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Tsai MR, Shieh WY, Tsai HH, Lotus Shyu YI, Chang KH, Wen FH, Liu CY. Appropriate volumes of water for non-invasive swallowing assessments of nursing home residents: A descriptive correlational study. Heliyon 2024; 10:e37340. [PMID: 39296193 PMCID: PMC11408772 DOI: 10.1016/j.heliyon.2024.e37340] [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: 12/11/2023] [Revised: 08/27/2024] [Accepted: 09/02/2024] [Indexed: 09/21/2024] Open
Abstract
Background The volume of water that can be swallowed without risk of choking or aspiration is a common way to assess swallowing function in patients with dysphagia in institutional settings. However, no evidence-based study has established what volumes of water are safest and most effective for testing. Objective A validated portable non-invasive device for swallowing and respiration (NIDSAR) was employed to determine safe swallowing volumes for nursing home residents with different levels of dysphagia. Methods Participants (N = 94) were grouped by the absence or presence of a nasogastric (NG)-tube: those without an NG-tube (n = 60) and those with an NG-tube (n = 34).Swallowing 1 ml, 3 ml, and 5 ml of water was assessed with the Functional Oral Intake Scale (FOIS) and compared with measures with objective scores from the portable NIDSAR. In addition, swallowing measures were compared between groups, as well as relationships with participant-reported choking frequency. Results Participants without an NG-tube had significant different scores for swallowing during the respiration phase and pharyngeal stage for both 3 ml (t = 3.894 to 4.277, p < .001) and 5 ml (t = 1.999 to 2.944, p < .05 to p < .01) compared with participants with an NG-tube. Discussion Our research revealed that participants with frequent episodes of choking required more time to swallow 1 ml compared with 3 ml or 5 ml which might be a function of piecemeal swallowing. Conclusions NIDSAR measures with 3 ml and 5 ml boluses of water are effective volumes for safely assessing swallowing ability of nursing home residents with dysphagia without risk of choking or aspiration.
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Affiliation(s)
- Meng Rung Tsai
- Department of Nursing, Meiho University, Neipu, Pingtung, Taiwan
| | - Wann Yun Shieh
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Yea Ing Lotus Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Kuo Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Fur Hsing Wen
- Department of International Business, Soochow University, Taipei City, Taiwan
| | - Chia Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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2
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Giray E, Eyigör S, Çalık Y, Albayrak Gezer İ, Sarı A, Umay E, Akaltun MS, Tıkız C, Ünlü Z, Vural M, Aydeniz B, Karahan AY. The caregiver burden of informal caregivers for stroke patients with and without dysphagia: A multi-center, cross-sectional study in Türkiye. Turk J Phys Med Rehabil 2023; 69:453-468. [PMID: 38766582 PMCID: PMC11099854 DOI: 10.5606/tftrd.2023.11894] [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: 10/09/2022] [Accepted: 03/10/2023] [Indexed: 05/22/2024] Open
Abstract
Objectives The aim of this study was to investigate the caregiver burden (CB) of informal caregivers for stroke survivors with and without dysphagia and to assess the relationship between the CB levels of informal caregivers for stroke survivors with dysphagia, patients' swallowing-related quality of life (QoL), and patients' stroke-specific QoL. Patients and methods This multi-center, prospective, cross-sectional study included a total of 120 stroke patients (76 males, 44 females; mean age: 61.1±12.3 years; range, 19 to 86 years) between October 2019 and 2020. Of the patients, 57 had dysphagia and 63 had no dysphagia. The Functional Oral Intake Scale (FOIS) was used to classify the degree of functional dietary limitation caused by each patient's swallowing impairment. Patients and caregivers completed the Eating Assessment Tool (EAT-10), Swallowing Quality of Life (SWQoL) questionnaire, Stroke Impact Scale (SIS), and the Zarit Caregiver Burden Interview (ZBI). Results The CB levels were higher in those caring for stroke patients with dysphagia than in those caring for stroke patients without dysphagia. Caregiver burden was found to be associated with patients' swallowing-related QoL and stroke-related QoL. Significant predictors of high CB scores (F=2.55, R2=0.59; p=0.007) were being an employed caregiver (B=17.48, p=0.003), being a caregiver with high school (B=-19.6, p=0.03), and secondary school (B=-16.28, p=0.02) educational status, being son, daughter (B=30.63, p=0.007) or other relative of the patient (B=20.06, p=0.01), lower FOIS stage (B=-3.14, p=0.011), lower SWQoL (B=0.52, p=0.009) and lower SIS (B=-0.37, p=0.04) scores. Conclusion Caregivers of stroke patients with dysphagia suffer from a higher CB than those without dysphagia. In stroke patients with dysphagia, swallowing-related QoL is associated with the QoL levels of stroke patients and the CB levels of their caregivers. Employment status, educational status of caregiver, caregiver's relativity to the patient, FOIS stage, swallowing and stroke related QoL of the patients are factors related to burden levels of caregivers of stroke patients with dysphagia. These results may help health professionals to understand dysphagia as an essential source of CB and consider it, while planning treatments.
