrition. Here, we evaluate the technological advances in extrusion-based 3D food printing and its possibilities to promote healthy and sustainable eating. We consider the challenges in implementing the technology in real-world applications. We propose viable applications for 3D food printing in health care, health promotion and food waste upcycling. Finally, we outline future work on 3D food printing in food safety, acceptability and economics, ethics and regulations.
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Affiliation(s)
- Liezhou Zhong
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Joshua R Lewis
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Discipline of Internal Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
- Royal Perth Hospital Research Foundation, Perth, WA, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Marc Sim
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Discipline of Internal Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
- Royal Perth Hospital Research Foundation, Perth, WA, Australia
| | - Catherine P Bondonno
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Discipline of Internal Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
- Royal Perth Hospital Research Foundation, Perth, WA, Australia
| | - Mark L Wahlqvist
- Monash Asia Institute, Monash University, Melbourne, VIC, Australia
- School of Public Health, National Defence Medical Centre, Taipei, Taiwan, Republic of China
| | - Amin Mugera
- The UWA Institute of Agriculture, The University of Western Australia, Perth, WA 6001, Australia
| | - Sharon Purchase
- Business School, University of Western Australia, Crawley, WA, Australia
| | - Kadambot H M Siddique
- The UWA Institute of Agriculture, The University of Western Australia, Perth, WA 6001, Australia
| | - Michael J Considine
- The UWA Institute of Agriculture, The University of Western Australia, Perth, WA 6001, Australia
- School of Molecular Sciences, University of Western Australia, Perth, WA, Australia
- Department of Primary Industries and Regional Development, Perth, WA, Australia
| | | | - Amanda Devine
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Jonathan M Hodgson
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Discipline of Internal Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
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Moreno-Fergusson ME, Caez-Ramírez GR, Sotelo-Díaz LI, Sánchez-Herrera B. Nutritional Care for Institutionalized Persons with Dementia: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6763. [PMID: 37754622 PMCID: PMC10531301 DOI: 10.3390/ijerph20186763] [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: 04/13/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Older people are at risk of malnutrition, especially when they suffer from cognitive impairment. Guidelines that orient nursing care in this regard need to be updated. The aim of this review is to address the best available evidence on interventions that can benefit nutritional nursing care for institutionalized older adults with dementia. METHODS Integrative review using the Dimensions and Eureka search engines, and the PubMed, Embase, Scielo, CINAHL, and ScienceDirect databases. We searched from the year 2015 through to 2021. We employed the MMAT guidelines for mixed, qualitative, and quantitative studies, and the PRISMA, CASP, and JBI guidelines to value the reviews. RESULTS A total of 55 studies met the inclusion criteria. The best available evidence to support nutritional nursing care for institutionalized older adults with dementia highlights several aspects related to the assessment and caring interventions that are focused on people with dementia, their caregivers, and their context. CONCLUSIONS Both the assessment and nutritional care interventions for older people with dementia should consider the patient-caregiver dyad as the subject of care and understand the context as a fundamental part of it. The analysis of the context should look further than the immediate environment.
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Affiliation(s)
| | | | - Luz Indira Sotelo-Díaz
- EICEA Department of Gastronomy, Campus Puente del Común, Universidad de La Sabana, Chía 250001, Colombia;
| | - Beatriz Sánchez-Herrera
- Nursing and Rehabilitation School, Campus Puente del Común, Universidad de La Sabana, Chía 250001, Colombia;
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Cheng H, Deng X, Li J, Tang Y, Yuan S, Huang X, Wang Z, Zhou F, Lyu J. Associations Between Dysphagia and Adverse Health Outcomes in Older Adults with Dementia in Intensive Care Units: A Retrospective Cohort Study. Clin Interv Aging 2023; 18:1233-1248. [PMID: 37554511 PMCID: PMC10405813 DOI: 10.2147/cia.s409828] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/17/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Dysphagia is common in elderly patients with dementia and is one of the common clinical geriatric syndromes. It imposes a heavy burden on patients and their caregivers and is becoming an important public health problem. This study examined the association between dysphagia in older dementia patients in the ICU and the subsequent adverse health outcomes they experience. PATIENTS AND METHODS A retrospective analysis of adults (≥65 years) with dementia in ICUs of a Boston tertiary academic medical center was conducted. Using the International Classification of Diseases' Ninth and Tenth Revisions, dementia patients were identified. The study cohort comprised 1009 patients, median age 84.82 years, 56.6% female, predominantly White (72.9%). Patients were grouped based on swallowing function: dysphagia (n=282) and no-dysphagia (n=727). Dysphagia was identified via positive bedside swallowing screening. Primary outcomes were 90- and 180-day mortality, secondary outcomes included aspiration pneumonia, pressure injury, and delirium. Cohort characteristics were compared using the Wilcoxon rank-sum and chi-square tests. Dysphagia and outcomes correlations were examined via Kaplan-Meier survival analysis, Cox proportional-hazards regression models, logistic regression models, and subgroup analysis. RESULTS After adjusting for covariates, the results from multivariate Cox proportional-hazards regression indicated that dysphagia was significantly associated with increased 90-day (HR=1.36, 95% CI=1.07-1.73, E-value=1.78) and 180-day (HR=1.47, 95% CI=1.18-1.82, E-value=1.94) mortality; the multifactorial logistic regression results indicated that dysphagia was associated with significant increases in pressure injury (OR=1.58, 95% CI=1.11-2.23, E-value=1.83) and aspiration pneumonia occurrence (OR=4.04, 95% CI=2.72-6.01, E-value=7.54), but was not significantly associated with delirium prevalence (OR=1.27, 95% CI=0.93-1.74). CONCLUSION Dysphagia is likely to increase the risk of adverse health outcomes in older adults with dementia in ICU, and these adverse outcomes mostly include 90- and 180-day mortality, aspiration pneumonia, and pressure injury.
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Affiliation(s)
- Hongtao Cheng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Xingwen Deng
- Department of Medical Information, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Jieyao Li
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Yonglan Tang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Shiqi Yuan
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Xiaxuan Huang
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Zichen Wang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, People’s Republic of China
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6
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Imaizumi M, Murono S. Will levels of experience of examiners affect the diet provided for patients with swallowing impairment? Auris Nasus Larynx 2023:S0385-8146(23)00034-2. [PMID: 36828744 DOI: 10.1016/j.anl.2023.02.001] [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: 11/10/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE Flexible endoscopic evaluation of swallowing (FEES) is widely performed to determine the safety of oral intake. However, evaluation results can vary among examiners depending on their experience. To analyze the impact of such differences, we investigated the diet provided for patients with swallowing impairment evaluated by experienced and inexperienced examiners. METHODS We included 20 subjects with swallowing impairment. They underwent FEES twice, once by an experienced examiner (EE) and once by an inexperienced examiner (IE), in random order. The second FEES was generally performed within one month of the first FEES. The diet provided by the EE (EE results) and by the IE (IE results) during and after FEES was investigated and statistically compared. Respiratory and oral intake conditions at each time of FEES were also investigated and the results were included in the corresponding EE or IE results. RESULTS The median interval between FEES was 13.5 days. There was no significant difference between the EE and IE results regarding swallowing impairment-related conditions, such as amount of sputum suctioned, oral intake status, or prevalence of fever after FEES. However, there was a significant difference in the texture-modified diet provided after FEES: A close-to-normal diet was provided by the EE compared to the diet provided by the IE. CONCLUSION This study demonstrated a difference in the provided diet for patients with swallowing impairment between the examiners with different levels of experience. Our results suggest that EEs may be able to safely recommend patients with swallowing impairment have a close-to-normal diet.
