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Hunter CJ, Tulunay-Ugur OE. Dysphagia in the Aging Population. Otolaryngol Clin North Am 2024; 57:685-693. [PMID: 38806319 DOI: 10.1016/j.otc.2024.03.006] [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: 05/30/2024]
Abstract
Older adults are projected to outnumber children aged under 18 years for the first time in United States history by 2034, according to Census Bureau projections. This will lead to significant increase in age-related disorders. One of the most important disorders that will increase in prevalence is dysphagia, as it leads to malnutrition, dehydration, aspiration pneumonia, and death. In this article, the physiology of dysphagia in the elderly, as well as the management options is discussed.
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Affiliation(s)
- Courtney J Hunter
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot 543, Little Rock, AR 72205, USA
| | - Ozlem E Tulunay-Ugur
- Division of Laryngology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot 543, Little Rock, AR 72205, USA.
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2
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Liu M, Chen X, Ma P, Deng M. Summary of the best evidence for the management of dysphagia in elderly patients. Eur Arch Otorhinolaryngol 2024; 281:3893-3901. [PMID: 38459985 DOI: 10.1007/s00405-024-08530-2] [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: 12/11/2023] [Accepted: 02/05/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To search for and summarize the best evidence for themanagement of elderly patients with dysphagia. METHODS Clinical decisions, recommended practices, evidence summaries, clinical practice guidelines, expert consensus, and systematic reviews on the management of dysphagia among elderly patients were systematically reviewed from domestic and foreign guideline websites, association websites, and Chinese and English databases according to the 6S model of evidence-based resources. The search period was between January 1, 2010 and November 1, 2023. Two researchers evaluated the quality of the included literature respectively and extracted evidence. RESULTS A total of 14 literatures were identified, including 2 guidelines, 2 clinical decisions, 5 evidence summaries, 3 expert consensus statements, and 2 systematic reviews. Twenty-four pieces of evidence from 7 aspects were summarized, including assessment, treatment and rehabilitation, medication care, nutrition management, oral care, complication management, and psychological care. CONCLUSION The best evidence-based recommendations for the management of dysphagia in elderly patients is summarized, it is suggested that the best evidence should be selected according to the actual situation of patients, and a personalized management plan should be formulated to improve the quality of life of patients and achieve high-quality nursing.
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Affiliation(s)
- Mengdan Liu
- School of Nursing, Chengdu Medical College, Chengdu, 610000, Sichuan, China
| | - Xushu Chen
- School of Nursing, Chengdu Medical College, Chengdu, 610000, Sichuan, China
| | - Peng Ma
- Intensive Care Unit, Longquanyi District Hospital of Chengdu University of Traditional Chinese Medicine, 783, Xindu Dadao, Xindu District, Chengdu, 610000, Sichuan, China
| | - Min Deng
- The Publicity Division, Neijiang First People's Hospital, Neijiang, 641000, Sichuan, China.
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He X, Yang D, Shao J, Wang H, Zhang H. Mapping Dysphagia Research Trends in Community Dwelling Older Adults: A Bibliometric Analysis. J Multidiscip Healthc 2024; 17:3073-3090. [PMID: 38974375 PMCID: PMC11227311 DOI: 10.2147/jmdh.s461046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 06/17/2024] [Indexed: 07/09/2024] Open
Abstract
Background In recent years, research on dysphagia has gained significant traction as one of the key topics of oral health research pertaining to the aged. Numerous academics have studied dysphagia in great detail and have produced numerous excellent scientific research findings. Objective To review the literature regarding dysphagia in community-dwelling older adults and identify the knowledge and trends using bibliometric methods. Methods The literature on dysphagia in older adults in the community was gathered from the Web of Science Core Collection (WoSCC), with inclusion criteria specifying English-language publications. The retrieval deadline was November 28, 2022. We extracted the following data: title, year, abstract, author, keywords, institution, and cited literature, and used CiteSpace (version 6.1.R3) to visualize the data through the knowledge map, burst keyword analysis, cluster analysis, and collaborative network analysis. Results A total of 979 articles and reviews were retrieved. Regarding productivity, the top 2 countries were the United States (n =239) and Japan (n =236). Hidetaka Wakabayashi (n =26) was one of the most prolific writers. The first paper in the frequency ranking of references cited was a white paper: European Society for Swallowing Disorders and European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome (n =53). "Prevalence" (n =173), "risk factor" (n =119), and "aspiration pneumonia" (n =108) were the most frequently occurring keywords (excluding defining nouns). The study identified reliability, tongue pressure, home discharge, and swallowing function as research hotspots from 2020 to 2022. Conclusion Prevalence, risk factors, and pneumonia are significant areas of study. Tongue pressure and sarcopenia are research hotspots and potential targets. In the future, research on dysphagia needs to refine strategies for prevention and control, as well as provide tertiary preventative services.
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Affiliation(s)
- Xiaona He
- Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, People’s Republic of China
| | - Dan Yang
- Zhejiang Nursing Association, Hangzhou, 310000, People’s Republic of China
| | - Jing Shao
- Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, People’s Republic of China
- Institute of Nursing Research, School of Medicine Zhejiang University, Hangzhou, 310058, People’s Republic of China
| | - Huafen Wang
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Huafang Zhang
- Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, People’s Republic of China
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Venkat S. Improving swallowing function with thickening agents in post-stroke oropharyngeal dysphagia: a real-world experience. Curr Med Res Opin 2024; 40:1163-1170. [PMID: 38864410 DOI: 10.1080/03007995.2024.2365406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/04/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Post-stroke dysphagia (PSD) is a widely prevalent and possibly life-threatening consequence that may lead to aspiration pneumonia, malnutrition, dehydration, and higher mortality risk. Recommending thickened fluids (TF) is a longstanding practice in the management of dysphagia. Augmenting liquid viscosity with a xanthan gum-based thickener benefits patients with PSD by aiding in the enhancement of bolus control, facilitating improved coordination in the swallowing mechanism, and lowering the risk of aspiration. Despite the widespread use of TF, limited high-quality evidence supports its benefits in PSD. CASE REPORT This manuscript presents the clinical experience with four varied cases of PSD. A comprehensive approach to management with TF decreased the risk of aspiration pneumonia and facilitated effective management of dietary recommendations both during hospitalization and after discharge (all Cases). In addition, TF maintained nutrition and hydration in patients with multiple hospital admissions (Case 2), maintained hydration in those unable to engage in swallow rehabilitation due to complex medical conditions (Cases 2, 3, and 4), and those who needed slow and longer recovery due to long-term risk of silent aspiration (Cases 2, 3, and 4). In one case (Case 4), the use of TF was extended for more than two years post-stroke with no reported incidence of chest infection. CONCLUSION In routine clinical practice, a comprehensive management approach with xanthan gum-based TFs reduces the risk of aspiration and aspiration pneumonia in patients with PSD while maintaining nutritional and hydration and improving swallowing function based on formal instrumental assessments. This clinical experience highlights the pivotal role of instrumental assessment, patient education, and informed decision-making to optimize outcomes with TF.
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Yli-Hukka J, Lignell J, Eriksson K, Bergström L. Dysphagia terminology for texture modified fluid and food: a national survey of speech-language pathologists' practice. LOGOP PHONIATR VOCO 2024; 49:47-57. [PMID: 36067123 DOI: 10.1080/14015439.2022.2117844] [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: 11/01/2021] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To investigate: (a) Swedish Speech-Language Pathologists (SLPs) dysphagia management with TMC, including terminology, inter-professional collaboration, and knowledge of standard TMC guides; and (b) the current TMC terminology/guides used within university hospitals, in Sweden. METHOD Part One surveyed SLPs from 19/21 regions. Recruitment occurred via regional SLP/department managers, the national SLP association and email lists. Non-parametric statistics were employed. Part Two explored TMC guides within the seven university hospitals. RESULT The initial survey identified 78 Swedish TMC terms. Overlap of both TMC terms and descriptions occurred. Different terms to describe same/similar textures were used by 70% of the SLPs. Knowledge of established guides was high (>90%), though TMC was often (60%) based on locally developed documents. Collaboration with other professions was reported by 97% of SLPs, however almost half perceived collaboration to be inadequate, citing difficulties with transfer of TMC recommendations. Variance in TMC terms/guides within/across the university hospitals occurred. CONCLUSION Variable TMC terminology is used in Sweden, impacting optimal dysphagia management. Future research should focus upon implementation of standardised TMC terminology.
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Affiliation(s)
- Julia Yli-Hukka
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Neurology and Rehabilitation Medicine, Region Västra Götaland, Södra Älvsborg Hospital, Borås, Sweden
| | - Joanna Lignell
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Allied Health, Møre og Romsdal Hospital Trust, Molde Hospital, Molde, Norway
| | - Karin Eriksson
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Pulmonary Disease, Allergology and Palliative Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Liza Bergström
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- REMEO Stockholm, Torsten Levenstams väg 8, Stockholm, Sweden
- Division of Neurology, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden
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Ocrospoma S, Restrepo MI. Severe aspiration pneumonia in the elderly. JOURNAL OF INTENSIVE MEDICINE 2024; 4:307-317. [PMID: 39035624 PMCID: PMC11258512 DOI: 10.1016/j.jointm.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 07/23/2024]
Abstract
The global population is aging at an unprecedented rate, resulting in a growing and vulnerable elderly population in need of efficient comprehensive healthcare services that include long-term care and skilled nursing facilities. In this context, severe aspiration pneumonia, a condition that carries substantial morbidity, mortality, and financial burden, especially among elderly patients requiring admission to the intensive care unit, has attracted greater concern. Aspiration pneumonia is defined as a pulmonary infection related to aspiration or dysphagia in etiology. Prior episodes of coughing on food or liquid intake, a history of relevant underlying conditions, abnormalities on videofluoroscopy or water swallowing, and gravity-dependent shadow distribution on chest imaging are among the clues that suggest aspiration. Patients with aspiration pneumonia tend to be elderly, frail, and suffering from more comorbidities than those without this condition. Here, we comprehensively address the epidemiology, clinical characteristics, diagnosis, treatment, prevention, and prognosis of severe aspiration community-acquired pneumonia in the elderly to optimize care of this high-risk demographic, enhance outcomes, and minimize the healthcare costs associated with this illness. Emphasizing preventive measures and effective management strategies is vital in ensuring the well-being of our aging population.
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Affiliation(s)
- Sebastian Ocrospoma
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Marcos I. Restrepo
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
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Rugaitienė M, Lesauskaitė V, Ulozienė I, Smičius L, Damulevičienė G. Impact of Modified Diet, Swallowing Exercises, and Electrostimulation on Quality of Life of Older Patients Suffering from Oropharyngeal Dysphagia. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1021. [PMID: 39064450 DOI: 10.3390/medicina60071021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Oropharyngeal dysphagia is defined as a swallowing disorder in which it becomes difficult to form a bolus and move food from the mouth to the proximal part of the esophagus. Several factors can cause this disorder in geriatric patients. With oropharyngeal dysphagia, the patient's social isolation and the risk of depression increase, while the quality of life deteriorates. Materials and Methods: In this study, oropharyngeal dysphagia was suspected based on the EAT-10 questionnaire and diagnosed with the water drink test and endoscopic swallowing evaluation, which assesses the aspiration risk by using an eight-point Penetration-Aspiration scale. Patients with oropharyngeal dysphagia received complex treatment: exercises to strengthen the swallowing muscles, electrostimulation of the swallowing muscles, and a modified diet. The quality of life of 64 patients was assessed by using the DHI, SWAL-QoL, and EAT-10 questionnaires before complex treatment and after treatment. The results show that the quality of life improved after the complex treatment of oropharyngeal dysphagia. Results: The mean age of patients was 77.8 (9.1) years, and 56.3% of patients were women. At baseline, mild oropharyngeal dysphagia was found in 18.8% of patients; moderate-in 51.6%; and severe-in 29.7%. Aspiration risk was low in 28.1% of patients; medium-in 39.1%; and high-in 32.8%. The severity of oropharyngeal dysphagia and aspiration risk significantly decreased after treatment (p = 0.002). The EAT-10 score mean was 15.23 (8.92) points before treatment and decreased to 11.50 (6.12) points after treatment (p < 0.001). Before treatment, the DHI physical score was 15.75 (6.813), the DHI functional score was 14.56 (8.659), and the DHI emotional score was 11.06 (7.848) (p < 0.001), and after complex treatment, the DHI physical score was 14.56 (8.659), the DHI functional score was 9.74 (7.165), and the DHI emotional score was 7.94 (6.588) (p < 0.001). The total SWAL-QoL score mean was 132.71 (34.392) points before treatment and increased to 152.42 (30.547) points after treatment (p < 0.001). Conclusions: Complex treatment of oropharyngeal dysphagia plays an important role in improving the quality of life and reducing aspiration risk in older people affected by this condition.