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Affiliation(s)
- Esra Giray
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Türkiye
| | - Sibel Eyigör
- Department of Physical Medicine and Rehabilitation, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Yalkın Çalık
- Department of Physical Medicine and Rehabilitation, Bolu Izzet Baysal Physical Treatment and Rehabilitation Training and Research Hospital, Bolu, Türkiye
| | - İlknur Albayrak Gezer
- Department of Physical Medicine and Rehabilitation, Selçuk University Faculty of Medicine, Konya, Türkiye
| | - Aylin Sarı
- Department of Physical Medicine and Rehabilitation, Erenköy Physical Medicine and Rehabilitation Hospital, Istanbul, Türkiye
| | - Ebru Umay
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Dışkapı Training and Research Hospital, Ankara, Türkiye
| | - Mazlum Serdar Akaltun
- Department of Physical Medicine and Rehabilitation, Gaziantep University Faculty of Medicine, Gaziantep, Türkiye
| | - Canan Tıkız
- Department of Physical Medicine and Rehabilitation, Manisa Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Zeliha Ünlü
- Department of Physical Medicine and Rehabilitation, Manisa Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Meltem Vural
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
| | - Banu Aydeniz
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
| | - Ali Yavuz Karahan
- Department of Physical Medicine and Rehabilitation, Medical Faculty of Uşak University, Uşak, Türkiye
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3
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Liu J, Liao M, Yang H, Chen X, Peng Y, Zeng J. Development and validation of a nomogram for predicting dysphagia in long-term care facility residents. Aging Clin Exp Res 2023; 35:1293-1303. [PMID: 37148466 DOI: 10.1007/s40520-023-02413-y] [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: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Dysphagia is a common problem that can seriously affect the health of elderly residents in long-term care facilities. Early identification and targeted measures can significantly reduce the incidence of dysphagia. AIM This study aims to establish a nomogram to evaluate the risk of dysphagia for elderly residents in long-term care facilities. METHODS A total of 409 older adults were included in the development set, and 109 were included in the validation set. Least absolute shrinkage selection operator (LASSO) regression analysis was used to select the predictor variables, and logistic regression was used to establish the prediction model. The nomogram was constructed based on the results of logistic regression. The performance of the nomogram was evaluated by receiver operating characteristic (ROC) curve, calibration, and decision curve analysis (DCA). Internal validation was performed using tenfold cross-validation with 1000 iterations. RESULTS The predictive nomogram included the following variables: stroke, sputum suction history (within one year), Barthel Index (BI), nutrition status, and texture-modified food. The area under the curve (AUC) for the model was 0.800; the AUC value for the internal validation set was 0.791, and the AUC value for the external validation set was 0.824. The nomogram showed good calibration in both the development set and validation set. Decision curve analysis (DCA) demonstrated that the nomogram was clinically valuable. DISCUSSION This predictive nomogram provides a practical tool for predicting dysphagia. The variables included in this nomogram were easy to assess. CONCLUSIONS The nomogram may help long-term care facility staff identify older adults at high risk for dysphagia.