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Affiliation(s)
- Mitsuyoshi Imaizumi
- Department of Otolaryngology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| | - Shigeyuki Murono
- Department of Otolaryngology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
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O’Keeffe ST, Leslie P, Lazenby-Paterson T, McCurtin A, Collins L, Murray A, Smith A, Mulkerrin S. Informed or misinformed consent and use of modified texture diets in dysphagia. BMC Med Ethics 2023; 24:7. [PMID: 36750907 PMCID: PMC9903443 DOI: 10.1186/s12910-023-00885-1] [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: 03/22/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Use of modified texture diets-thickening of liquids and modifying the texture of foods-in the hope of preventing aspiration, pneumonia and choking, has become central to the current management of dysphagia. The effectiveness of this intervention has been questioned. We examine requirements for a valid informed consent process for this approach and whether the need for informed consent for this treatment is always understood or applied by practitioners. MAIN TEXT Valid informed consent requires provision of accurate and balanced information, and that agreement is given freely by someone who knows they have a choice. Current evidence, including surveys of practitioners and patients in different settings, suggests that practice in this area is often inadequate. This may be due to patients' communication difficulties but also poor communication-and no real attempt to obtain consent-by practitioners before people are 'put on' modified texture diets. Even where discussion occurs, recommendations may be influenced by professional misconceptions about the efficacy of this treatment, which in turn may poison the well for the informed consent process. Patients cannot make appropriate decisions for themselves if the information provided is flawed and unbalanced. The voluntariness of patients' decisions is also questionable if they are told 'you must', when 'you might consider' is more appropriate. Where the decision-making capacity of patients is in question, inappropriate judgements and recommendations may be made by substitute decision makers and courts unless based on accurate information. CONCLUSION Research is required to examine the informed consent processes in different settings, but there is ample reason to suggest that current practice in this area is suboptimal. Staff need to reflect on their current practice regarding use of modified texture diets with an awareness of the current evidence and through the 'lens' of informed consent. Education is required for staff to clarify the importance of, and requirements for, valid informed consent and for decision making that reflects people's preferences and values.
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Affiliation(s)
- Shaun T. O’Keeffe
- grid.412440.70000 0004 0617 9371Department of Geriatric Medicine, Galway University Hospitals, Newcastle Rd, Galway, Ireland
| | - Paula Leslie
- grid.420004.20000 0004 0444 2244Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Tracy Lazenby-Paterson
- grid.39489.3f0000 0001 0388 0742NHS Lothian Community Learning Disability Service, Leith Community Treatment Centre, Edinburgh, UK
| | - Arlene McCurtin
- grid.10049.3c0000 0004 1936 9692School of Allied Health, University of Limerick, Limerick, Ireland ,grid.10049.3c0000 0004 1936 9692Health Implementation Science and Technology Research Group, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Lindsey Collins
- grid.6268.a0000 0004 0379 5283Centre for Applied Dementia StudiesFaculty of Health Studies, University of Bradford, Bradford, UK
| | - Aoife Murray
- grid.6142.10000 0004 0488 0789School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Alison Smith
- Pharmacy and Medicines Optimisation Team, Herts Valleys Clinical Commissioning Group, Hemel Hempstead, UK
| | - Siofra Mulkerrin
- grid.120073.70000 0004 0622 5016Department of Speech and Language Therapy, Addenbrooke’s Hospital, Cambridge, England, UK
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Dell'Aquila G, Peladic NJ, Nunziata V, Fedecostante M, Salvi F, Carrieri B, Liperoti R, Carfì A, Eusebi P, Onder G, Orlandoni P, Cherubini A. Prevalence and management of dysphagia in nursing home residents in Europe and Israel: the SHELTER Project. BMC Geriatr 2022; 22:719. [PMID: 36042405 PMCID: PMC9429699 DOI: 10.1186/s12877-022-03402-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022] Open
Abstract
Background Dysphagia is a frequent condition in older nursing home residents (NHRs) which may cause malnutrition and death. Nevertheless, its prevalence is still underestimated and there is still debate about the appropriateness and efficacy of artificial nutrition (AN) in subjects with severe dysphagia. The aim is to assess the prevalence of dysphagia in European and Israeli NHRs, its association with mortality, and the relationship of different nutritional interventions, i.e. texture modified diets and AN—with weight loss and mortality. Methods A prospective observational study of 3451 European and Israeli NHRs older than 65 years, participating in the SHELTER study from 2009 to 2011, at baseline and after 12 months. All residents underwent a standardized comprehensive evaluation using the interRAI Long Term Care Facility (LTCF). Cognitive status was assessed using the Cognitive Performance Scale (CPS), functional status using Activities of Daily Living (ADL) Hierarchy scale. Trained staff assessed dysphagia at baseline by clinical observation. Data on weight loss were collected for all participants at baseline and after 12 months. Deaths were registered by NH staff. Results The prevalence of dysphagia was 30.3%. During the one-year follow-up, the mortality rate in subjects with dysphagia was significantly higher compared with that of non-dysphagic subjects (31.3% vs 17.0%,p = 0,001). The multivariate analysis showed that NHRs with dysphagia had 58.0% higher risk of death within 1 year compared with non-dysphagic subjects (OR 1.58, 95% CI, 1.31–1.91). The majority of NHRs with dysphagia were prescribed texture modified diets (90.6%), while AN was used in less than 10% of subjects. No statistically significant difference was found concerning weight loss and mortality after 12 months following the two different nutritional treatments. Conclusions Dysphagia is prevalent among NHRs and it is associated with increased mortality, independent of the nutritional intervention used. Noticeably, after 12 months of nutritional intervention, NHRs treated with AN had similar mortality and weight loss compared to those who were treated with texture modified diets, despite the clinical conditions of patients on AN were more compromised.
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Affiliation(s)
- Giuseppina Dell'Aquila
- Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
| | - Nikolina Jukic Peladic
- Clinical Nutrition Unit, IRCCS INRCA Ancona, Via della Montagnola 81, 60127, Ancona, Italy
| | - Vanessa Nunziata
- Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy. .,Geriatrics and Geriatric Emergency Care, Italian National Research Center On Aging (IRCCS-INRCA), Via della Montagnola, 81, 60127, Ancona, Italy.
| | - Massimiliano Fedecostante
- Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
| | - Fabio Salvi
- Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy. .,Geriatrics and Geriatric Emergency Care, Italian National Research Center On Aging (IRCCS-INRCA), Via della Montagnola, 81, 60127, Ancona, Italy.
| | - Barbara Carrieri
- Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Carfì
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Eusebi
- Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore Di Sanità, Via Giano della Bella 34, 00161, Rome, Italy
| | - Paolo Orlandoni
- Clinical Nutrition Unit, IRCCS INRCA Ancona, Via della Montagnola 81, 60127, Ancona, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy
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9
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Taira K, Watanabe Y, Okada K, Kondo M, Takeda M, Ito K, Nakajima J, Iwasaki M, Itoda M, Inohara K, Sasaki R, Nishi Y, Furuya J, Watanabe Y, Umemoto G, Kishima M, Tohara T, Sato Y, Yoshida M, Yamazaki Y. Association between denture use and food form in older adults requiring long-term care: A multicenter cross-sectional study. J Prosthodont Res 2022. [PMID: 35989265 DOI: 10.2186/jpr.jpr_d_21_00161] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE This study aimed to determine whether denture use contributes to maintaining and improving food forms in long-term care facility (LTCFs) residents. METHODS In 888 residents of 37 LTCFs in Japan, the following were investigated: nutritional intake status, food forms, age, sex, Barthel index (BI), clinical dementia rating (CDR), number of teeth present, number of occlusal supports, swallowing function, and use of dentures. Among all residents, those who were well-nourished and had ≤9 occlusal supports were analyzed. Based on standardized criteria, the food forms consumed by the subjects were divided into two groups: dysphagia and normal diet, which were further classified into four levels. Analysis was performed using a generalized estimation equation with the four levels of food forms as dependent variables and age, sex, BI, CDR, presence of dysphagia, number of teeth present, and use of dentures as independent variables. RESULTS The final analysis included 622 (70.0%) residents. Of these, 380 (61.1%) used dentures. The analyses revealed that food form was significantly associated with age (adjusted odds ratio [OR], 0.98), BI (OR, 1.04), number of teeth present (OR, 1.03), presence of dysphagia (OR, 0.44), and use of dentures (OR, 2.82). CONCLUSION Denture use was associated with food forms among Japanese LTCF residents. This indicates that the use of dentures is related to the maintenance of food forms, even in the elderly who participate in few activities of daily living, have reduced cognitive function, and require long-term care.
