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Figueira RS, Xavier MO, Tomasi E, Demarco FF, Gonzalez MC, Bielemann RM. Validation of dysphagia perception to predict the risk for dysphagia in non-institutionalized older adults. Clin Nutr ESPEN 2023; 57:358-363. [PMID: 37739679 DOI: 10.1016/j.clnesp.2023.07.014] [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: 11/10/2022] [Revised: 05/08/2023] [Accepted: 07/11/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS Dysphagia is a swallowing disorder that affects mainly the older adults and can compromise quality of life, and increase the risk for malnutrition and aspiration. Early diagnosis is, therefore, essential to prevent adversities. We aimed to evaluate the validity of self-perceived dysphagia in community-dwelling older adults (60 years or older) from Pelotas, Brazil, participants in the "COMO VAI?" STUDY METHODS The Eating Assessment Tool (EAT-10) was used as the reference tool to identify the risk for dysphagia and the self-perception of dysphagia was assessed using the following question: "Do you have swallowing difficulties?" (Yes/No). The parameters of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were described with 95% confidence intervals (95% CI) and according to independent variables (sex, age, economic level, and education). RESULTS The prevalence of dysphagia risk according to EAT-10 and self-perception was 12.9% (95% CI 10.2-16.1) and 8.8% (95% CI 6.6-11.6), respectively. Sensitivity was 34.8% (95% CI 23.5-47.6) and the highest values were observed in women and the older individuals (80 years or older). Specificity was 95.1% (95% CI 92.6-96.9). PPV was 51.1% (95% CI 35.8-66.3), NPV 90.8% (95% CI 87.8-93.2) and accuracy 87.3%. CONCLUSIONS Considering the low sensitivity and PPV, the self-perception of dysphagia analyzed with a single question should be used with caution, as an individual at risk for dysphagia may not realize their condition.
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Affiliation(s)
| | - Mariana Otero Xavier
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
| | - Elaine Tomasi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
| | - Flávio Fernando Demarco
- Post-Graduate Program in Epidemiology and Post-Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil.
| | - Maria Cristina Gonzalez
- Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil.
| | - Renata Moraes Bielemann
- Nutrition College and Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
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Zhang H, Zheng L, Tang M, Guo F, Yang L, Liu S, Wang J, Chen J, Ye C, Shi Y, Li S, Xue W, Su J. Developing strategies "SATIA": How to manage dysphagia in older people? A Delphi panel consensus. Nurs Open 2023; 10:2376-2391. [PMID: 36440605 PMCID: PMC10006581 DOI: 10.1002/nop2.1493] [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: 12/21/2021] [Revised: 08/28/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Abstract
AIM To develop a set of evidence-informed strategies to assist older people to improve swallowing functions and prevent further damage from complications. DESIGN A two-round Delphi survey. METHODS An initial set of dysphagia care strategies with 74 relevant items for older people was formed based on a literature review by seven researchers. An online survey was conducted by 21 panellists, and data of experts' opinions were collected and analysed by improved Delphi method. RESULTS The positive coefficients in the two rounds of expert consultation were 85.71% and 83.33%, respectively. Consensus was reached with 53 items included and was allocated into the following five sections: (1) screening, (2) assessment, (3) training, (4) interventions and (5) management. These strategies were named with the acronym of each section-"SATIA". The management strategy can be applied to guide the management of older people with dysphagia.