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Affiliation(s)
- Jinmei Liu
- Chengdu Medical College, Chengdu, 610083, Sichuan, China
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Mingshu Liao
- Chengdu Medical College, Chengdu, 610083, Sichuan, China
| | - Hui Yang
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Xiaofang Chen
- Chengdu Medical College, Chengdu, 610083, Sichuan, China
| | - Yang Peng
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Jing Zeng
- Chengdu Medical College, Chengdu, 610083, Sichuan, China.
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Sari DW, Aurizki GE, Indarwati R, Farapti F, Rekawati E, Takaoka M. The Provision of Texture-Modified Foods in Long-term Care Facilities by Health Professionals: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e44201. [PMID: 36930183 PMCID: PMC10131749 DOI: 10.2196/44201] [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: 12/11/2022] [Revised: 02/06/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Malnutrition among older adults with dysphagia is common. Texture-modified foods (TMFs) are an essential part of dysphagia management. In long-term care (LTC) facilities, health professionals have implemented TMFs, but their application has not been fully elucidated, making them heterogeneous. OBJECTIVE We aim to explore the implementation of TMFs in LTC facilities, particularly focusing on the role of health professionals in nutritional care involving TMFs (eg, deciding the type of food, preparing and giving the food, and evaluating the outcomes). METHODS A scoping review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodological approach will be performed. A comprehensive search for published literature will be systematically performed in PubMed, CINAHL, MEDLINE, ProQuest, PsycINFO, and Science Citation Index (Web of Science). Data screening and extraction will be performed by 2 reviewers independently. The studies included will be synthesized, summarized, and reported, following the preferred reporting items of the Mixed Methods Appraisal Tool. Our review will consider the following study designs: mixed methods, quantitative, and qualitative. Studies with patients who are not older adults will be excluded. RESULTS Data extraction will be completed by February 2023. Data presentation and analyses will be completed by April 2023, and the final outcomes will be completed by June 2023. The study findings will be published in a peer-reviewed journal. CONCLUSIONS Our scoping review will consider studies related to TMF interventions for older adults in LTC residential facilities, with no exclusion restrictions based on country, gender, or comorbidities. Studies on interventions that address TMF-related issues, such as deciding the type of food, preparing and giving the food, and evaluating the outcomes, are qualified for inclusion. TRIAL REGISTRATION OSF Registries 79AFZ; https://osf.io/79afz. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/44201.
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Affiliation(s)
- Dianis Wulan Sari
- Department of Advanced Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.,Research Group for Community Health, Family, and Geriatric Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Gading Ekapuja Aurizki
- Research Group for Community Health, Family, and Geriatric Nursing, Universitas Airlangga, Surabaya, Indonesia.,Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Retno Indarwati
- Department of Advanced Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.,Research Group for Community Health, Family, and Geriatric Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Farapti Farapti
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Etty Rekawati
- Department of Community and Geriatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Manami Takaoka
- Department of Gerontological Home Care and Long-Term Care Nursing, The University of Tokyo, Tokyo, Japan
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5
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Robison R, (Focht) Garand KL, Affoo R, Yeh CK, Chin N, McArthur C, Pulia M, Rogus-Pulia N. New horizons in understanding oral health and swallowing function within the context of frailty. Age Ageing 2023; 52:afac276. [PMID: 36735843 PMCID: PMC9897303 DOI: 10.1093/ageing/afac276] [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: 06/13/2022] [Revised: 09/15/2022] [Indexed: 02/05/2023] Open
Abstract
Frailty is a complex and multidimensional condition wherein declines in physiologic reserve and function place individuals in a state of heightened vulnerability and decreased resiliency. There has been growing interest in both research and clinical settings to understand how to best define, assess and characterise frailty in older adults. To this end, various models and clinical assessment tools have been used to define and measure frailty. While differences exist among these models and tools, a common unifying theme is a focus on physical function and activity. Notably absent across many available conceptual models and clinical tools are items directly related to oral and swallowing function. This is an important oversight as widespread changes to both oral and swallowing function are evident in older adults. Indeed, emerging evidence suggests many of the functional domains affected in frail older adults, such as nutrition and sarcopenia, have cyclical relationships with impairments in oral (oral hypofunction) and swallowing function (dysphagia) as well. The increasing appreciation for the interrelationships among oral hypofunction, dysphagia and frailty provides an opportunity for refinement of frailty assessment and characterisation in older adults to incorporate metrics specific to oral and swallowing function.