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Affiliation(s)
- Kenshu Taira
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Yutaka Watanabe
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Kazutaka Okada
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Miyako Kondo
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Maaya Takeda
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Kayoko Ito
- Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Junko Nakajima
- Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, Chiba, Japan
| | | | - Masataka Itoda
- Department of Oral Rehabilitation Osaka Dental University Hospital, Osaka, Japan
| | - Ken Inohara
- Inohara Dental and Rehabilitation Clinic, Hiroshima, Japan.,Ota Memorial Hospital, Hiroshima, Japan
| | - Rikimaru Sasaki
- Rehabilitation Clinic for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tokyo, Japan
| | - Yasuhiro Nishi
- Department of Oral and Maxillofacial Prosthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Junichi Furuya
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo, Japan
| | | | - George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan
| | | | - Takashi Tohara
- The Nippon Dental University Tama Oral Rehabilitation Clinic, Tokyo, Japan
| | - Yuji Sato
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo, Japan
| | - Mitsuyohi Yoshida
- Department of Dentistry & Oral-Maxillofacial Surgery Fujita Health University, Aichi, Japan
| | - Yutaka Yamazaki
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
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10
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Villar F, Chacur K, Serrat R, Celdrán M. Resistance to Eating in People with Dementia Living in Long-term Care Facilities: Gaps between Common and Good Practices. Clin Gerontol 2022; 45:859-869. [PMID: 34100339 DOI: 10.1080/07317115.2021.1933292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The present study aims to explore the perception of common and best practices for dealing with resistance to eating of persons with dementia living in long-term care facilities. METHODS Forty-two staff members working in long-term care facilities were interviewed. They worked in four Spanish long-term care facilities; 21 were nursing assistants and 21 technical staff. Participants heard a vignette in which person with dementia showed resistance to eating. Participants were asked how a situation like that is commonly managed by their workmates, and how the situation should be managed. Responses were content-analyzed. RESULTS Strategies mentioned by participants were quite diverse and did not converge on common ground that harmonizes their responses. Less than half of the participants considered person-centered strategies as a best practice. Those strategies were lower on assistant carers, compared to technical staff. CONCLUSIONS Resistance to eating is a common situation faced by professionals. Nonetheless, there is not a common procedure to deal with this situation. Resistance to eating was seen more as a problem to be eradicated than a behavior to be understood. CLINICAL IMPLICATIONS Staff development initiatives are necessary in relation to mealtime situations. They should consider work position and competencies needed by assistant carers.
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Affiliation(s)
- Feliciano Villar
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Karima Chacur
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Rodrigo Serrat
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Montserrat Celdrán
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
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11
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Viñas P, Bolivar-Prados M, Tomsen N, Costa A, Marin S, Riera SA, Barcons N, Clavé P. The Hydration Status of Adult Patients with Oropharyngeal Dysphagia and the Effect of Thickened Fluid Therapy on Fluid Intake and Hydration: Results of Two Parallel Systematic and Scoping Reviews. Nutrients 2022; 14:2497. [PMID: 35745228 PMCID: PMC9228104 DOI: 10.3390/nu14122497] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The effect of oropharyngeal dysphagia (OD) and thickened fluid (TF) therapy on hydration status has not been well defined in the literature. We aimed to assess the hydration status in patients with OD and the effect TF therapy has on it. METHODS Two literature reviews following PRISMA methodology (each one including a systematic and a scoping review) were performed: (R1) hydration status in adult patients with OD; (R2) effect of TF therapy on fluid intake and dehydration. Narrative and descriptive methods summarized both reviews. Quality assessment was assessed by Joanna Briggs Institute tools and GRADE. RESULTS (R1) Five out of twenty-two studies using analytical parameters or bioimpedance showed poorer hydration status among OD and 19-100% prevalence of dehydration; (R2) two high quality studies (total of 724 participants) showed positive effects of TF on hydration status. Among the articles included, nine out of ten studies that evaluated fluid intake reported a reduced TF intake below basal water requirements. CONCLUSIONS Dehydration is a highly prevalent complication in OD. There is scientific evidence on the positive effect of TF therapy on the hydration status of patients with OD. However, strict monitoring of fluid volume intake is essential due to the low consumption of TF in these patients.
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Affiliation(s)
- Paula Viñas
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
| | - Mireia Bolivar-Prados
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Noemi Tomsen
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Alicia Costa
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
| | - Sergio Marin
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
- Pharmacy Department, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Stephanie A. Riera
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
| | - Núria Barcons
- Medical Affairs, Nestlé Health Science, CH-1800 Vevey, Switzerland;
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
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12
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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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13
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Consensus on the treatment of dysphagia in Parkinson's disease. J Neurol Sci 2021; 430:120008. [PMID: 34624796 DOI: 10.1016/j.jns.2021.120008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dysphagia is common in Parkinson's disease (PD). The effects of antiparkinsonian drugs on dysphagia are controversial. Several treatments for dysphagia are available but there is no consensus on their efficacy in PD. OBJECTIVE To conduct a systematic review of the literature and to define consensus statements on the treatment of dysphagia in PD and related nutritional management. METHODS A multinational group of experts in the field of neurogenic dysphagia and/or Parkinson's disease conducted a systematic evaluation of the literature and reported the results according to PRISMA guidelines. The evidence from the retrieved studies was analyzed and discussed in a consensus conference organized in Pavia, Italy, and the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. RESULTS The literature review retrieved 64 papers on treatment and nutrition of patients with PD and dysphagia, mainly of Class IV quality. Based on the literature and expert opinion in cases where the evidence was limited or lacking, 26 statements were developed. CONCLUSIONS The statements developed by the Consensus panel provide a guidance for a multi-disciplinary treatment of dysphagia in patients with PD, involving neurologists, otorhinolaryngologists, gastroenterologists, phoniatricians, speech-language pathologists, dieticians, and clinical nutritionists.
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14
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Thibault R, Abbasoglu O, Ioannou E, Meija L, Ottens-Oussoren K, Pichard C, Rothenberg E, Rubin D, Siljamäki-Ojansuu U, Vaillant MF, Bischoff SC. ESPEN guideline on hospital nutrition. Clin Nutr 2021; 40:5684-5709. [PMID: 34742138 DOI: 10.1016/j.clnu.2021.09.039] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 12/16/2022]
Abstract
In hospitals through Europe and worldwide, the practices regarding hospital diets are very heterogeneous. Hospital diets are rarely prescribed by physicians, and sometimes the choices of diets are based on arbitrary reasons. Often prescriptions are made independently from the evaluation of nutritional status, and without taking into account the nutritional status. Therapeutic diets (low salt, gluten-free, texture and consistency modified, …) are associated with decreased energy delivery (i.e. underfeeding) and increased risk of malnutrition. The European Society for Clinical Nutrition and Metabolism (ESPEN) proposes here evidence-based recommendations regarding the organization of food catering, the prescriptions and indications of diets, as well as monitoring of food intake at hospital, rehabilitation center, and nursing home, all of these by taking into account the patient perspectives. We propose a systematic approach to adapt the hospital food to the nutritional status and potential food allergy or intolerances. Particular conditions such as patients with dysphagia, older patients, gastrointestinal diseases, abdominal surgery, diabetes, and obesity, are discussed to guide the practitioner toward the best evidence based therapy. The terminology of the different useful diets is defined. The general objectives are to increase the awareness of physicians, dietitians, nurses, kitchen managers, and stakeholders towards the pivotal role of hospital food in hospital care, to contribute to patient safety within nutritional care, to improve coverage of nutritional needs by hospital food, and reduce the risk of malnutrition and its related complications.
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Affiliation(s)
- Ronan Thibault
- Unité de Nutrition, CHU Rennes, INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer Institute, NuMeCan, Rennes, France.
| | - Osman Abbasoglu
- Department of Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Elina Ioannou
- Department of Nutrition, Limassol General Hospital, Cyprus
| | - Laila Meija
- Riga Stradins University, Pauls Stradins Clinical University Hospital, Latvia
| | - Karen Ottens-Oussoren
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands
| | - Claude Pichard
- Unité de Nutrition, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Elisabet Rothenberg
- Faculty of Health Sciences Kristianstad University Kristianstad Sweden, Sweden
| | - Diana Rubin
- Vivantes Netzwerk für Gesundheit GmbH, Humboldt Klinikum und Klinikum Spandau, Berlin, Germany
| | | | | | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
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15
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Pu D, Choi YY, Chan KMK, Poon MMW. Modifying Puree Meals in Residential Aged Care Facilities: A Multi-Centre Feasibility and Acceptability Study. Geriatrics (Basel) 2021; 6:geriatrics6040108. [PMID: 34842703 PMCID: PMC8628769 DOI: 10.3390/geriatrics6040108] [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: 09/10/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
Purees are often recommended for older adults in residential aged care facilities (RACFs) to target swallowing difficulties and nutrition. However, they lack appeal and may have negative impacts on nutritional intake. This study investigated the subjective experiences and objective swallowing function and safety of older adults in response to a modified puree. Twenty-eight residents from three RACFs whose regular diets consisted of purees were recruited. Purees were modified to improve visual appeal by adding a commercial enzyme gellant. Each participant was observed during three puree and three modified puree meals, and completed a brief questionnaire after each meal. A videofluoroscopic swallowing study (VFSS) was performed with 16 of the participants. Compared to purees, modified purees were observed to be easier for oral processing and intake amount was higher, but participants required assistance more often and mealtimes were longer. Participants did not show preference for either type of puree. VFSS showed similar swallowing responses between the two puree types; however, a distinction was observed for modified pureed meat compared to other ingredients. Modifying puree meals in RACFs is a feasible approach to improve nutritional intake while maintaining swallowing safety, but their appeal to consumers is not definitive.
