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01.12.2017 | Research Article | Ausgabe 1/2017 Open Access

BMC Geriatrics 1/2017

A comprehensive intervention following the clinical pathway of eating and swallowing disorder in the elderly with dementia: historically controlled study

Zeitschrift:
BMC Geriatrics > Ausgabe 1/2017
Autoren:
Masahisa Arahata, Makoto Oura, Yuka Tomiyama, Naoe Morikawa, Hatsue Fujii, Shinji Minani, Yukihiro Shimizu
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12877-017-0531-3) contains supplementary material, which is available to authorized users.

Abstract

Background

Eating problems in patients with advanced dementia are strongly associated with their deteriorating survival. Food and drink intake in people with dementia may be supported by specific interventions, but the effectiveness of such interventions is backed by almost no evidence. However, comprehensive geriatric assessment (CGA) might potentially clarify the etiology of decreased oral intake in people with dementia; thus improving their clinical outcomes.

Methods

This study was a single-arm, non-randomized trial that included historically controlled patients for comparison. We defined elderly patients with both severely decreased oral intake depending on artificial hydration and/or nutrition (AHN) and dementia as “Eating and Swallowing Disorder of the Elderly with Dementia (ESDED)”. In the intervention group, participants received CGA through the original clinical pathway with multidisciplinary interventions. This was followed by individualized therapeutic interventions according to assessment of the etiology of their eating problems.

Results

During the intervention period (between 1st April 2013 and 31st March 2015), 102 cases of ESDED were enrolled in the study and 90 patients had completed receiving CGA. Conversely, 124 ESDED patient controls were selected from the same hospital enrolled during the historical period (between 1st April 2011 and 31st March 2012). Most participants in both groups were bedridden with severe cognitive impairment. For the intervention group, an average of 4.3 interventional strategies was recommended per participant after CGA. Serological tests, diagnostic imaging and other diagnostic examinations were much more frequently performed in the intervention group. Recovery rate from ESDED in the intervention group was significantly higher than that in the historical group (51% v.s. 34%, respectively, P = 0.02). The 1-year AHN-free survival in the intervention group was significantly higher than that in the historical group (28% v.s. 15%, respectively, P = 0.01). No significant difference between the two groups was found for 1-year overall survival (37% v.s. 28%, respectively, P = 0.08).

Conclusions

Use of CGA with multidisciplinary interventions could improve the functional status of eating and allow elderly patients with severe eating problems and dementia to survive independently without the need for AHN.

Trial registration

ISRCTN57646445, this trial was retrospectively registered on 8th December 2015.
Zusatzmaterial
Additional File 1: Fig. S1. The prescribed CGA form. The prescribed form was completed with many findings from each ESAT professional within the initial 2 days. These information and data were shared among all ESAT members and proved useful for discussion to determine the etiology of ESDED. ACE, Angiotensin converting enzyme; BUN, Blood urea nitrogen; CTR, Cardio thoracic ratio; CRP, C-reactive protein; FAST, Functional assessment staging; HDS-R, Hasegawa dementia rating scale - revised; L-DOPA, L-3,4-dihydroxyphenylalanine; MMSE, Mini–mental state examination; MRI, Magnetic resonance imaging; MWST, Modified water swallowing test; NSAIDs, Non-steroidal anti-inflammatory drugs; OT, Occupational therapist; PPIs, Proton pump inhibitors; PT, Physical therapist; PVH, Periventricular hyperintensity; RSST, Repetitive saliva swallowing test; ST, Speech therapist; T-Cho, Total cholesterol; TSH, Thyroid stimulating hormone; WBC, White blood cells Fig. S2. Interventional strategies suggested by the ESAT. Interventional strategies were recommended in addition to already performed medical care, supportive care, and rehabilitation. The patterns of suggestions varied widely; only three patterns were plural (pattern number 42, 72, 78) and all others were singular. This means that the interventions based on this study were well individualized. The pattern number does not equate to the participants’ ID or sequence of enrollment in this study. a The description “medication for swallowing disorder” means both starting a medicine and stopping a medicine. The former was expected to positively affect swallowing, while the later was expected to disturb swallowing. ADL, Activities of daily living; AHN, Artificial hydration and/or nutrition; OT, Occupational therapist; PT, Physical therapist; ST, Speech therapist. (PPTX 165 kb)
Literatur
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