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Affiliation(s)
- Margarita Rugaitienė
- Clinical Department of Geriatrics, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Vita Lesauskaitė
- Clinical Department of Geriatrics, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Ingrida Ulozienė
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Lukas Smičius
- Department of Infectious Diseases, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Gytė Damulevičienė
- Clinical Department of Geriatrics, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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Suarez-Patiño LV, Roldan-Vasco S, Suarez-Escudero JC, Orozco-Duque A, Perez-Giraldo E. sEMG as complementary tool for VFSS: A synchronized study in patients with neurogenic oropharyngeal dysphagia. J Electromyogr Kinesiol 2024; 78:102913. [PMID: 39004010 DOI: 10.1016/j.jelekin.2024.102913] [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: 03/20/2024] [Revised: 05/24/2024] [Accepted: 06/17/2024] [Indexed: 07/16/2024] Open
Abstract
The neurogenic oropharyngeal dysphagia is a prevalent functional swallowing disorder resulting from neurological causes. The conventional diagnosis involves ionizing radiation in Videofluoroscopy Swallowing Studies (VFSS). Surface electromyography (sEMG) offers a non-invasive alternative by recording muscle activity. This research compares bolus passage timing through anatomical structures using VFSS and sEMG-related activation times. Fifty confirmed oropharyngeal dysphagia patients underwent synchronized VFSS and sEMG, evaluating muscle groups during cracker and fluid ingestion. sEMG revealed activation patterns in masseters, suprahyoid, and infrahyoid muscles, occurring before bolus passage through the mandibular line and concluding near the upper esophageal sphincter complex. sEMG identified differences in dysphagia severity (EAT-10 score), age, and diagnosis, contrasting VFSS results. Results indicate potential complementarity between sEMG and VFSS for dysphagia screening, diagnosis, and monitoring.
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Affiliation(s)
- Laura V Suarez-Patiño
- Facultad de Ciencias Exactas y Aplicadas, Instituto Tecnológico Metropolitano, Medellín, Colombia.
| | | | - Juan Camilo Suarez-Escudero
- Escuela de Ciencias de la Salud, facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | - Estefania Perez-Giraldo
- Facultad de Ciencias Exactas y Aplicadas, Instituto Tecnológico Metropolitano, Medellín, Colombia
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Li H, Li J, Wang X, Zhang Z. A systematic review and meta-analysis of acupuncture in aspiration caused by post-stroke dysphagia. Front Neurol 2024; 15:1305056. [PMID: 38915795 PMCID: PMC11194430 DOI: 10.3389/fneur.2024.1305056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/29/2024] [Indexed: 06/26/2024] Open
Abstract
Objective This systematic review and meta-analysis aims to systematically evaluate the effectiveness and safety of acupuncture in the treatment of aspiration caused by post-stroke dysphagia. Methods A computer search was conducted in nine databases, including the China National Knowledge Infrastructure (CNKI), China Science and Technology Journal (VIP), Wan-fang Database, China Biomedical Literature Database (CBM), PubMed, Web of Science, Cochrane Library, Embase, and Chinese Clinical Trial Registry (ChiCTR), from their inception until April 2024. Clinical randomized controlled trials comparing acupuncture combined therapy or single therapy with control interventions for the treatment of aspiration caused by post-stroke dysphagia were included. The primary outcome measure was the Penetration Aspiration Scale (PAS), and secondary outcome measures included the overall effective rate, video fluoroscopic swallowing study (VFSS), and hyoid bone displacement. The statistical analysis was performed using RevMan 5.3 and Stata 16.0. Results A total of 16 articles involving 1,284 patients were included. The meta-analysis results showed that acupuncture combined therapy or single therapy was more effective in improving PAS scores compared to conventional rehabilitation therapy or balloon dilation of the catheter [WMD = -1.05, 95% CI (-1.30, -0.80), Z = 0.82, p = 0.00 < 0.05]. It was also more effective in improving VFSS scores [WMD = 1.32, 95% CI (0.08, 2.55), Z = 2.09, p = 0.04 < 0.05] and hyoid bone displacement [WMD = 2.02, 95% CI (0.86, 3.18), Z = 3.41, p = 0.00 < 0.05]. Additionally, acupuncture had a higher overall effective rate [WMD = 1.21, 95% CI (1.14, 1.29), Z = 5.76, p = 0.00 < 0.05] and a lower incidence of adverse events. Sensitivity analysis indicated that the literature had minimal impact on the results, and bias tests showed no publication bias. Conclusion Acupuncture combined therapy and acupuncture single therapy can effectively improve aspiration caused by post-stroke dysphagia with a low incidence of adverse events. However, due to the low quality of the included literature, more high-quality randomized controlled trials are still needed to confirm the effectiveness and safety of acupuncture in the treatment of aspiration caused by post-stroke dysphagia. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023462707, identifier CRD42023462707.
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Affiliation(s)
- Hongwei Li
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jie Li
- Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Xu Wang
- Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Zhilong Zhang
- Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
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Borges AFM, Taveira KVM, Eduardo JYM, Cavalcanti RVA. Orofacial and cervical myofunctional intervention programmes for older adults: A scoping review. Gerodontology 2024; 41:183-199. [PMID: 37847803 DOI: 10.1111/ger.12719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Senescent stomatognathic systems undergo anatomical changes that are not always compensated by physiology due to associated factors such as poorly fitted dentures, dental changes, and clinical conditions that trigger sarcopenia. When these conditions are not properly addressed, they can lead to nutritional deficiencies. Hence, this study aimed to map orofacial and cervical myofunctional intervention programmes for older adults, evaluate the current research in this area, and formulate suggestions for further investigation. METHODS Scoping review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. The EMBASE, LILACS, PubMed/Medline, Scopus, Web of Science, and grey literature databases were systematically searched. Studies addressing therapeutic programmes, myofunctional exercises, and their influence on the stomatognathic system of older adults were included. Studies with populations younger than 60 years, residing in long-term care facilities, homes, or hospital care, and with associated comorbidities were excluded, as well as secondary studies. RESULTS A total of 3098 studies were retrieved. After applying the eligibility criteria, nine studies were eligible for this review. The nine studies were published in English between 2008 and 2021 in the United States, Japan, and South Korea. The participants' mean ages ranged from 64 to 81 years, with a preponderance of females. Six of the studies divided the sample into intervention and control groups. Two studies referred to programmes to promote oral function through facial expression and tongue muscle exercises, salivary gland massage, and swallowing biomechanics. Seven studies report the positive influence of myofunctional exercises on the stomatognathic system. CONCLUSION The mapping concluded that therapeutic programmes, including educational actions, help prevent orofacial myofunctional disorders, and improve the functionality of the stomatognathic system.
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Affiliation(s)
- Allya Francisca Marques Borges
- Associated Postgraduate Program in Speech, Language and Hearing Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Research Group Studies in Orofacial Motricity and Oropharyngeal Dysphagia at Federal University of Rio Grande do Norte, Natal, Brazil
| | - Karinna Veríssimo Meira Taveira
- Department of Morphology, Center of Biosciences, Associated Postgraduate Program in Speech, Language and Hearing Sciences, Permanent Researcher of the Research Group Studies in Orofacial Motricity and Oropharyngeal Dysphagia, Federal University of Rio Grande do Norte, Natal, Brazil
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Multicenter Study Group, Brazil
| | | | - Renata Veiga Andersen Cavalcanti
- Department of Speech, Language and Hearing Sciences, Permanent Researcher of the Research Group Studies in Orofacial Motricity and Oropharyngeal Dysphagia, Federal University of Rio Grande do Norte, Natal, Brazil
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11
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Baqué J, Huret O, Rayneau P, Schleich M, Morinière S. Acoustic Analysis of Swallowing of an Experimental Meal of Three Food Textures: A Comparative Aging Study. Dysphagia 2024; 39:452-458. [PMID: 37979004 PMCID: PMC11127804 DOI: 10.1007/s00455-023-10629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
Swallowing disorders in the elderly represent a public health problem, their detections are a medico-economic issue. The acoustic analysis of swallowing has the advantages of being non-invasive with no radiation, compared to videofluoroscopy or fiberoptic swallowing assessments. Acoustic analysis of swallowing has been tested in many studies but only on small food boluses. The aim of this study was to compare the acoustic swallowing parameters of two groups of healthy subjects, before and after 70 years old, during the intake of a series of 3 food textures. A laryngophone was used to record the pharyngeal phase of swallowing. The experimental meal was composed of 100 ml of mashed potatoes, 100 ml of water, and 100 ml of yogurt. Group 1 (50-70 years old) comprised 21 subjects and group 2 (over 70 years old) 23 subjects. Acoustic parameters analyzed were the number of swallows, average duration of swallowing, average duration of inter-swallowing, meal duration, and the average frequency of swallowing per minute. These parameters for groups 1 and 2 were compared. The average duration of inter-swallowing and the meal duration were significantly higher in the older group (p < 0.001), with a mean duration of inter-swallowing that was 2.4 s longer than the younger group. The average swallowing frequency per minute was higher in the younger group (11.3 vs 7.9; p < 0.001). This study demonstrated that acoustic analysis of an experimental meal of three food textures generated usable data on swallowing. In the over 70 age group, there was a decrease in swallowing frequency, indicating a slowdown in food intake. A reduced swallowing frequency could become a criteria to assess presbyphagia.
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Affiliation(s)
- Jean Baqué
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France.
| | - Océane Huret
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
| | - Pierre Rayneau
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
| | - Marianne Schleich
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
| | - Sylvain Morinière
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
- Francois-Rabelais University of Tours, University Hospital of Tours, 10 Boulevard Tonnelé, 37032, Tours, France
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12
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Agnes CS, Nayak S, Devadas U. Prevalence of oropharyngeal dysphagia symptoms in community-dwelling older adults: A community survey. Indian J Gastroenterol 2024; 43:616-627. [PMID: 38105373 DOI: 10.1007/s12664-023-01476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/23/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Dysphagia is a common clinical condition in older adults with significant implications for health and quality of life (QOL). However, its prevalence and associated factors in the Indian community-dwelling older adults remain understudied. The present study aims at identifying the prevalence of oropharyngeal dysphagia symptoms in Indian community-dwelling older adults and identifying the age-related comorbid variables associated with an increased risk of oropharyngeal dysphagia in this population. METHODS Total 384 community-dwelling older adults (60 years of age or older) who were independent in performing daily activities were included in the present study. The Malayalam version of the Eating Assessment Tool-10 (EAT-10) questionnaire was used to assess individuals at risk for dysphagia. Additionally, they also completed a self-report questionnaire addressing age-related comorbid variables associated with an increased risk of oropharyngeal dysphagia. RESULT Using the Malayalam version of the EAT-10, the present study identified the prevalence of oropharyngeal dysphagia symptoms in 9.9% of community-dwelling older adults. Among the EAT-10 symptoms, cough while/after swallowing, difficulty swallowing solids and difficulty swallowing liquids were the most prevalent symptoms reported by participants. Increase in age and age-related comorbidities such as tooth loss, history of heart failure and digestive diseases were found to be significantly associated with the reporting of risk for dysphagia symptoms. CONCLUSION As dysphagia symptoms significantly impact the social, psychological and QOL of community-dwelling older adults, it is important to develop awareness about these symptoms among older adults, caretakers and physicians. Early detection and appropriate management of community-dwelling older adults at risk for dysphagia can contribute to better health outcomes and improved QOL.
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Affiliation(s)
- C S Agnes
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576 104, India
| | - Srikanth Nayak
- Department of Audiology and Speech-Language Pathology, Yenepoya Medical College, Yenepoya University (Deemed to Be University), Mangalore, 575 018, India
| | - Usha Devadas
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576 104, India.
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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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Reyes-Torres CA, Castillo-Martínez L, Ramos-Vázquez AG, Cassis-Nosthas L, Zavala-Solares M, García-de-la-Torre G, Serralde-Zúñiga AE. Effect of a texture-modified and controlled bolus volume diet on all-cause mortality in older persons with oropharyngeal dysphagia: Secondary analysis of a randomized controlled trial. Nutr Clin Pract 2024; 39:665-672. [PMID: 37537941 DOI: 10.1002/ncp.11052] [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: 01/12/2023] [Revised: 07/02/2023] [Accepted: 07/09/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Oropharyngeal dysphagia (OD) is common among older adults. Some studies have evaluated the efficacy of a texture-modified diet on mortality but with short-term follow-up. We aimed to evaluate the effect of a texture-modified diet and controlled bolus volume on all-cause mortality after 12 months in older persons with OD. METHODS This secondary analysis of a randomized clinical trial included patients aged ≥60 years with a diagnosis of OD. They were concurrently and randomly assigned to receive either a texture-modified food diet and controlled bolus volume (intervention group) or standard treatment (control group) with 12 months of follow-up. Secondary outcomes were oral intake, weight, handgrip strength, phase angle, and aspiration pneumonia. Kaplan-Meier analysis and the Cox proportional hazards model were used for mortality analysis. RESULTS A total of 127 participants (intervention group: 64 and control group: 63) were recruited, with a mean age of 76 years. The probability of all-cause mortality was significantly lower in the intervention group (n = 8, 12%) than in the control group (n = 18, 29%) (hazard ratio = 0.36 [95% CI = 0.16-0.86]; P = 0.01). There were 5 (7.9%) and 10 (16.1%) aspiration pneumonia events in the intervention and control groups, respectively (not significant) in 12 months of follow-up. Changes were observed in protein consumption (P = 0.01), body weight (P = 0.04), body mass index (P = 0.004), handgrip strength (P = 0.02), and phase angle (P = 0.04) between the treatment groups. CONCLUSION Compared with the standard treatment, the dietary intervention improved efficacy by limiting nutrition complications, aspiration pneumonia, and all-cause mortality.