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Affiliation(s)
- Dai Pu
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Frankston 3199, Australia
- Correspondence: (D.P.); (M.M.-W.P.)
| | - Yuen-Yu Choi
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong, China; (Y.-Y.C.); (K.M.-K.C.)
| | - Karen Man-Kei Chan
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong, China; (Y.-Y.C.); (K.M.-K.C.)
| | - May Man-Wai Poon
- ENT Laser Hearing & Speech Therapy Centre, 59–65 Queen’s Road Central, Hong Kong, China
- Correspondence: (D.P.); (M.M.-W.P.)
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Endo A, Watanabe Y, Matsushita T, Okada K, Ohara Y, Iwasaki M, Ito K, Nakajima J, Iwasa Y, Itoda M, Sasaki R, Nishi Y, Furuya J, Watanabe Y, Umemoto G, Kishima M, Hirano H, Sato Y, Yoshida M, Yamazaki Y. Association between Weight Loss and Food Form in Older Individuals Residing in Long-Term Care Facilities: 1-Year Multicenter Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010776. [PMID: 34682525 PMCID: PMC8535238 DOI: 10.3390/ijerph182010776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/05/2021] [Indexed: 12/17/2022]
Abstract
Changing the food form for older adults requiring nursing care from a regular to dysphagia diet is thought to impact their nutritional status. We assessed the association between changes in food form and weight loss over 1 year in older adults. Older adults residing in long-term care facilities in Japan (n = 455) who participated in the baseline (2018) and follow-up (2019) surveys were divided into two groups (regular diet, n = 284; dysphagia diet, n = 171). The regular diet group was further divided into the weight loss (n = 80; weight loss ≥5% over 1 year) and weight maintenance (n = 204; weight loss <5%) groups. After 1 year, the Barthel Index significantly decreased, and the proportion of participants who switched from a regular diet to a dysphagia diet significantly increased in the weight loss group than in the weight maintenance group. Multivariate logistic regression analysis found that Barthel index variation (odds ratio (OR): 0.97, 95% confidence interval (CI): 0.94‒0.99), change from a regular diet to a dysphagia diet (OR: 4.41, 95% CI: 1.87‒10.41), and body weight at baseline (OR = 1.06, 95% CI: 1.01‒1.11) were significantly associated with weight loss. Our results suggest that maintaining the food form inhibits weight loss and improves health outcomes in older adults.
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Affiliation(s)
- Akemi Endo
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
| | - Yutaka Watanabe
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
- Correspondence: ; Tel./Fax: +81-11-706-4582
| | - Takae Matsushita
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
| | - Kazutaka Okada
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (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, Chiba 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;
| | - Rikimaru Sasaki
- Rehabilitation Clinic for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tokyo 102-8158, 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, Miyagi 981-8522, Japan;
| | - George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka 814-0180, Japan;
| | - Masako Kishima
- Wakakusa-Tatsuma Rehabilitation Hospital, Osaka 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 Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima 734-8553, Japan;
| | - Yutaka Yamazaki
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
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Narrative Review of Low-Intake Dehydration in Older Adults. Nutrients 2021; 13:nu13093142. [PMID: 34579019 PMCID: PMC8470893 DOI: 10.3390/nu13093142] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 12/17/2022] Open
Abstract
Low-intake dehydration is a common and often chronic condition in older adults. Adverse health outcomes associated with low-intake dehydration in older adults include poorer cognitive performance, reduced quality of life, worsened course of illness and recovery, and a high number of unplanned hospital admissions and increased mortality. The subjective methods to assess (risk of) dehydration are not reliable, and the evidence about preventive measures are also limited. So is the knowledge about the optimal intake of beverages per day. This narrative review presents the state of the science on the role of low intake hydration in older adults. Despite its simple cause—the inadequate intake of beverages—low-intake dehydration appears to be a very complex problem to address and much more research is needed in the area. Based on the existing evidence, it seems necessary to take setting specific differences and individual problems and needs into account to tackle dehydration in older adults. Further, it is necessary to increase awareness of the prevalence and severity of low-intake dehydration among older adults and in nursing staff in care homes and hospitals as well as among caregivers of older adults living at home.
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Zanini M, Catania G, Ripamonti S, Watson R, Romano A, Aleo G, Timmins F, Sasso L, Bagnasco A. The WeanCare nutritional intervention in institutionalized dysphagic older people and its impact on nursing workload and costs: A quasi-experimental study. J Nurs Manag 2021; 29:2620-2629. [PMID: 34342076 PMCID: PMC9292428 DOI: 10.1111/jonm.13435] [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] [Received: 02/23/2021] [Revised: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 12/29/2022]
Abstract
AIM The aim of this study is to explore how a nutritional intervention that improves the biochemical and functional profile of dysphagic older people impacts on nursing workload and costs for nursing homes. BACKGROUND Dysphagic institutionalized older people particularly at risk of malnutrition require more intensive support from nursing staff and higher costs for nursing homes. METHOD This is an open pre-post longitudinal multicentre quasi-experimental study without a control group. RESULTS There is a significant reduction in the number of enemas (from 3.51 to 1.11 enemas), with an average nursing workload reduction from 52 to 16 min per patient every month. Each nurse also spent 20 h less per patient every month spoon-feeding. This resulted in nursing staff cost savings. CONCLUSIONS The nutritional intervention led to a significantly better quality of life for the patients manifested through increased independence and social engagement. This reduced workload for nursing staff and costs for nursing home administrators. IMPLICATIONS FOR NURSING MANAGEMENT Sensitive, targeted nutritional interventions have the potential to improve nursing home residents' quality of life and enable a more efficient use of resources. This study revealed reduced workload and cost savings due to less time spent administering enemas and spoon-feeding, in addition to reduced malnutritional consequences.
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Affiliation(s)
- Milko Zanini
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Gianluca Catania
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | | | - Roger Watson
- Faculty of Health and Social Care, University of Hull, Hull, UK
| | - Antonio Romano
- Pharmaceutical and Technical Chemistry, Head R&D Healthy Ageing Research Group, Cremona, Italy
| | - Giuseppe Aleo
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Fiona Timmins
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, Ireland
| | - Loredana Sasso
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Annamaria Bagnasco
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
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Chen S, Kent B, Cui Y. Interventions to prevent aspiration in older adults with dysphagia living in nursing homes: a scoping review. BMC Geriatr 2021; 21:429. [PMID: 34273953 PMCID: PMC8285814 DOI: 10.1186/s12877-021-02366-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/29/2021] [Indexed: 12/24/2022] Open
Abstract
Background Dysphagia is highly prevalent condition in older adults living in nursing homes. There is also evidence indicating that aspiration is one of the major health risks for these older adults, which is more likely to result in respiratory infections, aspiration pneumonia and sudden bolus death. Evidence syntheses have demonstrated the effectiveness of interventions for prevention of aspiration among hospitalized older people. The aim of this scoping review is to describe the current spread of interventions to prevent or reduce aspiration in older adults with dysphagia with a specific focus on those who reside in nursing homes. Methods The Joanna Briggs Institute methods and PRISMA-ScR guidelines were used to inform this review. MEDLINE, CINAHL, EMBASE, Cochrane Library, Joanna Briggs Institute EBP Database and Web of Science were searched for related articles from 2010 to 2020 as well as Chinese databases (CNKI, WANFANG DATA and VIP) and databases for unpublished material. A three-step search strategy was utilized, including the use of citation software to manage search results and de-duplication, abstract review and full-text review by two reviewers. Details of included studies were then extracted using a prepared data extraction tool. The resulting map was displayed in tabular form along with a narrative summary. Results Although 637 articles were located, 19 papers were included in the final analysis. Interventions to prevent aspiration in older adults with dysphagia living in nursing homes included: more bedside evaluation, modification of dietary, creating an appropriate environment for swallowing, providing appropriate feeding assistance, appropriate posture or maneuver for swallowing, appropriate rehabilitation program, medication treatment, and stimulation treatment. Conclusion Nursing homes, particularly those in developing countries, require more support for staff training and necessary equipment. Professional interventions provided by speech and language therapists are still limited in the setting of nursing homes. Modification of dietary was the most frequently used intervention to prevent or reduce aspiration. Multi-disciplinary interventions had the best results for aspiration management, but for many nursing homes, access to such teams is limited. Nursing home residents respond well to person-centered interventions that have a comprehensive consideration of their degree of aspiration risk, health condition, individual feelings and cognitive state.