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Affiliation(s)
- Huafang Zhang
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Li Zheng
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengling Tang
- Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hangzhou, China.,Department of Epidemiology and Biostatistics, and The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fanjia Guo
- Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hangzhou, China
| | - Lili Yang
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Suxiang Liu
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Jinyun Wang
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Jie Chen
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Chenxi Ye
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Yajun Shi
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Sihan Li
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenfeng Xue
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Su
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
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Bu K, Patel D, Morris R, Han W, Umeukeje G, Zhu T, Cheng F. Dysphagia Risk in Patients Prescribed Rivastigmine: A Systematic Analysis of FDA Adverse Event Reporting System. J Alzheimers Dis 2022; 89:721-731. [PMID: 35964196 DOI: 10.3233/jad-220583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dysphagia has been reported as an adverse event for patients receiving rivastigmine for Alzheimer's disease (AD) treatment. OBJECTIVE The purpose of this study was to determine the association between dysphagia and the usage of rivastigmine by using the pharmacovigilance data from the FDA Adverse Event Reporting System (FAERS). METHODS The risk of dysphagia in patients who took rivastigmine was compared with those of patients who took other medications. In addition, this study sought to determine if the dysphagia risk was influenced by sex, age, dosage, and medication routes of administration. RESULTS When compared to patients prescribed donepezil, galantamine, or memantine, individuals prescribed rivastigmine were almost twice as likely to report dysphagia as an adverse event. The dysphagia risk in individuals prescribed rivastigmine is comparable to individuals prescribed penicillamine but significantly higher than clozapine, drugs of which have been previously shown to be associated with elevated dysphagia likelihood. Individuals older than 80 were 122% more likely to report having dysphagia after being prescribed rivastigmine than patients that were 50-70 years of age. Oral administration of rivastigmine was associated with approximately 2 times greater likelihood of reporting dysphagia relative to users of the transdermal patch. In addition, dysphagia showed higher association with pneumonia than other commonly reported adverse events. CONCLUSION Patients prescribed rivastigmine were at greater risk of reporting dysphagia as an adverse event than patients prescribed many other medicines. This increase in dysphagia occurrence may be attributed to the dual inhibition of both acetylcholinesterase and butyrylcholinesterase.
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Affiliation(s)
- Kun Bu
- Department of Mathematics & Statistics, College of Art and Science, University of South Florida, Tampa, FL, USA
| | - Devashru Patel
- College of Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Robert Morris
- Department of Pharmaceutical Science, Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
- Department of Biostatistics & Epidemiology, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Weiru Han
- Department of Mathematics & Statistics, College of Art and Science, University of South Florida, Tampa, FL, USA
| | - Gibret Umeukeje
- Department of Pharmaceutical Science, Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Tianrui Zhu
- Department of Pharmaceutical Science, Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Feng Cheng
- Department of Pharmaceutical Science, Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
- Department of Biostatistics & Epidemiology, College of Public Health, University of South Florida, Tampa, FL, USA
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Shelf life stability and quality study of texture-modified chicken rendang using xanthan gum as thickener for the consumption of the elderly with dysphagia. FOOD BIOSCI 2021. [DOI: 10.1016/j.fbio.2021.101054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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5
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Kim HN, Kim JY. A Systematic Review of Oropharyngeal Dysphagia Models in Rodents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4987. [PMID: 34067192 PMCID: PMC8125817 DOI: 10.3390/ijerph18094987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/24/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022]
Abstract
Oropharyngeal dysphagia is a condition characterized by swallowing difficulty in the mouth and pharynx, which can be due to various factors. Animal models of oropharyngeal dysphagia are essential to confirm the cause-specific symptoms, pathological findings, and the effect of treatment. Recently, various animal models of dysphagia have been reported. The purpose of this review is to organize the rodent models of oropharyngeal dysphagia reported to date. The articles were obtained from Medline, Embase, and the Cochrane library, and selected following the PRISMA guideline. The animal models in which oropharyngeal dysphagia was induced in rats or mice were selected and classified based on the diseases causing oropharyngeal dysphagia. The animal used, method of inducing dysphagia, and screening methods and results were collected from the selected 37 articles. Various rodent models of oropharyngeal dysphagia provide distinctive information on atypical swallowing. Applying and analyzing the treatment in rodent models of dysphagia induced from various causes is an essential process to develop symptom-specific treatments. Therefore, the results of this study provide fundamental and important data for selecting appropriate animal models to study dysphagia.