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Affiliation(s)
- Carlos A Reyes-Torres
- Posgrado en Ciencias de la Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City, Mexico
| | - Lilia Castillo-Martínez
- Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Aniela G Ramos-Vázquez
- Posgrado en Ciencias de la Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City, Mexico
| | - Lorena Cassis-Nosthas
- Departamento de Ciencia y Tecnología de los Alimentos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Guadalupe García-de-la-Torre
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City, Mexico
| | - Aurora E Serralde-Zúñiga
- Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Guanyabens N, Tomsen N, Palomeras E, Mundet L, Clavé P, Ortega O. Neurophysiological characterization of oropharyngeal dysphagia in older patients. Clin Neurophysiol 2024; 162:129-140. [PMID: 38615499 DOI: 10.1016/j.clinph.2024.03.030] [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: 11/16/2023] [Revised: 03/09/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To characterize swallowing biomechanics and neurophysiology in older patients with oropharyngeal dysphagia (OD). METHODS Observational study in 12 young healthy volunteers (HV), 9 older HV (OHV) and 12 older patients with OD with no previous diseases causing OD (OOD). Swallowing biomechanics were measured by videofluoroscopy, neurophysiology with pharyngeal sensory (pSEP) and motor evoked-potentials (pMEP) to intrapharyngeal electrical and transcranial magnetic stimulation (TMS), respectively, and salivary neuropeptides with enzyme-linked immunosorbent assay (ELISA). RESULTS 83.3% of OOD patients had unsafe swallows (Penetration-Aspiration scale = 4.3 ± 2.1; p < 0.0001) with delayed time to laryngeal vestibule closure (362.5 ± 73.3 ms; p < 0.0001) compared to both HV groups. OOD patients had: (a) higher pharyngeal sensory threshold (p = 0.009) and delayed pSEP P1 and N2 latencies (p < 0.05 vs HV) to electrical stimulus; and (b) higher pharyngeal motor thresholds to TMS in both hemispheres (p < 0.05) and delayed pMEPs latencies (right, p < 0.0001 HV vs OHV/OOD; left, p < 0.0001 HV vs OHV/OOD). CONCLUSIONS OOD patients have unsafe swallow and delayed swallowing biomechanics, pharyngeal hypoesthesia with disrupted conduction of pharyngeal sensory inputs, and reduced excitability and delayed cortical motor response. SIGNIFICANCE These findings suggest new elements in the pathophysiology of aging-associated OD and herald new and more specific neurorehabilitation treatments for these patients.
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Affiliation(s)
- Nicolau Guanyabens
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Neurology Department, Hospital de Mataró, Barcelona, Spain
| | - Noemí Tomsen
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Lluís Mundet
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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Javorszky SM, Palli C, Domkar S, Iglseder B. Combined systematic screening for malnutrition and dysphagia in hospitalized older adults: a scoping review. BMC Geriatr 2024; 24:445. [PMID: 38773449 PMCID: PMC11110417 DOI: 10.1186/s12877-024-05070-6] [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: 03/12/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Dysphagia affects about 40% of patients admitted to acute geriatric wards, as it is closely associated with diseases that rise in prevalence with advancing age, such as stroke, Parkinson's disease, and dementia. Malnutrition is a highly associated predictive factor of dysphagia as well as one of the most common symptoms caused by dysphagia. Thus, the two conditions may exist simultaneously but also influence each other negatively and quickly cause functional decline especially in older adults. The purpose of this review was to determine whether institutions have established a protocol combining screenings for dysphagia and malnutrition on a global scale. If combined screening protocols have been implemented, the respective derived measures will be reported. METHODS A scoping review was conducted. A systematic database search was carried out in January and February 2024. Studies were included that examined adult hospitalized patients who were systematically screened for dysphagia and malnutrition. The results were managed through the review software tool Covidence. The screening of titles and abstracts was handled independently by two reviewers; conflicts were discussed and resolved by consensus between three authors. This procedure was retained for full-text analysis and extraction. The extraction template was piloted and revised following feedback prior to extraction, which was carried out in February 2024. RESULTS A total of 2014 studies were found, 1075 of which were included for abstract screening, 80 for full text screening. In the end, 27 studies were extracted and reported following the reporting guideline PRISMA with the extension for Scoping Reviews. CONCLUSION Most of the studies considered the prevalence and association of dysphagia and malnutrition with varying outcomes such as nutritional status, pneumonia, oral nutrition, and swallowing function. Only two studies had implemented multi-professional nutrition teams.
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Affiliation(s)
- Susanne M Javorszky
- Institute of Nursing Science and Research, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
- FH Campus Wien, Department of Health Sciences, Favoritenstraße, 226, 1100, Vienna, Austria.
| | - Christoph Palli
- FH Joanneum, Institute of Health and Nursing, Alte Post Straße 149, 8020, Graz, Austria
| | - Susanne Domkar
- FH Campus Wien, Department of Health Sciences, Favoritenstraße, 226, 1100, Vienna, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria
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17
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Fan Y, Shi Y, Wu Y, Yang F, Zhang C, Gu M, Hu P, Duan W, Wang H, Zhou Y. A nomogram-based prediction model for dysphagia in patients with chronic obstructive pulmonary disease: A cross-sectional study. J Clin Nurs 2024. [PMID: 38764243 DOI: 10.1111/jocn.17208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/21/2024] [Accepted: 04/27/2024] [Indexed: 05/21/2024]
Abstract
AIM AND OBJECTIVES To investigate the prevalence of dysphagia in patients with COPD, identify the risk factors for dysphagia, develop a visual clinical prediction model and quantitatively predict the probability of developing dysphagia. BACKGROUND Patients with COPD are at high risk of dysphagia, which is strongly linked to the acute exacerbation of their condition. The use of effective tools to predict its risk may contribute to the early identification and treatment of dysphagia in patients with COPD. DESIGN A cross-sectional design. METHODS From July 2021 to April 2023, we enrolled 405 patients with COPD for this study. The clinical prediction model was constructed according to the results of a univariate analysis and a logistic regression analysis, evaluated by discrimination, calibration and decision curve analysis and visualized by a nomogram. This study was reported using the TRIPOD checklist. RESULTS In total, 405 patients with COPD experienced dysphagia with a prevalence of 59.01%. A visual prediction model was constructed based on age, whether combined with cerebrovascular disease, chronic pulmonary heart disease, acute exacerbation of COPD, home noninvasive positive pressure ventilation, dyspnoea level and xerostomia level. The model exhibited excellent discrimination at an AUC of .879. Calibration curve analysis indicated a good agreement between experimental and predicted values, and the decision curve analysis showed a high clinical utility. CONCLUSION The model we devised may be used in clinical settings to predict the occurrence of dysphagia in patients with COPD at an early stage. RELEVANCE TO CLINICAL PRACTICE The model can help nursing staff to calculate the risk probability of dysphagia in patients with COPD, formulate personalized preventive care measures for high-risk groups as soon as possible to achieve early prevention or delay of dysphagia and its related complications and improve the prognosis. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Ying Fan
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Yuxin Shi
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, China
| | - Yunyun Wu
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Fang Yang
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Chao Zhang
- Xiangyang Hospital affiliated to of Hubei University of Chinese Medicine, Xiangyang, China
| | - Mengjun Gu
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Pengchao Hu
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | | | - Hongli Wang
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Yumei Zhou
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
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Martell P, Skogar Ö, Bergström L. Swallowing Characteristics and Water Swallow Capacity in Patients with Parkinsonism. Dysphagia 2024:10.1007/s00455-024-10685-3. [PMID: 38703231 DOI: 10.1007/s00455-024-10685-3] [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: 03/29/2023] [Accepted: 02/09/2024] [Indexed: 05/06/2024]
Abstract
Prevalence and characteristics of dysphagia (including aspiration) in patients with parkinsonism is variable, depending on type of assessment, diagnosis, disease stage and duration. The aim of this study was to further evaluate dysphagia characteristics in patients with different types of parkinsonism with both instrumental (Flexible Endoscopic Evaluation of Swallowing, FEES) and non-instrumental (Timed Water Swallow Test, TWST) assessments. Swallowing characteristics in 74 patients with parkinsonism were prospectively assessed using FEES and TWST. Statistics employed were (a) Spearman rank correlation to measure correlation between dysphagia results and Parkinson subtypes, disease severity and duration and (b) the non-parametric tests Mann Whitney U and Kruskal Wallis to measure difference between groups. Dysphagia was common, with 50 (67.6%) of the patients demonstrating a mild-severe Dysphagia Outcome Severity Scale (DOSS, level 1-5). During FEES, 42% aspirated and 68% of these had silent aspiration. Aspiration was seen more frequently with increased disease severity as per Hoehn and Yahr (H&Y) (r = .459, p = < 0.001) and disease duration (r = .269, p = .021). Thin liquid (IDDSI level 0) was the most common consistency to aspirate, and the frequency of aspiration decreased with thicker liquids. Dysphagia and aspiration are common in all subgroups of parkinsonism and seen in early stages of H&Y and within the first year of disease duration. Hence, it is recommended that these patients are evaluated early for optimal management and to avoid aspiration-related complications.
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Affiliation(s)
- Per Martell
- Department of Speech and Language Pathology, Region Halland, 30185, Halmstad, Sweden
- Logopedics, Phoniatrics and Audiology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Örjan Skogar
- Faculty of Medicine, University of Lund, Lund, Sweden
| | - Liza Bergström
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Remeo Stockholm, Torsten Levenstams väg 8, SE-128 64, Stockholm, Sweden.
- Department of Clinical Sciences, Division of Neurology, Karolinska Institute, Danderyd University Hospital, SE-182 88, Stockholm, Sweden.
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19
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Terano K, Motoi T, Nagata E, Oho T. Association of remaining tooth number with postoperative respiratory complications in heart valve surgery patients. Int J Dent Hyg 2024; 22:394-400. [PMID: 36760162 DOI: 10.1111/idh.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/23/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES This study examined the association between the number of remaining teeth and the incidence of postoperative respiratory complications in patients undergoing heart valve surgery. METHODS We retrospectively enrolled 157 patients who underwent heart valve surgery between April 2010 and March 2019. Data on patient characteristics including systemic and oral conditions were extracted and postoperative respiratory complications were set as outcomes. Patients were divided into two groups according to the number of remaining teeth (≥20, <20). After adjusting for confounding factors with propensity scoring, logistic regression analysis was performed to examine the association of remaining teeth number with the incidence of postoperative respiratory complications. In addition, subgroup analysis was performed by stratifying the data into quintiles based on the propensity score. RESULTS Univariate analysis showed significant differences between the two groups in factors, including age, past cardiac surgery experience, New York Heart Association functional classification class IV, denture use, tooth extraction before surgery, occlusal support, and periodontitis. Logistic regression analysis showed that patients with <20 remaining teeth had a significantly higher incidence of postoperative respiratory complications than those with ≥20 remaining teeth, with an odds ratio of 29.800 (p = 0.004). Subgroup analysis showed that the odds ratio for the patients with <20 remaining teeth was 9.000 (p = 0.038). CONCLUSIONS The results suggest that heart valve surgery patients shall get attention on oral disease prevention by dental care practitioners to maintain a sufficient number of teeth for the prevention of postoperative respiratory complications.
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Affiliation(s)
- Kurara Terano
- Division of Clinical Technology, Kagoshima University Hospital, Kagoshima, Japan
| | - Toshihiro Motoi
- Department of Preventive Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Emi Nagata
- Division of Preventive Dentistry, Kagoshima University Hospital, Kagoshima, Japan
| | - Takahiko Oho
- Department of Preventive Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Guo X, Mu H, Sun Y, Wang J, Wei J. Analysis of the Improvement Effect of Combined Application of Oral Rehabilitation Training and Neuromuscular Electrical Stimulation on Pediatric Swallowing Disorders. Int J Neurosci 2024:1-10. [PMID: 38651277 DOI: 10.1080/00207454.2024.2346802] [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: 03/22/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024]
Abstract
Pediatric swallowing disorders are common yet often overlooked neuro-muscular system diseases that significantly impact the quality of life and development of affected children. This study aims to explore the effect of combined application of oral rehabilitation training and neuromuscular electrical stimulation on improving pediatric swallowing disorders. Children meeting the inclusion criteria for swallowing disorders were divided into control and experimental groups based on different intervention protocols. The experimental group received combined oral rehabilitation training and neuromuscular electrical stimulation, while the control group received only oral rehabilitation training. Results showed that the intervention was more effective in the experimental group, with shorter recovery time for normal swallowing function and improved nutritional status and quality of life. This study provides scientific evidence for clinical treatment of pediatric swallowing disorders. In conclusion, the combined application of oral rehabilitation training and neuromuscular electrical stimulation effectively improves pediatric swallowing disorders, with superior efficacy compared to single treatment methods. Further research is needed to elucidate the mechanism of action and optimize treatment protocols to enhance the therapeutic outcomes and prognosis of pediatric swallowing disorders.