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Affiliation(s)
- Shen Chen
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Bridie Kent
- The University of Plymouth Centre for Innovations in Health and Social Care: A Joanna Briggs Institute Centre of Excellence, Plymouth, UK.,School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Yan Cui
- School of Nursing, Nanjing Medical University, Nanjing, China.
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Kwak S, Choo YJ, Choi KT, Chang MC. Safety and Efficacy of Specially Designed Texture-Modified Foods for Patients with Dysphagia Due to Brain Disorders: A Prospective Study. Healthcare (Basel) 2021; 9:healthcare9060728. [PMID: 34199175 PMCID: PMC8231767 DOI: 10.3390/healthcare9060728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
Providing texture-modified food for patients with dysphagia is a cornerstone of dysphagia treatment. This study aimed to evaluate the safety and efficacy of a specially designed texture-modified food that can be easily swallowed while maintaining the unique taste by adjusting hardness and adhesiveness in patients with brain disorders using a videofluoroscopic swallowing study. We included 101 patients with oropharyngeal dysphagia due to brain disorders who were referred to the rehabilitation department. To evaluate the safety and efficacy of a specially designed texture-modified food, rice gruel was compared with a regular instant rice porridge, and bulgogi mousse was compared with ground bulgogi, which normally serves as a texture-modified diet for patients with dysphagia in our hospital during the videofluoroscopic swallowing study. The Penetration–Aspiration Scale score, oropharyngeal transit time, number of swallows required to maximally eliminate food materials from the oropharyngeal space, and vallecular and pyriform sinus residue after swallowing scale score were compared. Rice gruel required a shorter oropharyngeal transit time and fewer number of swallowing per the given amount of food than regular instant rice porridge; however, no statistical difference was found in the vallecular and pyriform sinus residue after swallowing scale scores and the Penetration–Aspiration Scale scores. Bulgogi mousse required more swallowing and had lower Penetration–Aspiration Scale scores than ground bulgogi; however, no significant difference was found in the oropharyngeal transit time and the vallecular and pyriform sinus residue after swallowing scale scores. The study foods were safe and efficacious compared to control foods usually provided for patients with dysphagia from various brain disorders.
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21
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Wu XS, Miles A, Braakhuis AJ. Texture-Modified Diets, Nutritional Status and Mealtime Satisfaction: A Systematic Review. Healthcare (Basel) 2021; 9:624. [PMID: 34073835 PMCID: PMC8225071 DOI: 10.3390/healthcare9060624] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 12/24/2022] Open
Abstract
While the association between dysphagia and malnutrition is well established, there is a lack of clarity regarding the nutritional status and mealtime satisfaction of those consuming texture-modified diets (TMDs). This systematic review summarises and critically appraises the nutritional status and mealtime satisfaction of adults consuming TMDs. A systematic database search following PICO criteria was conducted using Cochrane Central (via Ovid), MEDLINE, CINAHL, EMBASE and Scopus. Nutritional status, mealtime satisfaction and costs were identified as primary outcomes. Eligible studies were grouped according to outcome measurement. In total, 26 studies met the inclusion criteria. Twenty studies evaluated the nutritional status by weight change or using malnutrition screening tools and found the consumption of TMDs correlated with weight loss or malnutrition. Nine studies evaluated mealtime satisfaction, with two reporting poor satisfaction for people on thickened fluids (TFs). Nutrition intervention through adjusting texture and consistency and nutrition enrichment showed positive effects on weight and mealtime satisfaction. The majority of the studies were rated as 'neutral' quality due to the limited number of experiments. TMD consumers had compromised nutritional status and poor mealtime satisfaction. More research input is required to identify promising strategies for improving the nutritional status and mealtime satisfaction of this population. Food services need to consider texture, consistency and fortification in designing menus for people on TMDs to avoid weight loss and malnutrition, and to enhance mealtime enjoyment.
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Affiliation(s)
- Xiaojing Sharon Wu
- Faculty of Medical and Health Sciences, Discipline of Nutrition, The University of Auckland, Auckland 1010, New Zealand;
| | - Anna Miles
- Faculty of Science, School of Psychology, Speech Science, The University of Auckland, Auckland 1010, New Zealand;
| | - Andrea J. Braakhuis
- Faculty of Medical and Health Sciences, Discipline of Nutrition, The University of Auckland, Auckland 1010, New Zealand;
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22
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Birchall O, Bennett M, Lawson N, Cotton S, Vogel AP. Fiberoptic endoscopic evaluation of swallowing and videofluoroscopy swallowing assessment in adults in residential care facilities: a scoping review protocol. JBI Evid Synth 2021; 18:599-609. [PMID: 32197020 DOI: 10.11124/jbisrir-d-19-00015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This scoping review will identify and explore existing evidence on the use of instrumental swallowing assessment in the diagnosis and management of dysphagia in adults living in residential care facilities. INTRODUCTION Oropharyngeal dysphagia is prevalent among adults living in residential care facilities. Videofluoroscopy and fiberoptic endoscopic evaluation of swallowing are instrumental assessment procedures commonly utilized in the evaluation of oropharyngeal dysphagia in hospital and community settings. However, little is known about the use of these procedures in residential care facilities. To ensure evidence-based assessment of oropharyngeal dysphagia and to guide future research, exploration of the current use and clinical utility of videofluoroscopy and fiberoptic endoscopic evaluation of swallowing in residential care facilities is needed. INCLUSION CRITERIA Published and gray literature written in English from 2000 onward that discusses instrumental swallowing assessment of adults in residential care facilities will be included in the review. METHODS A three-step search strategy will be used to explore relevant literature. All citations and articles retrieved during the searches will be imported into a software application for systematic reviews. Once duplicates are removed, two reviewers will screen the titles and abstracts against predefined inclusion criteria. Information will be extracted from literature that meets the selection criteria using a purposefully developed charting form. The search strategy and results will be illustrated through a Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram. Key findings and their relationship to the research questions will be summarized in a chart and discussed in interpretive narrative form.
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Affiliation(s)
- Olga Birchall
- Centre for Neurosciences of Speech, The University of Melbourne, Melbourne, Australia.,Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - Michelle Bennett
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Nadine Lawson
- Speech Pathology Department, Cabrini Hospital, Malvern, Australia
| | - Susan Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Adam P Vogel
- Centre for Neurosciences of Speech, The University of Melbourne, Melbourne, Australia.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Redenlab, Melbourne, Australia
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23
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González-Fernández M, Arbones-Mainar JM, Ferrer-Lahuerta E, Perez-Nogueras J, Serrano-Oliver A, Torres-Anoro E, Sanz-Paris A. Ultrasonographic Measurement of Masseter Muscle Thickness Associates with Oral Phase Dysphagia in Institutionalized Elderly Individuals. Dysphagia 2021; 36:1031-1039. [PMID: 33462765 DOI: 10.1007/s00455-020-10234-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Oral phase dysphagia is dependent on ability to chew. As people age, general muscle atrophy contributes to decreased masseter strength. The main objective of this study was to assess the relationship between the thickness of the masseter muscle measured by ultrasonography and the presence of dysphagia in a group of institutionalized elderly people. As a secondary objective, we aimed to establish cutoff points of masseters muscle thickness (MMT) to identify elderly individuals at risk of oral dysphagia. METHODS Cross-sectional study of all residents from 3 nursing homes. All individuals underwent ultrasonographic measurements of left and right MMT and were classified according to the presence of dysphagia assessed by both the EAT-10 screening questionnaire and the volume-viscosity swallow test (V-VST). RESULTS 469 patients (69% women, mean age 84.7 yrs) were recruited. Dysphagia was present in 41.6% and 26% of individuals according the EAT-10 and V-VST, respectively. Multivariate logistic regression showed that 1 mm increase in MMT reduced the risk of dysphagia by 21% according to the EAT-10 tool and by 30% using the V-VST after adjusting for age, sex, mini-nutritional assessment score, and body mass index. We used receiver operative characteristic (ROC) curves to identify cutoff points of MMT to detect dysphagic individuals according to either EAT-10 or V-VST. CONCLUSIONS The MMT measured by ultrasonography is reduced in elderly individuals with dysphagia. Based on MMT, clinicians may be better informed about the patients'´ ability to masticate solid foods and identify potential nutrient deficiencies in geriatric settings.