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Affiliation(s)
- Raele Robison
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Kendrea L (Focht) Garand
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile, AL 36688, USA
| | - Rebecca Affoo
- School of Communication Sciences and Disorders, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Chih-Ko Yeh
- Geriatric Research, Education and Clinical Center (GRECC), South Texas Veterans Health Care System (STVHCS), San Antonio, TX 78229, USA
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio (UTHSA), San Antonio, TX 78229, USA
| | - Nathaniel Chin
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Caitlin McArthur
- School of Physiotherapy, Faculty Health, Dalhousie University, Halifax, NS
| | - Michael Pulia
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI 53703, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53726, USA
- Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI 53705, USA
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6
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Chen K, Xing L, Xu B, Li Y, Liu T, Zhang T, Shi H, Lu H, Zhou W, Hou J, Shi H, Qin D. Research progress in the risk factors and screening assessment of dysphagia in the elderly. Front Med (Lausanne) 2022; 9:1021763. [PMID: 36419790 PMCID: PMC9676222 DOI: 10.3389/fmed.2022.1021763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/21/2022] [Indexed: 10/30/2023] Open
Abstract
With the aging of the population, the incidence of dysphagia has gradually increased and become a major clinical and public health issue. Early screening of dysphagia in high-risk populations is crucial to identify the risk factors of dysphagia and carry out effective interventions and health management in advance. In this study, the current epidemiology, hazards, risk factors, preventive, and therapeutic measures of dysphagia were comprehensively reviewed, and a literature review of screening instruments commonly used globally was conducted, focusing on their intended populations, main indicators, descriptions, and characteristics. According to analysis and research in the current study, previous studies of dysphagia were predominantly conducted in inpatients, and there are few investigations and screenings on the incidence and influencing factors of dysphagia in the community-dwelling elderly and of dysphagia developing in the natural aging process. Moreover, there are no unified, simple, economical, practical, safe, and easy-to-administer screening tools and evaluation standards for dysphagia in the elderly. It is imperative to focus on dysphagia in the community-dwelling elderly, develop unified screening and assessment tools, and establish an early warning model of risks and a dietary structure model for dysphagia in the community-dwelling elderly.
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Affiliation(s)
- Kerong Chen
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Liwei Xing
- The First School of Clinical Medicine, Yunnan University of Chinese Medicine, Kunming, China
| | - Bonan Xu
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Yi Li
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Tianyun Liu
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Tingjuan Zhang
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Hongping Shi
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Hanmei Lu
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Wengang Zhou
- Department of Medical, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Jianhong Hou
- Department of Orthopedics, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Hongling Shi
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Dongdong Qin
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
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7
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Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study. Geriatrics (Basel) 2022; 7:geriatrics7030067. [PMID: 35735772 PMCID: PMC9222299 DOI: 10.3390/geriatrics7030067] [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: 05/20/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Dysphagia has become more prevalent with age. Thus, the demand for texture-modified diets (TMDs) has increased. While the nutritional perspectives have been studied, the provision of TMDs and mealtime practice has received less attention. This study aimed to explore the TMD provision and mealtime challenges of residents requiring TMDs in aged care facilities. The study was conducted across five aged care facilities using a mixed methods design involving 14 TMD menu audits by a foodservice dietitian, 15 mealtime observations, and semi-structured interviews with residents and staff (n = 18). TMD menus failed to meet all nutrition requirements and foodservice and clinical standards based on the dietitian NZ foodservice and nutrition audit tool. A content analysis offered three main themes: (1) Foodservice production. Inconsistent quality and meal portions were observed. The variety, choice, and portion size of TMDs required improvement based on the residents’ preferences; (2) Serving procedures. There was a lack of standardisation of meal distribution and feeding assistance; and (3) Dining environment. The dining room set-up varied across facilities, and residents expressed different preferences towards the dining environment. There is a need to improve staff awareness of mealtime consistency and optimise feeding assistance. The dining environment should be individualised to accommodate residents’ psychosocial needs. Standardised policies and continuous training can facilitate quality mealtime implementation.
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