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Affiliation(s)
- Xiangjun Guo
- Stomatology clinic of Cangzhou central hospital, Hebei Province, China
| | - Hong Mu
- Stomatology clinic of Cangzhou central hospital, Hebei Province, China
| | - Yang Sun
- Stomatology clinic of Cangzhou central hospital, Hebei Province, China
| | - Jing Wang
- Stomatology clinic of Cangzhou central hospital, Hebei Province, China
| | - Jianming Wei
- Stomatology clinic of Cangzhou central hospital, Hebei Province, China
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21
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Dodderi T, Sreenath D, Shetty MJ, Chilwan U, Rai SPV, Moolambally SR, Balasubramanium RK, Kothari M. Prevalence of Self-Reported Swallowing Difficulties and Swallowing-Related Quality of Life Among Community-Dwelling Older Adults in India. Dysphagia 2024:10.1007/s00455-024-10696-0. [PMID: 38637434 DOI: 10.1007/s00455-024-10696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
Self-reported swallowing difficulties are highly prevalent but underreported among older adults. The aging population in India is increasing, yet there is a lack of empirical data on self-reported swallowing difficulties in older adults. In the present study, we aimed to estimate the prevalence of self-reported swallowing difficulties and assess the swallowing-related quality of life (QOL) among community-dwelling older adults in India. We recruited 361 older adults (60-91 years) from the community. Participants completed the Eating Assessment Tool-10 (EAT-10) to assess self-reported swallowing difficulties and the Dysphagia Handicap Index (DHI) to assess swallowing-related QOL. Participants rated the EAT-10 from 0 for 'no problem' to 4 for 'severe problem'. The DHI rating included 0 for 'never', 2 for 'sometimes', and 4 for 'always'. The total scores of EAT-10 and DHI were summarised using descriptive statistics. Statistically significant differences between pass-fail groups of EAT-10 and DHI were evaluated using an independent t-test and multivariate analysis of variance test, respectively. The overall mean score for EAT-10 was 3.34, and 7.56 for DHI, with higher scores observed among females. 36.6% of older adults self-reported experiencing swallowing difficulties, while 47.4% self-reported having poor swallowing-related QOL at p < 0.05. A strong positive correlation (r = 0.86) was found between EAT-10 and total DHI scores at p < 0.001. The present study sheds light on the widespread yet underreported issue of self-reported swallowing difficulties and the impact on swallowing-related QOL among older adults in India. These findings emphasize the urgent need for early swallowing screening programs among older adults.
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Affiliation(s)
- Thejaswi Dodderi
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Drishti Sreenath
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Mahima Jayaram Shetty
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Uzair Chilwan
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Santosh P V Rai
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Sheetal Raj Moolambally
- Department of General Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Radish Kumar Balasubramanium
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - Mohit Kothari
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
- Hammel Neurorehabilitation Center and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
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22
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Jung ES, Choi YY, Lee KH. Smartphone-based combined oral and whole-body exercise programme aimed at improving oral functions: A randomized clinical trial. Int J Dent Hyg 2024. [PMID: 38606673 DOI: 10.1111/idh.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES To investigate the effects of a smartphone-based oral and whole-body exercise programme on oral function in older adults. METHODS Individuals aged 65 years or above were randomized into three groups (non-app use, app use and control group), and a combined oral and whole-body exercise programme was conducted for 5 weeks. Oral muscle strength, saliva flow rate, Oral Health Impact Profile-14 (OHIP-14), and Geriatric Oral Health Assessment Index (GOHAI) were measured before and after the intervention. The changes in each group were analysed at the end of the programme using paired sample t-tests, and the differences among the groups were analysed using the chi-square test, Fisher's exact test and ANOVA. RESULTS The anterior tongue strength increased by 2.80 kPa after the intervention in the non-app use group; however, the change was not statistically significant. In the app use group, the anterior tongue strength significantly increased by 4.48 kPa. The saliva flow rate increased by 0.54 and 0.71 g/min in the non-app and app use groups, respectively, after the intervention (p < 0.05), and the change was greater in the app use group than in the other groups (p < 0.01). There were no significant changes in the posterior tongue strength, cheek strength, OHIP-14 or GOHAI scores over the course of the study. CONCLUSIONS A smartphone-based combined oral and whole-body exercise programme can improve anterior tongue strength and saliva flow rate in older participants. The programme, however, did not result in significant changes in posterior tongue strength, cheek strength and perceived oral health.
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Affiliation(s)
- Eun Seo Jung
- BK21 FOUR R&E Center for Learning Health Systems and Department of Public Health Science, Graduate School, Korea University, Seoul, Korea
| | - Yoon Young Choi
- Department of Dental Hygiene, College of Bioecological Health, Shinhan University, Uijeongbu, Korea
| | - Kyeong Hee Lee
- Department of Dental Hygiene, College of Bioecological Health, Shinhan University, Uijeongbu, Korea
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23
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Su J, Li Y, Xu Z, Sun D, Zhu X, Dong Y, He M, Bu B, Sun J. Effect of thickened water swallow training in tube-feeding and dysphagia patients in the acute and early subacute phases of stroke: A quasi-experimental study. J Oral Rehabil 2024; 51:743-753. [PMID: 38126235 DOI: 10.1111/joor.13645] [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: 07/28/2022] [Revised: 09/30/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Thickened water has been widely used in patients with dysphagia who receive oral feeding, but there is little evidence for tube-feeding patients. OBJECTIVE To explore the effects of thickened water swallow training in tube-feeding and dysphagia patients in the acute and early subacute phases of stroke. METHODS A quasi-experimental study. Hospitalised patients with acute and early subacute stroke who received tube feeding due to dysphagia were recruited from March to December 2021. Patients assigned to the intervention group (n = 23) received thickened water swallow training three times daily until the feeding tube was removed or they were discharged, and patients in the control group (n = 23) received usual care. The main outcomes were duration of tube feeding and rates of weaning at discharge. RESULTS Patients in the intervention group had a shorter tube-feeding duration (p = .046) and a higher rate of weaning at discharge (p = .017) than those in the control group. Significant interaction effects between time and group were detected regarding quality of life except for the swallowing burden dimension. CONCLUSIONS Thickened water swallow training is feasible and effective for stroke patients with tube feeding and can shorten the duration of tube feeding and improve the rates of weaning and quality of life. Healthcare providers in nonrehabilitation units should actively conduct swallowing function intervention training to maximise the potential for acute and early subacute phase rehabilitation.
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Affiliation(s)
- Jianping Su
- School of Nursing, Jilin University, Changchun, Jilin, China
- School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yijing Li
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Zhihua Xu
- China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Dan Sun
- China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Xiangning Zhu
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Yueyang Dong
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Meng He
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Buyin Bu
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Jiao Sun
- School of Nursing, Jilin University, Changchun, Jilin, China
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24
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Sasegbon A, Cheng I, Hamdy S. The neurorehabilitation of post-stroke dysphagia: Physiology and pathophysiology. J Physiol 2024. [PMID: 38517302 DOI: 10.1113/jp285564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
Swallowing is a complex process involving the precise contractions of numerous muscles of the head and neck, which act to process and shepherd ingested material from the oral cavity to its eventual destination, the stomach. Over the past five decades, information from animal and human studies has laid bare the complex network of neurones in the brainstem, cortex and cerebellum that are responsible for orchestrating each normal swallow. Amidst this complexity, problems can and often do occur that result in dysphagia, defined as impaired or disordered swallowing. Dysphagia is common, arising from multiple varied disease processes that can affect any of the neuromuscular structures involved in swallowing. Post-stroke dysphagia (PSD) remains the most prevalent and most commonly studied form of dysphagia and, as such, provides an important disease model to assess dysphagia physiology and pathophysiology. In this review, we explore the complex neuroanatomical processes that occur during normal swallowing and PSD. This includes how strokes cause dysphagia, the mechanisms through which natural neuroplastic recovery occurs, current treatments for patients with persistent dysphagia and emerging neuromodulatory treatments.
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Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
- Academic Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
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25
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Verma H, Kumar S, Sharma A, Mishra R, Nagamani B. Swallowing dysfunction between the community-living older adults with and without comorbid conditions using Patient-Reported Outcome Measures (PROM). Geriatr Nurs 2024; 56:64-73. [PMID: 38301436 DOI: 10.1016/j.gerinurse.2023.12.020] [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: 09/29/2023] [Revised: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The present study aimed to investigate older adults' perspective on their swallowing physiology using a PROM tool. The study further explored the swallowing issues among older adults with and without comorbid conditions. METHOD One hundred twenty-two (122) participants participated in the e-survey. A questionnaire was developed to assess the swallowing deficits among older adults, and Eating Assessment Tool-10 (EAT-10) was administered to assess the PROM. RESULTS The results revealed that 40% of older adults with comorbid conditions had EAT-10 scores greater than 3, suggesting swallowing deficits. A significant difference was observed between the two groups with respect to swallowing deficits, as reported on EAT-10. CONCLUSION Based on the results, it can be delineated that swallowing deficits emerge with aging. More of older adults with comorbid conditions reported swallowing deficits in comparison to those without comorbid conditions. Hence, their nutritional and health status gets compromised, leading to poor quality of life.
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Affiliation(s)
- Himanshu Verma
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabh Kumar
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Sharma
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Roshani Mishra
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Banumathy Nagamani
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Márquez-Sixto A, Navarro-Esteva J, Batista-Guerra LY, Simón-Bautista D, Rodríguez-de Castro F. Prevalence of Oropharyngeal Dysphagia and Its Value as a Prognostic Factor in Community-Acquired Pneumonia: A Prospective Case-Control Study. Cureus 2024; 16:e55310. [PMID: 38559503 PMCID: PMC10981800 DOI: 10.7759/cureus.55310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Although oropharyngeal dysphagia (OD) is a common finding in patients with community-acquired pneumonia (CAP), specific recommendations are not provided in the current clinical guidelines. OBJECTIVES To estimate the prevalence of OD and its associated factors among patients hospitalized for CAP and to assess one-year outcomes according to the presence or absence of OD. METHODS We studied 226 patients hospitalized for CAP and 226 patients hospitalized for respiratory conditions other than CAP. We screened the risk of OD using the Eating Assessment Tool-10 (EAT-10), followed by the volume-viscosity swallow test (V-VST). RESULTS A total of 122 (53.9%) patients with CAP had confirmed OD compared with 44 (19.4%) patients without CAP. Patients with CAP and OD were older (p < 0.001; 1.02-1.07) and had less familial/institutional support (p = 0.036; 0.12-0.91) compared to patients with CAP and no OD. OD was more prevalent as the CURB-65 score increased (p < 0.001). Patients with OD spent more time in the hospital (14.5 vs. 11.0 days; p = 0.038) and required more visits to the emergency room (ER). Twenty (16.4%) patients with CAP and OD died after discharge vs. one (0.8%) patient with CAP and no OD (p < 0.001; CI = 2.24-42.60). CONCLUSIONS The prevalence of OD in hospitalized patients with CAP is higher than in patients hospitalized for other respiratory diagnoses. Advanced age, lower familial/institutional support, and increased CAP severity are associated with OD. Patients with CAP and OD are more frequent ER visitors after discharge and have a higher mortality. In patients with CAP and OD, aspiration pneumonia is likely underestimated.
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Affiliation(s)
- Amando Márquez-Sixto
- Pulmonary Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, ESP
| | - Javier Navarro-Esteva
- Pulmonary Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, ESP
| | - Lucía Yomara Batista-Guerra
- Physical Medicine and Rehabilitation, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, ESP
| | - David Simón-Bautista
- Physical Medicine and Rehabilitation, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, ESP
| | - Felipe Rodríguez-de Castro
- Pulmonary Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, ESP
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27
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Zagloul MM, Bock JM, Blumin JH, Friedland DR, Adams JA, Tong L, Osinksi KI, Khani M, Luo J. Evaluation of Social Determinants of Health on Dysphagia Care Pathways at a Tertiary Care Facility. Laryngoscope 2024; 134:1139-1146. [PMID: 37681733 DOI: 10.1002/lary.31040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Limited research exists evaluating the impact of social determinants of health in influencing care pathways for patients with dysphagia. A better understanding of whether these determinants correlate to altered care and resource utilization is essential as it relates to patient outcomes. STUDY DESIGN Retrospective chart review. METHODS All adult patients seen at a tertiary midwestern hospital were screened for ICD codes of dysphagia diagnoses from 2009 to 2019. Demographic information was collected from these patients with dysphagia including sex, race, ethnicity, and insurance status. Subgroup analysis was performed to assess referral pattern rates and types of diagnostic interventions ordered (none, videofluoroscopic swallow study, esophagram, and esophagogastroduodenoscopy). RESULTS A total of 31,858 patients with dysphagia were seen at our institution during the study period, with a majority being female (56.36%), Caucasian (79.83%), and publicly insured (63.16%), at a median age of 60.35 years. There were no significant care delivery pattern differences based on geography/zip code analyses. African American patients were significantly more likely to have imaging or interventions performed (odds ratio [OR] 1.463, p = 0.005). Patients with public insurance also had higher rates of diagnostic study utilization (OR 1.53, p = 0.01). Only 3% of all patients with dysphagia were seen by laryngologists. CONCLUSION No significant differences were seen in dysphagia evaluation modalities based on zip code analyses surrounding this tertiary care facility. African American patients and those with public insurance had significantly higher utilization of subsequent testing and intervention for dysphagia care. Further studies are necessary to delineate causes and outcome differences for these measurable differences in dysphagia care pathways. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1139-1146, 2024.