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Affiliation(s)
| | - Jose M Arbones-Mainar
- Instituto de Investigacion Sanitaria Aragon (IIS-Aragon), Zaragoza, Spain. .,Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, University Hospital Miguel Servet, Instituto Aragones de Ciencias de la Salud (IACS), 50009, Zaragoza, Spain. .,Centro de Investigacion Biomedica en Red Fisiopatología Obesidad Y Nutricion (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.
| | | | | | | | | | - Alejandro Sanz-Paris
- Department of Nutrition, University Hospital Miguel Servet, Zaragoza, Spain.,Instituto de Investigacion Sanitaria Aragon (IIS-Aragon), Zaragoza, Spain
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Prevalence of signs of dysphagia and associated risk factors in geriatric patients admitted to an acute medical unit. Clin Nutr ESPEN 2021; 41:208-216. [PMID: 33487266 DOI: 10.1016/j.clnesp.2020.12.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Dysphagia is a prevalent disorder among the older persons. Despite this, signs of dysphagia often go unnoticed in hospital settings. This cross-sectional study aimed at investigating the prevalence of signs of dysphagia among patients aged 65 or older in a Danish acute care setting. METHODS We studied 334 patients aged 65 years or older admitted to the acute medical unit (AMU) at Aalborg University Hospital, Denmark. Signs of dysphagia were assessed using bedside screening tools including the Eating Assessment Tool (EAT-10), a 30 mL Water Swallowing Test (WST) and the Gugging Swallowing Screen tool (GUSS). Other risk factors were assessed using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS), the Nutritional Risk Screening 2002 (NRS), and the Charlson's Comorbidity Index (CCI). RESULTS Signs of dysphagia were identified in 144 of 334 (43.1%) patients. Geriatric patients with signs of dysphagia were significantly older (79.5 years [74; 85] vs. 77 years [72; 84], p = 0.025) and had higher CCI scores (3 points [2; 4] vs. 2 points [1; 4], p = 0.001) than those with normal swallowing capacity. Furthermore, a multivariate logistic regression model found signs of dysphagia to be independently associated with nutritional risk (OR = 2.169, 95% CI 1.313-3.582, p = 0.002), cerebrovascular disease (OR = 2.209, 95% CI 1.235-3.953, p = 0.008), chronic pulmonary disease (OR = 2.276, 95% CI 1.338-3.871, p = 0.002) and rheumatic disease (OR = 2.268, 95% CI 1.099-4.683, p = 0.027). Age was not independently associated with signs of dysphagia among the geriatric patients. CONCLUSION Signs of dysphagia were common among patients aged 65 or older in the acute care setting. Signs of dysphagia were associated with nutritional risk, higher CCI scores and specific comorbidities. These findings could indicate a need for systematic screening for dysphagia in acute geriatric patients, yet further investigation is needed to assess clinical outcomes associated with dysphagia within this population.
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25
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Treatment for Adults. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00011-1] [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]
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26
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Cost, microbiological, and nutritional properties of pureed food production in nursing homes. The ABADIA Study. NUTR HOSP 2021; 38:470-477. [PMID: 33775099 DOI: 10.20960/nh.03465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: although nutritional differences between different types of texture-modified diet (TMD) have been evaluated, the resources and costs associated with their preparation have been less studied. Objective: to describe the nutritional, microbiological properties and costs of: 1) in-home produced pureed food (hTMD); 2) concentrated nutrient-dense commercial food products, hand-blended (cTMD); 3) food prepared using the MixxPro® automatic food mixer (cTMD-Mix). Methods: an observational, prospective study carried out in three geriatric nursing-homes. Patients ≥ 65 years, receiving TMD, with a stable clinical condition, estimated survival/expected internment > 1 month, and sufficient cognitive capacity were included. The following data were recorded: 1) patient socio-demographic and clinical variables; 2) TMD compliance and symptoms related to dysphagia during the meal; 3) patient appetite; and 4) kitchen information and resources used to prepare a TMD. Results: sixty-two residents were included (65.0 % women, 88.3 years (SD: 9.3); 43.5 % malnourished, 79.0 % with good appetite). The proportion of food eaten/median kcal served/portion/mean kcal consumed were: hTMD: 95.5 % (SD: 10.7)/92.4 kcal (IQR: 75.6-128.1)/88.2 kcal (IQR: 72.2-122.3); cTMD: 89.2 % (SD: 15.9)/323.4 kcal (IQR: 284.2-454.1)/288.5 kcal (IQR: 253.5-325.1); and cTMD-Mix: 80.3 % (SD: 21.4)/358.0 kcal (IQR: 344.0-372.1)/287.5 kcal (IQR: 276.5-298.8). No microorganisms were detected. The average time spent in preparing each portion and its costs were: hTMD: 11.2 min (SD: 3.89)/€2.33 (SD: 0.63); cTMD: 1.7 min (SD: 0.28)/€2.01 (SD: 0.39); and cTMD-Mix: 1.6 min (SD: 0.00)/€2.00 (SD: 0.33). Conclusions: in patients with dysphagia and/or chewing difficulties, concentrated nutrient-dense food products, particularly those produced using the MixxPro® automatic food mixer, ensure a high caloric intake and allow quick and safe food preparation.
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Rondanelli M, Faliva MA, Peroni G, Perna S, Gasparri C, Fazia T, Bernardinelli L, Infantino V. A favorable effect on nutritional status of 12-week tailored texture-modified sous-vide cooking meals in institutionalized elderly women with oropharyngeal dysphagia: an intervention study. Minerva Endocrinol (Torino) 2020; 46:202-213. [PMID: 32969627 DOI: 10.23736/s2724-6507.20.03232-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Dysphagic patients are not always able to meet their energy, micro and macronutrients needs for various causes and therefore are at high risk of malnutrition. The aim of the present study was to evaluate the effectiveness on satisfaction of the meal (by a 10-cm visuo-analogical scale), food intake (by visual estimation of food waste), nutritional status (anthropometric measures, mini nutritional assessment [MNA], vitamin D, B12, folic acid), functional (handgrip) and blood chemistry metabolic parameters of a tailored texture-modified sous-vide cooking meals (TTMSVC), well balanced in macro and micronutrients, in elderly women suffering from oropharyngeal dysphagia at long-term care facilities. METHODS A 12-week intervention study was conducted on female elderly subjects affected by oropharyngeal dysphagia of level 3-5. The treated group received TTMSVC with the consistencies standardized using viscosimeter (5000-10000 mP/s). The control group maintained pureed hospital diet. RESULTS 50 subjects, 25 in treatment group and 25 in control group, with mean±SD age 89.12±4.18 and mini mental state examination (MMSE) 20.58±1.63 were enrolled. The treatment and control groups were similar at baseline. The changes over time between the two groups showed significant differences for food intake, meal appreciation, Body Mass Index (BMI), calf circumference, arm circumference, MNA, prealbumin, albumin, folic acid, vitamin D, ionized calcium, C-Reactive Protein (CRP), Tumor Necrosis Factor (TNF-α), handgrip. Significant positive correlations were observed in the treatment group between the meal appreciation and prealbumin and vitamin D. CONCLUSIONS This study demonstrated that elderly dysphagic women at long-term care facilities can eat better and increase nutritional status by eating 12-week tailored appealing TTMSVC.
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Affiliation(s)
- Mariangela Rondanelli
- IRCCS Mondino Foundation, Pavia, Italy.,Unit of Human and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Milena A Faliva
- Unit of Endocrinology and Nutrition, ASP Santa Margherita Institute, University of Pavia, Pavia, Italy
| | - Gabriella Peroni
- Unit of Endocrinology and Nutrition, ASP Santa Margherita Institute, University of Pavia, Pavia, Italy -
| | - Simone Perna
- Department of Biology, College of Science, University of Bahrain, Sakhir, Bahrain
| | - Clara Gasparri
- Unit of Endocrinology and Nutrition, ASP Santa Margherita Institute, University of Pavia, Pavia, Italy
| | - Teresa Fazia
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Luisa Bernardinelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Vittoria Infantino
- Unit of Human and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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Abstract
Constipation is a common condition in adults and symptoms such as straining and the sensation of incomplete bowel emptying can be distressing for patients. The nurse's role includes preventing, monitoring and managing the condition. Fibre and fluid intake have an important role in prevention, while first-line treatments include increased consumption of wholegrain carbohydrates, fruit and vegetables. This article outlines the role of diet in preventing and managing constipation in adults and offers practical advice for nurses caring for this group of patients.