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Affiliation(s)
- Han-Na Kim
- Department of Dental Hygiene, College of Health and Medical Sciences, Cheongju University, Cheongju 28503, Korea;
| | - Ji-Youn Kim
- Department of Dental Hygiene, College of Health Science, Gachon University, Incheon 21936, Korea
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6
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Frohnhofen H, Stieglitz S. [Pneumonia in old age]. PNEUMOLOGE 2021; 18:174-181. [PMID: 33746676 PMCID: PMC7963464 DOI: 10.1007/s10405-021-00388-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 11/08/2022]
Abstract
Die Pneumonie ist eine bei alten Menschen häufige und schwere Erkrankung. Sie steht in dieser Patientengruppe an vierter Stelle der zum Tode führenden Erkrankungen. Die Diagnose kann oft aufgrund einer atypischen klinischen Präsentation schwierig sein. Daher sollte bei jeder Verschlechterung eines alten Menschen ursächlich auch an eine Pneumonie gedacht werden. Geriatrische Probleme wie Gebrechlichkeit und physische und psychische Einschränkungen sollten ebenso erfasst werden wie die soziale Situation, da alle diese Faktoren prognoserelevant sind. Prognostisch ungünstiger verlaufen Pneumonien, die im Pflegeheim oder von Pflegebedürftigen erworben wurden. Sie gelten zwar als ambulant erworben, sollten dennoch besonders beachtet werden. Die Behandlung unterscheidet sich nicht grundsätzlich von der Behandlung jüngerer Patient, sollte aber besondere Situationen wie den in einer Patientenverfügung festgelegten Patientenwunsch bei der Therapieplanung berücksichtigen. Gerade ältere Menschen zeigen unter einer COVID(coronavirus disease)-19-Infektion oft atypische klinische Bilder, sodass bei akuten Veränderungen im Alter auch daran zu denken ist.
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Affiliation(s)
- Helmut Frohnhofen
- Fakultät für Gesundheit Department Humanmedizin, Universität Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58448 Witten, Deutschland.,Universitätklinikum Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Deutschland
| | - Sven Stieglitz
- Klinik für Pneumologie, Allergologie, Schlaf- und Intensivmedizin Petruskrankenhaus Wuppertal, Wuppertal, Deutschland
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Relationships between high comorbidity index and nutritional parameters in patients with Oropharyngeal Dysphagia. Clin Nutr ESPEN 2020; 38:218-222. [PMID: 32690161 DOI: 10.1016/j.clnesp.2020.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/28/2020] [Accepted: 04/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS Oropharyngeal dysphagia (OD) and comorbidities can exert an influence on nutritional status and contribute to mortality. The aim of the present study was to examine relationships between high Charlson Comorbidity Index (CCI) scores and OD outcomes, including OD severity, feeding route, nutritional status and one-year mortality rate in adults and elderly individuals. METHODS A longitudinal study, whose the final sample comprised 110 patients with OD and 75 of whom were evaluated for one-year mortality outcome. Swallowing (videofluoroscopy), nutritional status [body mass index (BMI)], CCI, type of feeding route, medications and hospitalization were evaluated. Multinomial logistic regression was performed to calculate the unadjusted and adjusted odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS Overall sample of the study were adults and elders with a median age (years) of 61.3 [interquartile range (IQR): 58.4-64.2]. The median CCI was 2.3 (IQR: 2.1-2.6) and the mortality rate was 10.8%. Hospitalization was significantly associated with underweight (p = 0.013) and number of medications (p = 0.023). After adjustment, sex/age and nº-Medications/Hospitalization (nº-M/H), CCI ≥3 was associated with nasogastric tube feeding (OR 4.57, 95%CI 1.59-13.1 and OR 3.39, 95%CI 1.21-9.51 respectively) and swallowing performance (OR 0.73, 95%CI 0.59-0.90 and OR 0.74, 95%CI 0.61-0.90 respectively). CONCLUSIONS A high CCI was associated with OD severity and feeding route, but not with nutritional status or mortality.