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Affiliation(s)
- Maie M Zagloul
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Jonathan M Bock
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Joel H Blumin
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - David R Friedland
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Jazzmyne A Adams
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Ling Tong
- Department of Health Informatics and Administration, University of Wisconsin - Milwaukee, Milwaukee, Wisconsin, U.S.A
| | - Kristen I Osinksi
- Clinical and Translational Science Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Masoud Khani
- Department of Engineering and Applied Science, University of Wisconsin - Milwaukee, Milwaukee, Wisconsin, U.S.A
| | - Jake Luo
- Department of Health Informatics and Administration, University of Wisconsin - Milwaukee, Milwaukee, Wisconsin, U.S.A
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28
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Putri AR, Chu YH, Chen R, Chiang KJ, Banda KJ, Liu D, Lin HC, Niu SF, Chou KR. Prevalence of swallowing disorder in different dementia subtypes among older adults: a meta-analysis. Age Ageing 2024; 53:afae037. [PMID: 38536471 DOI: 10.1093/ageing/afae037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Ageing process and abnormal protein accumulation in dementia damage neural pathways affecting the swallowing process and leading to swallowing disorder. OBJECTIVE To estimate the prevalence of swallowing disorder among older adults with different dementia subtypes. METHODS We conducted a systematic search across multiple databases, including PubMed, Embase, Scopus, Web of Science and OVID Medline. The meta-analysis employed R (version 4.0.2) and utilised a generalised linear mixed model with a random-effect approach to estimate the pooled prevalence of swallowing disorder among older adults, considering various dementia subtypes. The quality of included studies was assessed using Hoy's criteria. Heterogeneity was identified through Cochrane's Q and I2 statistics. To further explore heterogeneity, moderator analysis was performed to identify the contributing variables among the included studies. RESULTS Eighteen studies with 12,532 older adults with different dementia subtypes were enrolled in our meta-analysis. The pooled prevalence of swallowing disorder among older adults with dementia was 58%, with 46.5% for Alzheimer's dementia, 34.9% for Parkinson's dementia, 18.8% for vascular dementia, 16.3% for mixed dementia and 12.2% for Lewy body dementia. According to assessment tools, Alzheimer's dementia had the highest prevalence, with 58% in instrumental assessments and 39% in clinical assessments. Medical history, Alzheimer's dementia, moderate-to-severe Clinical Dementia Rating, delayed oral phase, delayed pharyngeal phase and poor tongue motility contributed to the heterogeneity of the included studies. CONCLUSIONS More than half of older adults with dementia demonstrate to have swallowing disorder. Our findings offer valuable insights to healthcare professionals for the identification of swallowing disorder in ageing population with dementia.
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Affiliation(s)
- Alfiani Rahmi Putri
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
| | - Yu-Hao Chu
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei City 110, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
| | - Kai-Jo Chiang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
- School of Nursing, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Nursing, Tri-Service General Hospital, Taipei City 114202, Taiwan
| | - Kondwani Joseph Banda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
- Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Ministry of Health, Lilongwe, Malawi
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei City 116, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei City 116, Taiwan
| | - Hui-Chen Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei City 116, Taiwan
| | - Shu-Fen Niu
- Department of Nursing, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City 111, Taiwan
- Department of Nursing, Fu Jen Catholic University, New Taipei City 242062, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City 110, Taiwan
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei City 110, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei City 116, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei City 110, Taiwan
- Research Center for Neuroscience, Taipei Medical University, Taipei City 110, Taiwan
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Kusama T, Takeuchi K, Kiuchi S, Aida J, Osaka K. Poor oral health and dementia risk under time-varying confounding: A cohort study based on marginal structural models. J Am Geriatr Soc 2024; 72:729-741. [PMID: 38064294 DOI: 10.1111/jgs.18707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Bidirectional association between oral health, including tooth loss and oral hypofunction, and cognitive impairment can induce time-varying confounding in association with dementia. This study aimed to investigate the association between oral health and the development of dementia among older adults, considering cognitive impairment as a time-varying confounder. METHODS This nine-year follow-up cohort study targeted independent older adults aged ≥65 years who participated in the Japan Gerontological Evaluation Study. The exposure variables were self-reported poor oral health (≤19 remaining teeth, edentulousness, chewing difficulty, swallowing problems, and xerostomia), which were assessed in 2010 and 2013. The outcome variable was the incidence of dementia between 2013 and 2019, which was obtained from the municipalities' administrative database. Furthermore, in 2010 and 2013, we considered cognitive impairment as a time-varying confounder and treated it based on a marginal structural model (MSM), including possible baseline confounders. Oral health and cognitive impairment were assessed using the items of Kihon checklist. We employed a Cox proportional hazards model with a stabilized inverse probability weight and estimated hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Among 37,556 participants (mean age: 72.8 years [1 SD = 5.5], males: 46.8%), the dementia incidence rate was 2.2/100 person-year. The proportions of those with ≤19 remaining teeth, edentulousness, chewing difficulty, swallowing problems, and xerostomia were 61.3%, 11.0%, 24.4%, 14.7%, and 19.2%, respectively. From the regression analysis based on MSM, ≤19 remaining teeth (HR = 1.12, 95% CI = 1.03-1.23), edentulousness (HR = 1.20, 95% CI = 1.09-1.32), chewing difficulty (HR = 1.11, 95% CI = 1.02-1.21), and xerostomia (HR = 1.10, 95% CI = 1.01-1.20) were significantly associated with an increased risk of dementia; however, swallowing problems were not significantly associated with dementia onset (p > 0.05). CONCLUSIONS Even after considering time-varying confounding by cognitive function at baseline and follow-up, we observed significant associations between poor oral health and increased risk of dementia among older adults.
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Affiliation(s)
- Taro Kusama
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Kenji Takeuchi
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sakura Kiuchi
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Miyagi, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
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Pullen D, Pillay BS, Krüger E. Tube feeding in advanced dementia: Insights from South African speech-language therapists. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2024; 71:e1-e11. [PMID: 38426734 PMCID: PMC10913100 DOI: 10.4102/sajcd.v71i1.970] [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: 03/09/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Speech-language therapists (SLTs) may recommend tube feeding even with minimal research evidence of its effectiveness, and an understanding of SLTs' perceived practices is warranted. OBJECTIVES To qualitatively describe a sample of South African SLTs' perceived practices regarding feeding tube placement in people with advanced dementia. METHOD Semi-structured online interviews were conducted via Microsoft Teams. Eight South African SLTs with a particular interest in advanced dementia, in public and private settings, were recruited. Data were analysed using inductive reflexive thematic analysis. RESULTS Three main themes were identified: (1) factors influencing SLTs' decisions for feeding tube placement in people with advanced dementia; (2) nature of clinical setting and SLTs' decision-making and (3) SLTs' considerations to improve management of people with advanced dementia. Existing local palliative care guidelines were not employed in decisions about tube feeding. Most participants did not recommend tube feeding during end-of-life care. Perceived burden of care influenced participants' decisions about tube feeding. CONCLUSION Speech-language therapists in South Africa likely have an increased reliance on clinical experience rather than recent research and guidelines for decisions about feeding tube placement. Findings accentuate the importance of clinical supervision, mentoring and continuous professional development in the workplace. The findings are an urgent call to action to improve SLTs' overall practices and ethical service delivery for people with advanced dementia and their families.Contribution: Factors and needs regarding SLTs' decision-making about feeding tubes in people with advanced dementia are highlighted.
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Affiliation(s)
- Danette Pullen
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria.
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31
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Chen J, Lu G, Wang Z, Zhang J, Ding J, Zeng Q, Chai L, Zhao L, Yu H, Li Y. Prediction Models for Dysphagia in Intensive Care Unit after Mechanical Ventilation: A Systematic Review and Meta-analysis. Laryngoscope 2024; 134:517-525. [PMID: 37543979 DOI: 10.1002/lary.30931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/16/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Dysphagia is a common condition that can independently lead to death in patients in the intensive care unit (ICU), particularly those who require mechanical ventilation. Despite extensive research on the predictors of dysphagia development, consistency across these studies is lacking. Therefore, this study aimed to identify predictors and summarize existing prediction models for dysphagia in ICU patients undergoing invasive mechanical ventilation. METHODS We searched five databases: PubMed, EMBASE, Web of Science, Cochrane Library, and the China National Knowledge Infrastructure. Studies that developed a post-extubation dysphagia risk prediction model in ICU were included. A meta-analysis of individual predictor variables was performed with mixed-effects models. The risk of bias was assessed using the prediction model risk of bias assessment tool (PROBAST). RESULTS After screening 1,923 references, we ultimately included nine studies in our analysis. The most commonly identified risk predictors included in the final risk prediction model were the length of indwelling endotracheal tube ≥72 h, Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥15, age ≥65 years, and duration of gastric tube ≥72 h. However, PROBAST analysis revealed a high risk of bias in the performance of these prediction models, mainly because of the lack of external validation, inadequate pre-screening of variables, and improper treatment of continuous and categorical predictors. CONCLUSIONS These models are particularly susceptible to bias because of numerous limitations in their development and inadequate external validation. Future research should focus on externally validating the existing model in ICU patients with varying characteristics. Moreover, assessing the acceptance and effectiveness of the model in clinical practice is needed. LEVEL OF EVIDENCE NA Laryngoscope, 134:517-525, 2024.
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Affiliation(s)
- Juan Chen
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Guangyu Lu
- Institute of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Zhiyao Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Jingyue Zhang
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Jiali Ding
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Qingping Zeng
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Liying Chai
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
- Institute of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Li Zhao
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
- Institute of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Hailong Yu
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yuping Li
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
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Liu T, Zheng J, Du J, He G. Food Processing and Nutrition Strategies for Improving the Health of Elderly People with Dysphagia: A Review of Recent Developments. Foods 2024; 13:215. [PMID: 38254516 PMCID: PMC10814519 DOI: 10.3390/foods13020215] [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: 11/28/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Dysphagia, or swallowing difficulty, is a common morbidity affecting 10% to 33% of the elderly population. Individuals with dysphagia can experience appetite, reduction, weight loss, and malnutrition as well as even aspiration, dehydration, and long-term healthcare issues. However, current therapies to treat dysphagia can routinely cause discomfort and pain to patients. To prevent these risks, a non-traumatic and effective treatment of diet modification for safe chewing and swallowing is urgently needed for the elderly. This review mainly summarizes the chewing and swallowing changes in the elderly, as well as important risk factors and potential consequences of dysphagia. In addition, three texture-modified food processing strategies to prepare special foods for the aged, as well as the current statuses and future trends of such foods, are discussed. Nonthermal food technologies, gelation, and 3D printing techniques have been developed to prepare soft, moist, and palatable texture-modified foods for chewing and swallowing safety in elderly individuals. In addition, flavor enhancement and nutrition enrichment are also considered to compensate for the loss of sensory experience and nutrients. Given the trend of population aging, multidisciplinary cooperation for dysphagia management should be a top priority.
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Affiliation(s)
- Ting Liu
- Key Laboratory of Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China;
| | - Jianheng Zheng
- Nutrilite Health Institute, Shanghai 200032, China; (J.Z.); (J.D.)
| | - Jun Du
- Nutrilite Health Institute, Shanghai 200032, China; (J.Z.); (J.D.)
| | - Gengsheng He
- Key Laboratory of Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China;
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Thiem U, Jäger M, Stege H, Wirth R. Diagnostic accuracy of the 'Dysphagia Screening Tool for Geriatric Patients' (DSTG) compared to Flexible Endoscopic Evaluation of Swallowing (FEES) for assessing dysphagia in hospitalized geriatric patients - a diagnostic study. BMC Geriatr 2023; 23:856. [PMID: 38097922 PMCID: PMC10722677 DOI: 10.1186/s12877-023-04516-7] [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: 11/09/2022] [Accepted: 11/24/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Oropharyngeal dysphagia is highly prevalent among hospitalized geriatric patients. The screening instruments used to date have been evaluated primarily in stroke patients. This diagnostic study aimed to validate a new screening instrument for oropharyngeal dysphagia, the 'Dysphagia Screening Tool for Geriatric Patients' (DSTG), as compared to one of the gold standards, flexible endoscopic evaluation of swallowing (FEES). MATERIALS AND METHODS Geriatric inpatients admitted to five geriatric hospitals in Germany were consecutively evaluated using both DSTG and FEES in random order and by different evaluators blinded to the results of the other evaluation. In the FEES examination, a score of more than 3 on Rosenbek's Penetration Aspiration Scale was considered evidence of clinically relevant oropharyngeal dysphagia. Sensitivity, specificity and further measures of test performance were calculated for DSTG. RESULTS The 53 volunteers recruited were on average 85 years of age, 56.6% were women. Twenty patients (37.7%) were diagnosed with dysphagia using FEES. Of these, 12 were screened as positive on DSTG. Of the 33 FEES negative patients, 4 tested positive on DSTG. The following test parameters were calculated for DSTG: sensitivity: 0.60, 95% confidence interval [0.39 ; 0.78], specificity 0.88 [0.73 ; 0.95], positive predictive value 0.75 [0.51 ; 0.90], negative predictive value 0.78 [0.63 ; 0.89], positive likelihood ratio 4.95 [1.85 ; 13.27], negative likelihood ratio 0.46 [0.26 ; 0.79]. In a receiver-operator characteristic (ROC) curve analysis, the area under the curve (AUC) was 0.77 [0.62 ; 0.91]. No adverse events occurred. CONCLUSION The DSTG appears to be a valid instrument for screening of oropharyngeal dysphagia in geriatric inpatients.