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Affiliation(s)
- Julie Thompson
- Information Manager/Specialist Gastroenterology Dietitian, Guts UK Charity, The Media Centre, Huddersfield, England
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30
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Ballesteros-Pomar MD, Cherubini A, Keller H, Lam P, Rolland Y, Simmons SF. Texture-Modified Diet for Improving the Management of Oropharyngeal Dysphagia in Nursing Home Residents: An Expert Review. J Nutr Health Aging 2020; 24:576-581. [PMID: 32510109 DOI: 10.1007/s12603-020-1377-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This paper provides evidence-based and, when appropriate, expert reviewed recommendations for long-stay residents who are prescribed texture-modified diets (TMDs), with the consideration that these residents are at high risk of worsening oropharyngeal dysphagia (OD), malnutrition, dehydration, aspiration pneumonia, and OD-associated mortality, poorer quality of life and high costs. DESIGN Nestlé Health Science funded an initial virtual meeting attended by all authors, in which the unmet needs and subsequent recommendations for OD management were discussed. The opinions, results, and recommendations detailed in this paper are those of the authors, and are independent of funding sources. SETTING OD is common in nursing home (NH) residents, and is defined as the inability to initiate and perform safe swallowing. The long-stay NH resident population has specific characteristics marked by a shorter life expectancy relative to community-dwelling older adults, high prevalence of multimorbidity with a high rate of complications, dementia, frailty, disability, and often polypharmacy. As a result, OD is associated with malnutrition, dehydration, aspiration pneumonia, functional decline, and death. Complications of OD can potentially be prevented with the use of TMDs. RESULTS This report presents expert opinion and evidence-informed recommendations for best practice on the nutritional management of OD. It aims to highlight the practice gaps between the evidence-based management of OD and real-world patterns, including inadequate dietary provision and insufficient staff training. In addition, the unmet need for OD screening and improvements in therapeutic diets are explored and discussed. CONCLUSION There is currently limited empirical evidence to guide practice in OD management. Given the complex and heterogeneous population of long-stay NH residents, some 'best practice' approaches and interventions require extensive efficacy testing before further changes in policy can be implemented.
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Affiliation(s)
- M D Ballesteros-Pomar
- María Ballesteros-Pomar, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain,
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The Swallowing Characteristics of Thickeners, Jellies and Yoghurt Observed Using an In Vitro Model. Dysphagia 2019; 35:685-695. [PMID: 31707519 PMCID: PMC7351813 DOI: 10.1007/s00455-019-10074-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/24/2019] [Indexed: 02/03/2023]
Abstract
Drinks and foods may be thickened to improve swallowing safety for dysphagia patients, but the resultant consistencies are not always palatable. Characterising alternative appetising foods is an important task. The study aims to characterise the in vitro swallowing behaviour of specifically formulated thickened dysphagia fluids containing xanthan gum and/or starch with standard jellies and yoghurt using a validated mechanical model, the “Cambridge Throat”. Observing from the side, the model throat can follow an experimental oral transit time (in vitro-OTT) and a bolus length (BL) at the juncture of the pharynx and larynx, to assess the velocity and cohesion of bolus flow. Our results showed that higher thickener concentration produced longer in vitro-OTT and shorter BL. At high concentration (spoon-thick), fluids thickened with starch-based thickener showed significantly longer in vitro-OTT than when xanthan gum-based thickener was used (84.5 s ± 34.5 s and 5.5 s ± 1.6 s, respectively, p < 0.05). In contrast, at low concentration (nectar-like), fluids containing xanthan gum-based thickener demonstrated shorter BL than those of starch-based thickener (6.4 mm ± 0.5 mm and 8.2 mm ± 0.8 mm, respectively, p < 0.05). The jellies and yoghurt had comparable in vitro-OTT and BL to thickeners at high concentrations (honey-like and spoon-thick), indicating similar swallowing characteristics. The in vitro results showed correlation with published in vivo data though the limitations of applying the in vitro swallowing test for dysphagia studies were noted. These findings contribute useful information for designing new thickening agents and selecting alternative and palatable safe-to-swallow foods.
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32
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Mathieu ME, Reid RER, King NA. Sensory Profile of Adults with Reduced Food Intake and the Potential Roles of Nutrition and Physical Activity Interventions. Adv Nutr 2019; 10:1120-1125. [PMID: 31121014 PMCID: PMC6855938 DOI: 10.1093/advances/nmz044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/20/2018] [Accepted: 03/29/2019] [Indexed: 12/12/2022] Open
Abstract
The sensory profile, referring to sight, smell, taste, hearing, and touch, plays an essential role in optimizing the habitual intake of energy and macronutrients. However, specific populations, such as older adults, are known to have impaired energy intake. In this paper, the relevance of sensory impairments in this older population is described, and the extent to which nutritional and physical activity interventions can modulate these sensory responses when food intake is insufficient is explored. With aging, all senses deteriorate, and in most cases, such deteriorations diminish the nutritional response. The only exception is sight, for which both positive and negative impacts on nutritional response have been reported. From a prevention perspective, nutritional interventions have been understudied, and to date, only hearing is known to be positively affected by a good nutritional profile. In comparison, physical activity has been more frequently studied in this context, and is linked to an improved preservation of 4 senses. Regarding treatment, very few studies have directly targeted sensory training, and the focus of research has tended to be on nutrition and physical activity intervention. Sensory training, and nutritional and physical activity treatments all have beneficial effects on the senses. In the future, researchers should focus on exploring gaps in the literature specifically concerning prevention, treatment, and sensory response to understand how to improve the efficacy of current approaches. In order to maintain sensory acuity and recover from sensory impairment, the current state of knowledge supports the importance of improving nutritional habits as well as physical activity early on in life. A combined approach, linking a detailed lifestyle profile with the assessment of numerous senses and one or more interventional approaches (nutrition, physical activity, sensory training, etc.), would be required to identify effective strategies to improve the nutritional state of older individuals.
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Affiliation(s)
- Marie-Eve Mathieu
- École de kinésiologie et des sciences de l'activité physique, Université de Montréal, Montréal, Canada,Sainte-Justine University Hospital Center, Montréal, Canada,Address correspondence to M-EM (E-mail: )
| | - Ryan E R Reid
- École de kinésiologie et des sciences de l'activité physique, Université de Montréal, Montréal, Canada,Sainte-Justine University Hospital Center, Montréal, Canada
| | - Neil A King
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
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Burger C, Kiesswetter E, Alber R, Pfannes U, Arens-Azevedo U, Volkert D. Texture modified diet in German nursing homes: availability, best practices and association with nursing home characteristics. BMC Geriatr 2019; 19:284. [PMID: 31646961 PMCID: PMC6806511 DOI: 10.1186/s12877-019-1286-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/20/2019] [Indexed: 11/21/2022] Open
Abstract
Background For nursing home (NH) residents with swallowing or chewing problems, appealing texture-modified-diets (TMD) need to be available in order to support adequate nutrition. The aim of this study was to describe the availability of TMD and best practices for TMD in German NHs and to identify related NH characteristics. Methods Information on NH characteristics, available texture-modified (TM)-levels (soft, “minced & moist”, pureed) and implemented best practices for TMD (derived from menu plan, separately visible components, re-shaped components, considering individual capabilities of the resident) was collected in a survey in German NHs. The number of TM-levels as well as the number of best practices for TMD were tested for their association with 4 structural, 16 operational and 3 resident-related NH characteristics. Results The response rate was 7.2% (n = 590) and 563 NHs were included. The vast majority of NHs (95.2%) reported offering “minced & moist” texture and 84.2% preparing separately visible meal components. Several operational characteristics were more frequently (p < 0.05) reported from NHs offering three TM-levels (27.7%) or four best practices for TMD (13.0%) compared to NHs offering one TM-level (28.4%) or one best practice for TMD (20.1%): special diets and delivery forms (e.g. fingerfood 71.2% vs 38.8%; 80.8% vs. 44.3%), written recipes (69.9% vs. 53.1%; 68.5% vs. 53.9%), a dietetic counseling service (85.9% vs. 66.3%; 89.0% vs. 65.2%), a quality circle for nutritional care (66.7% vs. 43.8%; 71.2% vs. 50.4%), regular staff training (89.7% vs. 73.1%; 95.9% vs. 74.8%) and process instructions (73.7% vs. 53.1%; 75.3% vs. 47.8%). No associations were found regarding structural and resident-related NH characteristics, except a higher percentage of residents receiving TMD in NHs with three compared to one TM-level (median 16.3% vs. 13.2%, p = 0.037). Conclusion All participating NHs offer some form of TMD, but only a small number offers a selection of TMD and pays adequate attention to its preparation. Operational NH characteristics – which might reflect a general nutritional awareness of the NH – seem to be pivotal for provision of TMD, whereas neither structural nor resident-related characteristics seem to play a role in this regard.
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Affiliation(s)
- Carina Burger
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany.