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8
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The relationship of serum 25-hydroxyvitamin D concentration with clinical variables in patients with oropharyngeal dysphagia. Clin Nutr ESPEN 2020; 38:229-235. [PMID: 32690163 DOI: 10.1016/j.clnesp.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/06/2020] [Accepted: 04/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The relationship between vitamin D and oropharyngeal dysphagia (OD) is still poorly understood. The aim of this study was to evaluate 25-hydroxyvitamin D [25(OH)D] concentration in patients with OD and to verify its association to nutritional status, functional independence measure (FIM), time of clinical signs (TCS) and OD severity. This is a cross-sectional study conducted with outpatients. Body mass index (BMI), FIM, TCS, causes of OD, comorbidities, penetration-aspiration scale (PAS) and severity scale were evaluated. METHODS A multiple linear regression and effect size were performed to evaluate the association between serum 25(OH)D concentration and independent variables. RESULTS Forty-eight participants were included, with a mean age of 60.1 ± 15.3 years. The mean of the 25(OH)D concentration was 26.10 ± 12.0 ng/mL. The prevalence of hypovitaminosis D (<30 ng/mL) was 73%. In the multiple linear regression analysis (adjusted for sex, age, BMI, dietary intake and solar radiation), 25(OH)D concentration was significantly related with the TCS (p = 0.01, f2 = 0.48). Patients with hypovitaminosis D had a moderate effect (p = 0.08, δ = 0.36) for a lower FIM score. CONCLUSIONS These findings indicate that serum 25(OH)D concentration may be related to the TCS and the functional capacity of patients with OD.
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Maunsell R, Bloomfield S, Erridge C, Foster C, Hardcastle M, Hogden A, Kidd A, Lisiecka D, McDermott CJ, Morrison K, Recio-Saucedo A, Rickenbach L, White S, Williams P, Wheelwright SJ. Developing a web-based patient decision aid for gastrostomy in motor neuron disease: a study protocol. BMJ Open 2019; 9:e032364. [PMID: 31857308 PMCID: PMC6937039 DOI: 10.1136/bmjopen-2019-032364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Motor neuron disease (MND) is a progressive, incurable disease, characterised by degeneration of the nerves in the brain and spinal cord. Due to the multisystem effects of the disease, patients are faced with many complex, time-sensitive decisions, one of which is the decision on gastrostomy feeding. There are currently no published decision aids (DAs) to support patients making this decision in the UK. This study will develop and pilot a patient DA to provide evidence-based information on gastrostomy placement and feeding that is relevant to people with MND; communicate the risks and benefits associated with each option; check understanding and clarify personal values and preferences, enabling patients to make a decision congruent with their values and appropriate for them. METHODS AND ANALYSIS A two-phase process, observing the International Patient Decision Aid Standards, will be used to develop the DA, over 24 months starting January 2019. Phase 1 will use literature reviews and stakeholder interviews and surveys to identify essential content for the DA, and explore the best way to present this. In the second phase, a prototype DA will be developed and revised using stakeholder feedback in an iterative process. Stakeholders will include individuals with MND, their carers and the healthcare professionals working with them. ETHICS AND DISSEMINATION Ethical approval for the study has been granted by West of Scotland Research Ethics Service, reference 19/WS/0078. Study findings will be disseminated through academic and non-academic publications, conference presentations, stakeholder websites and social media. A feasibility study will follow to explore the acceptability and practicality of the DA for patients, carers and HCPs in practice and to assess whether the DA shows promise of being beneficial for the intended population.