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Affiliation(s)
- Ulrich Thiem
- Albertinen-Haus Hamburg, Sellhopsweg 18-22, 22459, Hamburg, Germany.
- Geriatrics and Gerontology, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Martin Jäger
- Hüttenhospital gemeinnützige GmbH, Am Marksbach 28, 44269, Dortmund, Germany
| | - Holger Stege
- Department of Geriatrics, ukrb University Clinic Ruppin-Brandenburg, Fehrbelliner Straße 38, 16816, Neuruppin, Germany
| | - Rainer Wirth
- Department of Geriatrics, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
- Chair of Geriatrics, Ruhr-University Bochum, Bochum, Germany
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Clavé P, Ortega O, Rofes L, Alvarez-Berdugo D, Tomsen N. Brain and Pharyngeal Responses Associated with Pharmacological Treatments for Oropharyngeal Dysphagia in Older Patients. Dysphagia 2023; 38:1449-1466. [PMID: 37145201 DOI: 10.1007/s00455-023-10578-x] [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: 07/05/2022] [Accepted: 04/07/2023] [Indexed: 05/06/2023]
Abstract
Impaired pharyngo-laryngeal sensory function is a critical mechanism for oropharyngeal dysphagia (OD). Discovery of the TRP family in sensory nerves opens a window for new active treatments for OD. To summarize our experience of the action mechanism and therapeutic effects of pharyngeal sensory stimulation by TRPV1, TRPA1 and TRPM8 agonists in older patients with OD. Summary of our studies on location and expression of TRP in the human oropharynx and larynx, and clinical trials with acute and after 2 weeks of treatment with TRP agonists in older patients with OD. (1) TRP receptors are widely expressed in the human oropharynx and larynx: TRPV1 was localized in epithelial cells and TRPV1, TRPA1 and TRPM8 in sensory fibers mainly below the basal lamina. (2) Older people present a decline in pharyngeal sensory function, more severe in patients with OD associated with delayed swallow response, impaired airway protection and reduced spontaneous swallowing frequency. (3) Acute stimulation with TRP agonists improved the biomechanics and neurophysiology of swallowing in older patients with OD TRPV1 = TRPA1 > TRPM8. (4) After 2 weeks of treatment, TRPV1 agonists induced cortical changes that correlated with improvements in swallowing biomechanics. TRP agonists are well tolerated and do not induce any major adverse events. TRP receptors are widely expressed in the human oropharynx and larynx with specific patterns. Acute oropharyngeal sensory stimulation with TRP agonists improved neurophysiology, biomechanics of swallow response, and safety of swallowing. Subacute stimulation promotes brain plasticity further improving swallow function in older people with OD.
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Affiliation(s)
- Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Laia Rofes
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - Daniel Alvarez-Berdugo
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - Noemí Tomsen
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain.
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Chen L, Hemsley B, Debono D. The Impact of Food-Shaping Techniques on Nutrition, Mealtime Experiences, and Quality of Life for Older Adults in Aged Care Settings: A Systematic Review. Curr Nutr Rep 2023; 12:744-766. [PMID: 37665541 PMCID: PMC10766673 DOI: 10.1007/s13668-023-00493-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] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Food-shaping methods, particularly for texture-modified foods, present numerous opportunities to improve the visual appeal of food and potentially the nutrition of older people with dysphagia (swallowing difficulty). This review appraises and synthesizes the evidence on the use of food-shaping methods to enhance nutrition in older adults with swallowing difficulties. METHODS In August 2022, five electronic databases (PubMed, CINAHL, Scopus, Cochrane Library, and Web of Science) were searched for original research related to the intersection of nutrition, food shaping, and older adults with swallowing difficulties. Characteristics of included studies were described and data from results and findings extracted for analysis across studies. RESULTS Eighteen studies met the inclusion criteria and encompassed a variety of settings, including aged care settings (n = 15) and food science laboratories (n = 3). Qualitative and quantitative findings demonstrated a variety of impacts of food shaping for the older adult with swallowing difficulty, including enhanced nutrition and wellbeing. The content themes identified across studies were: links between food shaping and nutrition, shaping food for individual choice, food shaping for enjoyment, a combination of supporting factors, collaborative inter-disciplinary teams and roles, and implementation aligns with local contexts. CONCLUSION With recent growth in research on food shaping, the body of studies reviewed identified an influence of food-shaping methods on the nutritional status of older adults with swallowing difficulties. Given the identified potential benefit of food shaping and attention to the visual appeal of food for older people, further research examining links between food shaping and nutrition are warranted.
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Affiliation(s)
- Lily Chen
- University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Sydney, Australia.
| | - Bronwyn Hemsley
- University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Sydney, Australia
| | - Deborah Debono
- University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Sydney, Australia
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Hossain MZ, Kitagawa J. Transient receptor potential channels as an emerging therapeutic target for oropharyngeal dysphagia. JAPANESE DENTAL SCIENCE REVIEW 2023; 59:421-430. [PMID: 38022386 PMCID: PMC10665593 DOI: 10.1016/j.jdsr.2023.09.002] [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: 07/03/2023] [Revised: 09/10/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Oropharyngeal dysphagia is a serious health concern in older adults and patients with neurological disorders. Current oropharyngeal dysphagia management largely relies on compensatory strategies with limited efficacy. A long-term goal in swallowing/dysphagia-related research is the identification of pharmacological treatment strategies for oropharyngeal dysphagia. In recent decades, several pre-clinical and clinical studies have investigated the use of transient receptor potential (TRP) channels as a therapeutic target to facilitate swallowing. Various TRP channels are present in regions involved in the swallowing process. Animal studies have shown that local activation of these channels by their pharmacological agonists initiates swallowing reflexes; the number of reflexes increases when the dose of the agonist reaches a particular level. Clinical studies, including randomized clinical trials involving patients with oropharyngeal dysphagia, have demonstrated improved swallowing efficacy, safety, and physiology when TRP agonists are mixed with the food bolus. Additionally, there is evidence of plasticity development in swallowing-related neuronal networks in the brain upon TRP channel activation in peripheral swallowing-related regions. Thus, TRP channels have emerged as a promising target for the development of pharmacological treatments for oropharyngeal dysphagia.
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Affiliation(s)
- Mohammad Zakir Hossain
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
| | - Junichi Kitagawa
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
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Kim SJ, Yeo MS, Kim SY, Kang SY. A scoping review of music-based interventions for swallowing difficulties: implications for treating older adults with presbyphagia. Front Med (Lausanne) 2023; 10:1285835. [PMID: 38034547 PMCID: PMC10687455 DOI: 10.3389/fmed.2023.1285835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives Presbyphagia refers to age-related changes in the swallowing mechanism (e.g., reduced skeletal muscle strength that decreases bolus control). If left untreated, these changes can lead to dysphagia, which refers to impaired swallowing (e.g., coughing or choking when eating). Given that swallowing difficulties are common among older adults that they make up the fastest growing age group globally, the need for interventions to address presbyphagia is gaining urgency. To begin to address this need, we conducted a scoping review to analyze music therapy research aimed at enhancing swallowing function. The objective was to identify key intervention characteristics and propose clinical implications for treating presbyphagia using music therapy. Methods This review followed the methodological frameworks outlined by Arksey and O'Malley and Levac et al. and used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews for analysis and reporting. Four electronic databases (i.e., ProQuest, PubMed, RISS, Web of Science) were searched for quantitative and qualitative studies in English or Korean that used music-based interventions to address swallowing function in older adults. Content analysis was conducted to identify and compare the main features of music interventions for swallowing difficulties among older adults. Results Ten articles were identified and analyzed. It was found that three core components-respiration, vocalization, and singing-were employed to enhance swallowing function in populations with neurological impairments, dementia, or head and neck cancer. Notably, actions closely linked to swallowing function, such as laryngeal elevation and oral movements, were utilized therapeutically to speak or sing. Based on these characteristics, clinical implications are proposed to address presbyphagia. Conclusion Singing entails a systematic and focused incorporation of stepwise activities that can be used to address swallowing disorders. In this context, critical clinical implications that music therapists should consider when treating individuals with presbyphagia include warmup breathing, vocalizing targeting laryngeal control, and singing targeting oral motor control. This review can contribute to the expansion of music therapy with older adults and the advancement of music therapy techniques.
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Affiliation(s)
- Soo Ji Kim
- Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Republic of Korea
| | - Myung Sun Yeo
- Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Music Therapy, Graduate School, Ewha Womans University, Seoul, Republic of Korea
| | - Seo Yeon Kang
- Department of Music Therapy, Graduate School, Ewha Womans University, Seoul, Republic of Korea
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Leiman DA, Jones HN, North R, Porter Starr KN, Pieper CF, Cohen SM. Self-Reported Dysphagia and Psychosocial Health Among Community-Dwelling Older Adults: Results of a National Study. J Gen Intern Med 2023; 38:3329-3338. [PMID: 37254012 PMCID: PMC10681967 DOI: 10.1007/s11606-023-08232-1] [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: 01/20/2023] [Accepted: 05/08/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND The risk of dysphagia increases with age, affecting up to 33% of adults over the age of 65. Older adults with dysphagia are at increased risk for negative physical health outcomes such as aspiration pneumonia and death. However, the relationship between dysphagia and psychosocial health is uncertain in this population. OBJECTIVE We aimed to assess the associations between dysphagia and psychosocial health among older adults (≥ 65) with self-reported dysphagia. DESIGN We performed a cross-sectional assessment of the National Health and Aging Trends Study (NHATS) conducted in 2019. MAIN MEASURES Weighted logistic and linear regression models were used to assess the relationship between self-reported dysphagia and psychosocial health using established patient-reported outcome measures including those for depression, anxiety, and social isolation previously used in NHATS analyses, while adjusting for demographics, comorbid conditions, and risk factors for dysphagia identified by purposeful selection. KEY RESULTS Among the 4041 adults in this cohort, almost half (40%) were between 70 and 74 years old, more than half were female (55%), and a significantly higher proportion were White, non-Hispanic respondents (78.1%, p < 0.01) compared with other races and ethnicities. There were 428 (10.5%) respondents reporting dysphagia symptoms within the previous month. In the multivariable model, dysphagia was associated with significantly increased odds of anxiety (OR 1.33 [1.06, 1.67]) and a significantly decreased sense of well-being (coefficient - 1.10 [- 1.66, - 0.54]), but no association was detected for social isolation. CONCLUSIONS When accounting for factors associated with underlying physical health status, self-reported dysphagia is independently associated with negative psychosocial health and warrants attention by healthcare providers. Future studies should aim to identify causal factors and the extent to which interventions may mitigate these factors.
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Affiliation(s)
- David A Leiman
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA.
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
| | - Harrison N Jones
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca North
- Center for the Study of Aging, Duke University School of Medicine, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Kathryn N Porter Starr
- Center for the Study of Aging, Duke University School of Medicine, Durham, NC, USA
- Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA
- Geriatrics Research, Education, and Clinical Center, Durham VA Health Care Center, Durham, NC, USA
| | - Carl F Pieper
- Center for the Study of Aging, Duke University School of Medicine, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Seth M Cohen
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
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Zhang H, Zhang S, Ye C, Li S, Xue W, Su J, Qiu Y, Zhao L, Fu P, Jiang H, He X, Deng S, Zhou T, Zhou Q, Tang M, Chen K. Cross-sectional study on dysphagia evaluation in community-dwelling older adults using the Eating Assessment Tool (EAT) -10, EAT-2, and Water Swallow Test. Geriatr Nurs 2023; 54:258-263. [PMID: 37897931 DOI: 10.1016/j.gerinurse.2023.10.002] [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: 07/25/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Dysphagia is a health concern that causes severe complications and affects the life quality of the older population. This study aimed to determine the diagnostic performance of the Eating Assessment Tool (EAT)-2 compared with the EAT-10 and the Water Swallow Test (WST) in screening for dysphagia. METHODS A cross-sectional study was conducted among 5,090 community-dwelling older adults. Dysphagia was evaluated using both a subjective measure, the 10-item EAT (EAT-10) and an objective measure, the WST. The kappa index in pairs were analyzed. The validity and reliability of EAT-2 were also assessed. RESULTS The sensitivity and specificity of the EAT-2 were 96.3 % and 94.8 %, respectively. The kappa index between the EAT-2 and EAT-10 was 0.64, whereas it was 0.11 between the EAT-10 and WST. CONCLUSIONS The EAT-2 was a simpler screening tool for dysphagia. Combining the subjective questionnaire (EAT-10 or EAT-2) and the objective test (WST) is recommended.