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany
| | - Rowena Alber
- Faculty Life Sciences, University of Applied Sciences Hamburg, Hamburg, Germany
| | - Ulrike Pfannes
- Faculty Life Sciences, University of Applied Sciences Hamburg, Hamburg, Germany
| | | | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany
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Leite KKDA, Sassi FC, Medeiros GCD, Comerlatti LR, Andrade CRFD. Clinical swallowing prognostic indicators in patients with acute ischemic stroke. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:501-508. [PMID: 31365642 DOI: 10.1590/0004-282x20190080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/16/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A swallowing disorder is present in more than 50% of patients with acute stroke. To identify clinical prognostic indicators of the swallowing function in a population with acute ischemic stroke and to determine prioritization indicators for swallowing rehabilitation. METHODS Participants were adults admitted to the emergency room who were diagnosed with acute ischemic stroke. Data gathering involved a swallowing assessment to determine the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS) and the verification of demographic and clinical variables. RESULTS The study sample included 295 patients. For analysis purposes, patients were grouped as follows: ASHA NOMS levels 1 and 2 - ASHA1 (n = 51); levels 3, 4 and 5 - ASHA2 (n = 96); levels 6 and 7 - ASHA3 (n = 148). Statistical analyses indicated that patients who presented a poorer swallowing function (ASHA1) were older (age ≥ 70 years); had anterior circulation infarct; had lower scores on the Glasgow Coma Scale (GCS ≤ 14 points); took longer to initiate swallowing rehabilitation; had longer hospital stays; made more use of alternative feeding methods; needed more sessions of swallowing rehabilitation to remove alternate feeding methods; took longer to return to oral feeding and had poorer outcomes (fewer individuals discharged from swallowing rehabilitation sessions and increased mortality). CONCLUSION Patients with acute ischemic stroke, admitted to the emergency room, aged ≥ 70 years, score on the GCS ≤ 14, anterior circulation infarct and dementia should be prioritized for swallowing assessment and rehabilitation.
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Affiliation(s)
- Karoline Kussik de Almeida Leite
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Fonoaudiologia do Instituto Central, São Paulo SP, Brasil
| | - Fernanda Chiarion Sassi
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brasil
| | - Gisele Chagas de Medeiros
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Fonoaudiologia do Instituto Central, São Paulo SP, Brasil
| | - Luiz Roberto Comerlatti
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Clínica Neurológica, Serviço de Neurologia de Emergência, São Paulo SP, Brasil
| | - Claudia Regina Furquim de Andrade
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brasil
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Berkman C, Ahronheim JC, Vitale CA. Speech-Language Pathologists’ Views About Aspiration Risk and Comfort Feeding in Advanced Dementia. Am J Hosp Palliat Care 2019; 36:993-998. [DOI: 10.1177/1049909119849003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Speech-language pathologists (SLPs) are often called upon to assess swallowing function for older adults with advanced dementia at high risk of aspiration and make recommendations about whether the patient can safely continue oral nutrition. Objective: To describe the circumstances under which SLPs recommend oral nutritional intake for these patients. Methods: A mail survey of a national probability sample of SLPs (n = 731). Speech-language pathologists were asked if there were circumstances in which they would recommend oral feeding for patients with advanced dementia at high risk of aspiration, and if yes, to describe the circumstances under which they do so. Results: Six themes emerged: (1) when patient preferences are known; (2) for quality of life near end of life; (3) if aspiration risk mitigation strategies are employed; (4) if physician’s preference; (5) if aspiration risk is clearly documented and acknowledged; and (6) if SLP is knowledgeable about current evidence of lack of benefit of feeding tubes in advanced dementia or that nothing by mouth status will not necessarily prevent aspiration pneumonia. Conclusions: Speech-language pathologists have an important role within the interprofessional team in assessing swallowing in patients with advanced dementia, advising family and hospital staff about risks and benefits of oral feeding, and the safest techniques for doing so, to maximize quality of life for these patients near the end of life. Speech-language pathologists are often faced with balancing concerns about aspiration risk and recommending the more palliative approach of oral feeding for pleasure and comfort, potentially creating moral distress for the SLP.
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Affiliation(s)
- Cathy Berkman
- Graduate School of Social Service, Fordham University, New York, NY, USA
| | | | - Caroline A. Vitale
- Division of Geriatric and Palliative Medicine, University of Michigan and VA Ann Arbor GRECC, Ann Arbor, MI, USA
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Hermabessière S, Campo JF, Lacoste-Ferré MH, Rolland Y. [Swallowing disorders, training and assessment of geriatric practices]. SOINS. GERONTOLOGIE 2019; 24:29-34. [PMID: 31084806 DOI: 10.1016/j.sger.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In geriatrics, swallowing disorders are frequent, representing a daily source of anxiety for the nursing teams. Training in this area, aimed at caregivers in a long-stay care unit, has been developed based on an assessment of professional practices.
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Affiliation(s)
- Sophie Hermabessière
- Gérontopôle, CHU de Toulouse, hôpital Garonne, 224 avenue de Casselardit, 31059 Toulouse, France.
| | - Jean-François Campo
- Gérontopôle, CHU de Toulouse, hôpital Garonne, 224 avenue de Casselardit, 31059 Toulouse, France
| | | | - Yves Rolland
- Gérontopôle, CHU de Toulouse, hôpital Purpan-Casselardit, 170 avenue de Casselardit, 31059 Toulouse, France
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Leon AM, Aguilera JM, Park DJ. Mechanical, rheological and structural properties of fiber-containing microgels based on whey protein and alginate. Carbohydr Polym 2019; 207:571-579. [DOI: 10.1016/j.carbpol.2018.11.094] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/25/2018] [Accepted: 11/29/2018] [Indexed: 02/08/2023]
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Aguilera JM, Kim BK, Park DJ. Particular Alimentations for Nutrition, Health and Pleasure. ADVANCES IN FOOD AND NUTRITION RESEARCH 2018; 87:371-408. [PMID: 30678818 DOI: 10.1016/bs.afnr.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
People around the world select their foods and meals according to particular choices based on physiological disorders and diseases, traditions, lifestyles, beliefs, etc. In this chapter, two of these particular alimentations are reviewed: those of the gourmet and the frail elderly. They take place in an environment where food is usually synonymous of body health disregarding its effects on social, cultural and psychological aspects, including emotions. Based on an extensive literature review, it is proposed that the paradigm changes from food equals health to food means well-being, the latter encompassing physical and physiological aspects as well as psychological, emotional and social aspects at the individual and societal levels. The growing food and nutrition requirements of an aging population are reviewed and special nutritious and enjoyable products available for this group are discussed.
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Affiliation(s)
- José Miguel Aguilera
- Department of Chemical and Bioprocess Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Bum-Keun Kim
- Division of Strategic Food Research, Korea Food Research Institute, Seoul, South Korea
| | - Dong June Park
- Division of Strategic Food Research, Korea Food Research Institute, Seoul, South Korea
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O'Keeffe ST. Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? BMC Geriatr 2018; 18:167. [PMID: 30029632 PMCID: PMC6053717 DOI: 10.1186/s12877-018-0839-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/19/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although modifying diets, by thickening liquids and modifying the texture of foods, to reduce the risk of aspiration has become central to the current management of dysphagia, the effectiveness of this intervention has been questioned. This narrative review examines, and discusses possible reasons for, the apparent discrepancy between the widespread use of modified diets in current clinical practice and the limited evidence base regarding the benefits and risks of this approach. DISCUSSION There is no good evidence to date that thickening liquids reduces pneumonia in dysphagia and this intervention may be associated with reduced fluid intake. Texture-modified foods may contribute to undernutrition in those with dysphagia. Modified diets worsen the quality of life of those with dysphagia, and non-compliance is common. There is substantial variability in terminology and standards for modified diets, in the recommendations of individual therapists, and in the consistency of diets prepared by healthcare staff for consumption. Although use of modified diets might appear to have a rational pathophysiological basis in dysphagia, the relationship between aspiration and pneumonia is not clear-cut. Clinical experience may be a more important determinant of everyday practice than research evidence and patient preferences. There are situations in the management of dysphagia where common sense and the necessity of intervention will clearly outweigh any lack of evidence or when application of evidence-based principles can enable good decision making despite the absence of robust evidence. Nevertheless, there is a significant discrepancy between the paucity of the evidence base supporting use of modified diets and the beliefs and practices of practitioners. CONCLUSION The disconnect between the limited evidence base and the widespread use of modified diets suggests the need for more careful consideration as to when modified diets might be recommended to patients. Patients (or their representatives) have a choice whether or not to accept a modified diet and must receive adequate information, about the potential risks and impact on quality of life as well as the possible benefits, to make that choice. There is an urgent need for better quality evidence regarding this intervention.
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Affiliation(s)
- Shaun T O'Keeffe
- Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland.
- Unit 4, Merlin Park University Hospital, Galway, Ireland.
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