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Affiliation(s)
- Rose Maunsell
- Health Sciences, University of Southampton, Southampton, UK
| | | | - Clare Erridge
- MND Care Centre, Southampton General Hospital, Southampton, UK
| | - Claire Foster
- Health Sciences, University of Southampton, Southampton, UK
| | | | - Anne Hogden
- Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia
| | - Alison Kidd
- Carer Representative, University of Southampton, Southampton, Hampshire, UK
| | | | | | - Karen Morrison
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Alejandra Recio-Saucedo
- NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC), University of Southampton, Southampton, Hampshire, UK
| | - Louise Rickenbach
- Motor Neurone Disease Association, Northampton, Northamptonshire, UK
| | - Sean White
- Dietetic Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Peter Williams
- Patient Representative, University of Southampton, Southampton, UK
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Garrec P, Legris S, Soyer Y, Vi-Fane B, Jordan L. [Orthodontic management of obstructive sleep-disordered respiratory disorders]. Orthod Fr 2019; 90:321-335. [PMID: 34643519 DOI: 10.1051/orthodfr/2019029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Through his/her knowledge of cranio-facial growth, the orthodontist plays a leading role within the multidisciplinary team that tracks and treats sleep-disordered breathing (SDB) in children. Correction of craniofacial risk factors (maxillary deficiency and retrognathia) is commonly used by practitioners alongside orthodontic treatment such as OMA and RME in the optimal conditions afforded by childhood growth. Myofunctional therapies are performed to restore correct stomatognathic function and play a central role in the management of SDB in children. The orthodontist is therefore a key player in the medical treatment chain of these children.
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Affiliation(s)
- Pascal Garrec
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Sylvie Legris
- AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Yves Soyer
- Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Brigitte Vi-Fane
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Laurence Jordan
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, PSL Research University, Institut de Recherche de Chimie Paris, UMR 8247-Chimie ParisTech, 75005 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
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Tsai MH, Ku SC, Wang TG, Hsiao TY, Lee JJ, Chan DC, Huang GH, Chen CCH. Swallowing dysfunction following endotracheal intubation: Age matters. Medicine (Baltimore) 2016; 95:e3871. [PMID: 27310972 PMCID: PMC4998458 DOI: 10.1097/md.0000000000003871] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To evaluate postextubation swallowing dysfunction (PSD) 21 days after endotracheal extubation and to examine whether PSD is time-limited and whether age matters.For this prospective cohort study, we evaluated 151 adult critical care patients (≥20 years) who were intubated for at least 48 hours and had no pre-existing neuromuscular disease or swallowing dysfunction. Participants were assessed for time (days) to pass bedside swallow evaluations (swallow 50 mL of water without difficulty) and to resume total oral intake. Outcomes were compared between younger (20-64 years) and older participants (≥65 years).PSD, defined as inability to swallow 50 mL of water within 48 hours after extubation, affected 92 participants (61.7% of our sample). At 21 days postextubation, 17 participants (15.5%) still failed to resume total oral intake and were feeding-tube dependent. We found that older participants had higher PSD rates at 7, 14, and 21 days postextubation, and took significantly longer to pass the bedside swallow evaluations (5.0 vs 3.0 days; P = 0.006) and to resume total oral intake (5.0 vs 3.0 days; P = 0.003) than their younger counterparts. Older participants also had significantly higher rates of subsequent feeding-tube dependence than younger patients (24.1 vs 5.8%; P = 0.008).Excluding patients with pre-existing neuromuscular dysfunction, PSD is common and prolonged. Age matters in the time needed to recover. Swallowing and oral intake should be monitored and interventions made, if needed, in the first 7 to 14 days postextubation, particularly for older patients.
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Affiliation(s)
- Min-Hsuan Tsai
- Department of Nursing, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzu-Yu Hsiao
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jang-Jaer Lee
- Department of Dentistry, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital Zhu-dong Branch, Hsinchu, Taiwan
| | - Guan-Hua Huang
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
| | - Cheryl Chia-Hui Chen
- Department of Nursing, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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12
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Fallon A, O’Neill D. Bacterial Pneumonia in Older People. J Gerontol A Biol Sci Med Sci 2015; 70:662. [DOI: 10.1093/gerona/glu239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/22/2014] [Indexed: 11/14/2022] Open
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