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Affiliation(s)
- Huafang Zhang
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Simei Zhang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Chenxi Ye
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Sihan Li
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Wenfeng Xue
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Jie Su
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Yufeng Qiu
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Lancai Zhao
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Pingping Fu
- Department of Rehabilitation Medicine, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Haiyan Jiang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Xiaona He
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Shunfeng Deng
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Tao Zhou
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Qi Zhou
- Department of Nursing, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| | - Mengling Tang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Kun Chen
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China.
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Xu F, Bai L, Dai Z, Cheng H. Research hotspots and trends in post-stroke dysphagia: a bibliometric analysis. Front Neurosci 2023; 17:1275748. [PMID: 37942140 PMCID: PMC10628302 DOI: 10.3389/fnins.2023.1275748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Background Dysphagia represents one of the common complications following a stroke, and post-stroke dysphagia (PSD) can lead to aspiration, pneumonia, and malnutrition, thus prolonging hospital stay, escalating medical expenditures, and imposing a substantial economic strain on both patients and society. The utilization of bibliometric analysis offers a quantitative approach for investigating the existing literature and recognizes the current status of the research. However, bibliometric analysis on the subject of PSD remains absent. Consequently, we carried out this study to provide researchers with insights, facilitating their further exploration of PSD. Methods Conducting a bibliometric analysis of articles pertaining to PSD retrieved over the past two decades enables us to acquire the research hotspots and trends in this area. The publications concerning PSD were searched from the Core Collection of Web of Science, spanning the period ranging from 2003 to 2023. Articles or reviews published in English were included in this study. Subsequently, we employed CiteSpace and VOSviewer software to visualize the retrieved articles, thereby identifying the cooperative relationships of authors, institutions, and countries, as well as relevant information about journals and references. Results This study comprised 866 papers in total, and the number of articles published each year shows an overall growth trend. As for the analysis of the authors, Dziewas R. was the most prolific author with 21 articles. The most frequently published institutions, countries, and journals were the University of Manchester, China, and Dysphagia, with 28, 254, and 75 publications, respectively. And the co-cited authors and journals with the highest counts were Martino R and Stroke. According to the analysis of keywords and references, dysphagia screening and assessment, prevention of pneumonia, rehabilitation approaches, and nutritional management of PSD are considered research hotpots. Additionally, future research may focus on the topics of systematic review and meta-analysis, noninvasive brain stimulation, and lesion location. Conclusion Through the bibliometrics analysis of PSD, we can capture the research hotspots and frontiers of PSD, thereby providing inspiration and reference for subsequent studies in this field.
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Affiliation(s)
- Fangyuan Xu
- The First Clinical Medical School, Anhui University of Chinese Medicine, Hefei, China
| | - Lin Bai
- Department of Neurology, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Ziliang Dai
- Department of Rehabilitation Medicine, Wuhan Iron and Steel (Group) Second Staff Hospital, Wuhan, China
| | - Hongliang Cheng
- Department of Neurology, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
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Bahia MM, Lowell SY. Hyolaryngeal Movement During Normal and Effortful Swallows Determined During Ultrasonography. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3856-3870. [PMID: 37668547 DOI: 10.1044/2023_jslhr-23-00088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
PURPOSE This study investigated (a) the effects of the effortful swallow under two different instructions (tongue emphasis vs. pharyngeal squeezing) on hyoid displacement and hyoid-larynx approximation, (b) the association between tongue pressure and hyolaryngeal movement during normal swallowing and the effortful swallow produced with tongue emphasis, and (c) age-related differences in hyolaryngeal movement during normal and effortful swallows (tongue emphasis vs. pharyngeal squeezing) in healthy individuals. METHOD Forty healthy adults (20 younger and 20 older) swallowed their saliva as they normally do (normal swallow) and performed the effortful swallow with tongue emphasis and pharyngeal squeezing. Tongue-to-palate pressure during swallowing was measured using the Iowa Oral Performance Instrument, hyolaryngeal movement was measured using ultrasonography, and submental surface electromyography was used to track swallows. RESULTS Results revealed differences in hyolaryngeal movement across swallowing types. Both types of effortful swallows showed greater hyolaryngeal movement than normal swallows. Additionally, hyolaryngeal movement was greater during the effortful swallow with tongue emphasis than the effortful swallow with pharyngeal squeezing. Age-related differences were found only in hyoid-larynx approximation during the effortful swallow with tongue emphasis (younger > older adults). Furthermore, moderate positive correlations were identified between tongue pressure and hyolaryngeal movement during normal swallows and the effortful swallow with tongue emphasis. CONCLUSIONS The findings show that varying instructions of the effortful swallow affect hyolaryngeal movement differently, suggesting that clinicians may need to individualize the effortful swallow instruction according to the physiological impairments of each patient. Additionally, natural age-related changes in swallowing physiology do not seem to affect an individual's ability to perform the effortful swallow or to impact hyolaryngeal movement. Finally, the association between tongue pressure and hyolaryngeal movement during normal swallows and the effortful swallow with tongue emphasis suggests that the tongue plays a critical role in swallowing, priming subsequent swallowing events.
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Affiliation(s)
- Mariana M Bahia
- Department of Communication Sciences and Disorders, Syracuse University, NY
| | - Soren Y Lowell
- Department of Communication Sciences and Disorders, Syracuse University, NY
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Chang WH, Chen MH, Liu JF, Chung WL, Chiu LL, Huang YF. Surface Electromyography for Evaluating the Effect of Aging on the Coordination of Swallowing Muscles. Dysphagia 2023; 38:1430-1439. [PMID: 37106228 PMCID: PMC10471631 DOI: 10.1007/s00455-023-10572-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 03/31/2023] [Indexed: 04/29/2023]
Abstract
Swallowing function can deteriorate with age, leading to a risk of dysphagia. Swallowing evaluation by surface electromyography (sEMG) can be easily and extensively applied for an elderly population. This study evaluated the temporal events observed by sEMG to clarify how aging affects the coordination among the masticatory and suprahyoid muscles. We recruited elderly individuals (over 65 years old) who denied dysphagia. The sEMG activities of anterior temporalis, masseter, and suprahyoid muscles were recorded during 3, 15, and 30 ml water swallowing tests (WST). We calculated the time interval between anterior temporalis and suprahyoid peak activity (T-SH interval) and masseter and suprahyoid peak activity (M-SH interval) and analyzed their correlation with age. The subjects who could and could not swallow 30 ml of water in one gulp were further assigned into the one-gulp and piecemeal groups, respectively, for subgroup analysis. We recruited 101 subjects, among whom 75 (26 males and 49 females) were analyzed after excluding those with suspected dysphagia or low-quality sEMG recordings. Age was significantly correlated with the bilateral T-SH (left: r = 0.249, p = 0.031; right: r = 0.412, p < 0.01) and right M-SH (r = 0.242, p = 0.037) intervals in the 30 ml WST. The correlation between intervals and age were observed in both subgroups. sEMG can be used to investigate the effect of aging on the temporal coordination between masticatory and suprahyoid contraction. Further studies are needed to verify the validity of screening subclinical dysphagia in the elderly.
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Affiliation(s)
- Wei-Han Chang
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan City, 333323, Taiwan
- Department of Physical Medicine and Rehabilitation, Keelung Chang Gung Memorial Hospital, Keelung, 204201, Taiwan
- Department of Nutrition and Health Sciences, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan City, 333324, Taiwan
| | - Mei-Hui Chen
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333423, Taiwan
| | - Jen-Fang Liu
- Department of Nutrition and Health Sciences and Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan City, 333324, Taiwan
| | - Wei Li Chung
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333423, Taiwan
| | - Li-Ling Chiu
- Department of Nutrition and Health Sciences and Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan City, 333324, Taiwan.
- Department of Nutrition and Health Sciences and Geriatric and Long-Term Care Research Center, College of Human Ecology, Chang Gung University of Science and Technology, No. 261, Wenhua 1st Rd, Guishan Dist, Taoyuan City, 333324, Taiwan.
| | - Yi-Fang Huang
- Department of General Dentistry, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Gueishan Dist, Taoyuan City, 333423, Taiwan.
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 110301, Taiwan.
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan City, 333323, Taiwan.
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Chen WC, Lin CW, Wu MN, Fong YO, Chen CH, Hsieh SW, Chen CYE, Huang P. Consistencies among miscellaneous scales for evaluation of post-stroke dysphagia. Eur Arch Otorhinolaryngol 2023; 280:4561-4567. [PMID: 37428229 DOI: 10.1007/s00405-023-08101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Post-stroke dysphagia (PSD) is the most common type of dysphagia. Stroke patients with sustained dysphagia have poorer outcomes. The severity of PSD is assessed using miscellaneous scales with unknown consistencies. We aim to investigate the consistencies among miscellaneous scales, which could aid in the assessment of PSD. METHODS A total of 49 PSD patients were enrolled. Functional Oral Intake Scale (FOIS), Dysphagia Severity Scale (DSS), Ohkuma Questionnaire, Eating Assessment Tool-10, and Repetitive Saliva Swallowing Test were performed. FOIS was performed by physicians, and DSS was conducted by both the physicians and nurses; the physicians used either videofluoroscopy (VF) or videoendoscopy (VE) for evaluation; while, the nurses assessed PSD by observation and subjective judgment. RESULTS When using VF (VF-DSS and VF-FOIS) as the gold standard for the evaluation, VE-FOIS (κ = 0.625, 95% CI 0.300-0.950, p < 0.001) has a substantial agreement with VF-FOIS, and VE-DSS (κ = 0.381, 95% CI 0.127-0.636, p = 0.007) has a fair agreement with VF-DSS. The weighted kappa of FOIS to DSS in VE (weighted κ = 0.577, 95% CI 0.414-0.740, p < 0.001) is not lower than that in VF (weighted kappa = 0.249, 95% CI 0.136-0.362, p < 0.001). CONCLUSION For both DSS and FOIS, only VE has a statistically significant agreement with VF. Though VF has been viewed as the traditional gold standard of dysphagia screening, it has the limitations of being invasive and equipment dependent. For PSD, VE could be considered as a substitution when VF is not available or suitable.
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Affiliation(s)
- Wen-Ching Chen
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
| | - Chung-Wei Lin
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Ni Wu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
| | - Yi-On Fong
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
| | - Chun-Hung Chen
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Multidisciplinary Swallowing Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sun-Wung Hsieh
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Yin Elizabeth Chen
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Poyin Huang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan.
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Multidisciplinary Swallowing Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Yang ZC, Yong ZZ, Hua L, Li WC. Superiority of Percutaneous Endoscopic Gastrostomy Over Nasogastric Feeding for Stroke-Induced Severe Dysphagia: A Comparative Study. Med Sci Monit 2023; 29:e940613. [PMID: 37766420 PMCID: PMC10546899 DOI: 10.12659/msm.940613] [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: 04/03/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Patients with dysphagia due to stroke may require enteral feeding using either a nasogastric (NG) feeding tube or a percutaneous endoscopic gastrostomy (PEG) tube. This study aimed to compare outcomes from NG tube and PEG tube feeding in 40 patients with severe dysphagia due to stroke. MATERIAL AND METHODS We enrolled 40 patients admitted to the hospital from April 2019 to December 2022 due to severe stroke dysphagia, who were divided into the gastrostomy group (20 patients) and the nasogastric feeding group (20 patients) in accordance with the random number table method. Percutaneous endoscopic gastrostomy was performed in both groups and we assessed differences in swallowing function, nutritional recovery, safety, and hope levels. RESULTS Standardized Swallowing Assessment (SSA) scores in both groups clearly decreased after the intervention, but there was greater reduction in the gastrostomy group (P<0.001). Both groups had distinct improvements of the levels of a variety of nutritional indicators after the intervention, but there was greater improvement in the gastrostomy group (P<0.001). The gastrostomy group also had fewer overall complications (P<0.001). Herth Hope Scale scores in both groups were significantly increased after intervention, and the gastrostomy group had a larger increase that the nasogastric feeding group (P<0.001). CONCLUSIONS Compared with nasogastric tube feeding, percutaneous endoscopic gastrostomy has advantages in SSA score, protein level, and Herth Hope Scale in the treatment of stroke patients with dysphagia.
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Affiliation(s)
- Zhong Chang Yang
- Department of Cerebrovascular Diseases, Hangzhou Third People’s Hospital, Hangzhou, Zhejiang, PR China
| | - Zhang Zu Yong
- Department of Neurosurgery, Hangzhou Third People’s Hospital, Hangzhou, Zhejiang, PR China
| | - Li Hua
- Admission Preparation Center, Hangzhou Third People’s Hospital, Hangzhou, Zhejiang, PR China
| | - Wu Chun Li
- Department of Cerebrovascular Diseases, Hangzhou Third People’s Hospital, Hangzhou, Zhejiang, PR China
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Wakabayashi T, Hamaguchi S, Morimoto K. Clinically defined aspiration pneumonia is an independent risk factor associated with long-term hospital stay: a prospective cohort study. BMC Pulm Med 2023; 23:351. [PMID: 37718411 PMCID: PMC10506309 DOI: 10.1186/s12890-023-02641-y] [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: 11/02/2022] [Accepted: 09/07/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Long-term hospital stay is associated with functional decline in patients with pneumonia, especially in the elderly. Among elderly patients with pneumonia, aspiration pneumonia is a major category. Clinical definition is usually used because it can occur without apparent aspiration episodes. It is still not clear whether a long-term hospital stay is due to aspiration pneumonia itself caused by underlying oropharyngeal dysfunction or simply due to functional decline in elderly patients with multiple comorbidities during acute infection. The aim of this study is to identify whether clinically defined aspiration pneumonia itself was associated with a long-term hospital stay. METHODS A prospective observational study on community-acquired (CAP) or healthcare-associated pneumonia (HCAP) was conducted from January 2012 through January 2014. Aspiration pneumonia was clinically defined as pneumonia not only occurring in patients after documented aspiration episodes, but also occurring in those with underlying oropharyngeal dysfunction: chronic disturbances of consciousness and/or chronic neuromuscular diseases. We defined thirty-day hospital stay as a long-term hospital stay and compared it with logistic regression analysis. Potential confounders included age, sex, HCAP, body mass index (BMI), long-term bed-ridden state, heart failure, cerebrovascular disorders, dementia, antipsychotics use, hypnotics use, and CURB score which is a clinical prediction tool used to assess the severity, standing for; C (presence of Confusion), U (high blood Urea nitrogen level), R (high Respiratory rate), and B (low Blood pressure). In a sub-analysis, we also explored factors associated with long-term hospital stay in patients with aspiration pneumonia. RESULTS Of 2,795 patients, 878 (31.4%) had aspiration pneumonia. After adjusting potential confounders, the aspiration pneumonia itself was significantly associated with long-term hospital stay (adjusted odds ratio 1.44; 95% confidence interval 1.09-1.89, p < 0.01), as were higher age, male sex, high CURB score, HCAP, low BMI, heart failure, cerebrovascular disease, and antipsychotics use. Sub-analysis revealed factors associated with long-term hospital stay in the aspiration pneumonia, which included male sex, and multi-lobar chest X-ray involvement. CONCLUSIONS Clinically defined aspiration pneumonia itself was independently associated with long-term hospital stay. This result could potentially lead to specific rehabilitation strategies for pneumonia patients with underlying oropharyngeal dysfunction.
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Affiliation(s)
- Takao Wakabayashi
- Department of General and Emergency Medicine, Japan Community Healthcare Organization Sapporo Hokushin Hospital, 2-1,2-Jo,6-Chome, Atsubetsu-Cho, Atsubetsu-Ku, Sapporo, 004-8618, Japan
- Department of General Internal Medicine, Ebetsu City Hospital, Hokkaido, Japan
| | - Sugihiro Hamaguchi
- Department of General Internal Medicine, Ebetsu City Hospital, Hokkaido, Japan.
- Department of General Internal Medicine, Fukushima Medical University, 1, Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Konosuke Morimoto
- Department of Respiratory Infections, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
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Ito H, Nagao A, Maeda S, Nakahira M, Hyodo M. Clinical Significance of Surgical Intervention to Restore Swallowing Function for Sustained Severe Dysphagia. J Clin Med 2023; 12:5555. [PMID: 37685624 PMCID: PMC10488804 DOI: 10.3390/jcm12175555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Owing to rapid population aging, patients with dysphagia are significantly increasing in society. Dysphagia treatment is aimed at the restoration of the swallowing function and the prevention of recurrent aspiration-induced pulmonary infection. However, despite intensive rehabilitation, oral food intake remains inadequate in many patients with severe dysphagia, which results in the deterioration of patients' quality of life and joy of living. Surgical intervention may serve as a useful therapeutic strategy to restore swallowing function in these patients. The study included 25 patients (mean, 70.4 years; male/female ratio, 20:5) with chronic dysphagia. Dysphagia was associated with cerebrovascular diseases in sixteen patients; with age-induced physiological deterioration in five patients; and with miscellaneous etiologies in four cases. Cricopharyngeal and infrahyoid myotomies were performed in all patients. Laryngeal elevation and the medialization of the paralyzed vocal fold were performed in 15 and 3 patients, respectively. The Food Intake Level Scale (FILS) and videoendoscopic examination score (VEES) were used to evaluate swallowing function. The FILS showed a restoration of oral food intake alone in 72% of patients, and 64% of patients maintained this improvement at their last follow-up visit. We observed significantly improved VEES scores postoperatively. However, patients with cognitive impairment or advanced age showed poor outcomes. In conclusion, surgical intervention may be an effective therapeutic option to restore swallowing function in cases of sustained severe dysphagia; however, surgical indications require careful consideration.
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Affiliation(s)
- Hiroaki Ito
- Department of Otolaryngology, Kochi Medical School, Kohasu, Okou-cho, Nankoku 783-8505, Japan; (H.I.); (A.N.); (S.M.)
| | - Asuka Nagao
- Department of Otolaryngology, Kochi Medical School, Kohasu, Okou-cho, Nankoku 783-8505, Japan; (H.I.); (A.N.); (S.M.)
| | - Suguru Maeda
- Department of Otolaryngology, Kochi Medical School, Kohasu, Okou-cho, Nankoku 783-8505, Japan; (H.I.); (A.N.); (S.M.)
| | - Maya Nakahira
- Department of Rehabilitation, Kochi Medical School Hospital, Kohasu, Okou-cho, Nankoku 783-8505, Japan;
| | - Masamitsu Hyodo
- Department of Otolaryngology, Kochi Medical School, Kohasu, Okou-cho, Nankoku 783-8505, Japan; (H.I.); (A.N.); (S.M.)
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Javorszky SM, Reiter R, Iglseder B. Validation of a Geriatric Bedside Swallowing Screen (GEBS): Protocol of a Prospective Cohort Study. JMIR Res Protoc 2023; 12:e46252. [PMID: 37566452 PMCID: PMC10457692 DOI: 10.2196/46252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/13/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Demographic changes will raise the need for specialized care of older patients. Oropharyngeal dysphagia has recently been declared a geriatric syndrome reflecting its multifactorial background. Alongside multimorbidity, sarcopenia, frailty, and disability, swallowing disorders increase with advancing age, with prevalence rates reported to be as high as 44% in acute geriatric hospital settings and 80% in long-term care facilities. Hence, systematic screening of older patients to diagnose dysphagia and initiate treatment is of paramount importance to prevent bolus death, aspiration pneumonia, and malnutrition and improve quality of life. Several screening tools have been evaluated in emergency and stroke units. However, no published dysphagia screening tool has been validated in the hospitalized, older adult population using a gold standard in dysphagia diagnostics as a reference test. The validation of the proposed test is a first step. OBJECTIVE The Geriatric Bedside Swallowing Screen (GEBS) study aims to validate a new screening tool developed specifically for older inpatients against an instrumental swallowing evaluation, the flexible endoscopic evaluation of swallowing (FEES), which is considered a gold standard. Primary outcomes to be evaluated are sensitivity and specificity for the GEBS in the detection of dysphagia in a mixed older adult population. The presence of dysphagia will be defined by an instrumental swallowing evaluation (FEES), analyzed by the standardized penetration-aspiration scale. METHODS To validate the GEBS, a prospective cohort study will be carried out. Two institutions, an acute geriatric department and a long-term care facility, will aim to recruit a total of 100 patients aged ≥75 years. After giving their informed consent, patients will undergo the full screening protocol described in the GEBS as well as an evaluation of swallowing function using the FEES. Investigators will be blinded to the results of the respective other testing. The analysis of pseudonymized data sets will be done by a third investigator. Outcomes to be considered are sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood quotient, and the reliability of the proposed dysphagia screening tool using the κ coefficient. RESULTS Recruitment started in October 2022 and will end in April 2024. Data publication is planned for early 2025. CONCLUSIONS If proven to be a valid screening tool for the early detection of dysphagia, further studies including different older adult populations as well as studies to determine the impact of systematic dysphagia screening on parameters, such as rates of aspiration pneumonia or nutritional status, should be planned. Effective screening of dysphagia will lead to earlier detection of patients with impaired swallowing. Those who fail the screening will be referred to speech language pathology for further diagnosis, thus optimizing care while streamlining personnel resources. TRIAL REGISTRATION ISCRTN Registry ISRCTN11581931; https://www.isrctn.com/ISRCTN11581931. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46252.
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Affiliation(s)
- Susanne Maria Javorszky
- Institute for Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
- Department of Health Sciences, University of Applied Sciences, Vienna, Austria
| | - Raphael Reiter
- Department of Geriatric Medicine, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
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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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Curtin C, Barrett A, Burke FM, McKenna G, Healy L, Hayes M. Exploring facilitators and barriers associated with oral care for inpatients with dysphagia post-stroke. Gerodontology 2023. [PMID: 37531498 DOI: 10.1111/ger.12709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE To explore the attitudes, facilitators and barriers in providing oral care for inpatients with dysphagia post-stroke as perceived by healthcare professionals. BACKGROUND Dysphagia is a common complication of stroke and is associated with a higher incidence of aspiration pneumonia, malnutrition and dehydration. In the acute phase of stroke recovery, a dental professional is not usually part of the multidisciplinary team caring for the patient and oral care is the responsibility of the healthcare professionals in the stroke unit. There is a lack of high-quality evidence to demonstrate the most effective method of providing oral care for patients with dysphagia post-stroke. MATERIALS AND METHODS This was a single-site study conducted with healthcare professionals working in the Stroke Unit of Cork University Hospital in Ireland, using focus groups and a qualitative thematic analysis approach. RESULTS A total of three focus groups were conducted in the Stroke Unit with 17 healthcare professionals. The focus groups included representation from all healthcare professional groups providing direct clinical care to patients on the Stroke Unit including geriatric medicine, dietetics, speech and language therapy, healthcare assistance, nursing, occupational therapy and physiotherapy. A qualitative thematic analysis was carried out and seven overarching themes emerged from the data. Three themes related to facilitators to providing oral care for this patient group: (i) a focus on oral care in both policy and practice, (ii) expanding professional roles in the provision of oral care, (iii) perceived importance of oral care in recovery and rehabilitation. Four themes related to barriers to the provision of oral care for this patient group: (i) lack of confidence and concerns related to the perceived risk for patients with dysphagia, (ii) unique challenges of patient and stroke-related factors, (iii) lack of resources and time and (iv) perceived importance of oral care in recovery and its relative importance with competing demands. CONCLUSION Members of the stroke multidisciplinary team believe that they all have a part to play in the delivery of oral care for patients with dysphagia post-stroke. Opportunities exist for the development of multidisciplinary interventions to improve the oral cavity assessment and oral care provided in the Stroke Unit.
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Affiliation(s)
| | | | | | - Gerald McKenna
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Khatri S, Chamay S, Chacko S, Sharma S. Hemiazygos vein dilation as a radiological finding and multifactorial cause of dysphagia. Radiol Case Rep 2023; 18:2581-2585. [PMID: 37250481 PMCID: PMC10220463 DOI: 10.1016/j.radcr.2023.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Dysphagia is a common issue observed among the elderly, which can arise from various etiologies such as motility disorders and chronic neurologic conditions. Radiologists play a crucial role in diagnosing the cause of dysphagia, as they can identify anatomical abnormalities that may lead to the condition. One such anomaly is the hemiazygos vein, which is the left side equivalent of the azygos vein and can cause dysphagia if it crosses over the esophagus. To our knowledge, there are only 2 other recorded cases of azygos aneurysm/dilation causing esophageal dysphagia. In this context, we present a case report of a 73-year-old female with a 1-month history of weight loss and dysphagia due to a prominent hemiazygos vein. The case highlights the importance of thorough radiological evaluation in identifying the underlying cause of dysphagia and ensuring timely and appropriate treatment.
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Affiliation(s)
- Shivam Khatri
- CUNY School of Medicine, 160 Convent Ave, New York, NY 10031, USA
| | - Salomon Chamay
- Division of Internal Medicine, Department of Medicine, St. Barnabas Hospital, Bronx, NY 10457, USA
| | - Steven Chacko
- CUNY School of Medicine, 160 Convent Ave, New York, NY 10031, USA
| | - Shorabh Sharma
- Division of Internal Medicine, Department of Medicine, St. Barnabas Hospital, Bronx, NY 10457, USA
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