Background: Dysphagia, which can result in aspiration pneumonia and death, is a well-known problem in patients with dementia and Parkinson's disease. Subsequently, 19 papers were identified for data extraction, including one of which was identified via grey literature and reference lists. They are very easy to learn and do not need great efforts [50]. You may have chronic aspiration if this occurs frequently. Preventing Aspiration in Older Adults with Dysphagia J Neurosci Nurs. J Speech Lang Hear Res. Post-rule education showed an average number of cases per month of 4.0. Dysphagia and aspiration pneumonia are the 2 most serious medical conditions seen in late-stage Alzheimer's disease (AD) patients. Predicting Aspiration in Patients With Ischemic Stroke - PMC Implement postural changes that improve swallowing. End-of-life issues in advanced dementia - PMC Cite this article. Effect of community nursing intervention in elderly people with dysphagia in nursing homes. Mann G, Hankey GJ, Cameron D. Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Olchik MR, Rech RS, Jacinto-Scudeiro LA, Mello AM, Santos VB. As Table2 shows, the interventions from included studies can be classified into eight groups. 2018;39(4):43642. Paranji, S., Paranji, N., Wright, S., & Chandra, S. (2017). The impact of dysphagia on mortality of nursing home residents: results from the NutritionDay project. Nobrega AC, Rodrigues B, Melo A. Aging issues: nursing imperatives for healthcare reform. https://doi.org/10.1007/PL00009579. Journal of the American Medical Directors Association, 9(2), 128-135. Risk factors of aspiration pneumonia in Alzheimer's disease patients 2012;72:5766. sleep more talk less often. https://doi.org/10.1016/j.pupt.2010.10.003. The high prevalence of dysphagia among individuals with dementia is the result of age-related changes to sensory and motor functions, in addition to those produced by neuropathology 4.The prevalence of dysphagia in moderate to severe AD is from 84 to 93% 5-7.Ironically, dysphagia remains an overlooked symptom, even when its complications can lead to longer . Using unusual words to refer to familiar objects. School of Nursing, Nanjing Medical University, Nanjing, China, The University of Plymouth Centre for Innovations in Health and Social Care: A Joanna Briggs Institute Centre of Excellence, Plymouth, UK, School of Nursing and Midwifery, University of Plymouth, Plymouth, UK, You can also search for this author in At the end of the training period, aspiration signs were significantly reduced in the intervention group when . Luk also indicated that liquids thickener is expensive, and blending and pureeing are labor-intensive [33]. Most swallow screens use varying volumes of water to assess the ability to swallow (Smithard, 2016). Although the complications of dysphagia and aspiration can be severe, they are often undetected and untreated [22]. Furthermore, the risk of aspiration improved significantly after these rehabilitation programs [37, 38, 40]. https://doi.org/10.1159/000339986. Two independent reviewers screened the title and abstract of each article to determine its relevance to the inclusion criteria. Interdisciplinary interventions have a huge advantage in aspiration management. Dysphagia. PubMed However, these benefits have not been found in systematic review of the literature among patients with advanced dementia. Urinary Tract Infections: Dangerous for Dementia Patients A flow chart showing the number of citations at each stage is described in Fig. In addition to mortality and morbidity related to the insertion procedure, the tubes cause morbidity from leakage, discomfort, and . https://doi.org/10.1159/000339989. The primary methods used to prevent aspiration during oral intake in dysphagic stroke patients include texture modification of food/liquids and positional swallowing maneuvers, such as chin-tuck or head rotation (Smithard, 2016). Provided by the Springer Nature SharedIt content-sharing initiative. 2012;18(23):29738. According to these data, it is important to explore more fully the interventions that might help older adults who reside in institutions, such as nursing homes and residential care facilities, as they are more likely to suffer from dysphagia. 2019;20(8):9525. 2013;34(3):2127. Madhavan A, LaGorio LA, Crary MA, Dahl WJ, Carnaby GD. Nestle Nutr Inst Workshop Ser. For example, food may be placed on the right side of the mouth if left facial weakness is present. Particularly in patients with Alzheimer's disease (AD), mortality from pneumonia is high and accounts for 70% of the causes of death. Investigation of compensatory postures with videofluoromanometry in dysphagia patients. All types of interventions, intervention providers, target residents of intervention, locations of intervention, and results of intervention were included as concepts. Cook IJ, Kahrilas PJ. Therefore, it has been questioned whether it is a reliable and justified intervention and whether it is necessarily better, as there is no strong evidence to show such methods reduce pneumonia [32, 36, 47]. (2016). Post-Stroke Aspiration Pneumonia - U.S. Pharmacist Hickson M, Frost G. An investigation into the relationship between quality of life, nutritional status and physical function. 2018;18(1):167. https://doi.org/10.1186/s12877-018-0839-7. https://doi.org/10.1111/ggi.13056. Garon BR, Sierzant T, Ormiston C. Silent aspiration: results of 2,000 video fluoroscopic evaluations. Gilmore-Bykovskyi AL, Rogus-Pulia N. Temporal associations between caregiving approach, behavioral symptoms and observable indicators of aspiration in nursing home residents with dementia. Informing current debate over the fluid recommendation for adults aged 70+ years. Of all the included studies, only three, which were literature reviews, reported that some neurostimulation approaches could reduce the risk of aspiration by improving swallowing function, based on the theory that thermal or mechanical stimulation at the anterior oropharynx can bring about reflex swallowing action [13, 33, 38]. Of these studies, seven used this intervention as a part of an interdisciplinary prevention plan [13, 33, 34, 37, 38, 40, 41]; the others focused on it to explore its independent effects [30, 32, 35, 36, 39]. PubMed Central Hajjar S, Wollman D. Resident presentation dysphagia in elderly. Dysphagia. Dysphagia is a serious condition that may lead to a decline in quality of life and is associated with many poor outcomes [10]. Smithard, D.G. 2009;41(4):17885. American Journal of Alzheimers Disease & Other Dementias, 32(1), 5-11. Using specific postures or maneuvers was also a popular intervention in many studies. After using for 2 to 4weeks, 11 patients demonstrated decreased cough while eating. J Gerontol A Biol Sci Med Sci. (2013). Frailty: an emerging research and clinical paradigm-issues and controversies. 2013;25(11):888e701. 2012;72:6776. (dysphagi* or orophargngeal dysphagia or esophageal dysphagia or deglutition disorder* or swallowing disorder* or swallowing dysfunction or swallowing problem* or swallowing difficult* or difficulty in swallowing or swallowing disabilit*).mp, (aspiration or penetration or airway invasion or aspiration pneumonia* or silent aspiration or aspirator or choking).mp, (older persons or older adults or older people or older patients or geriatric* or aged or aging or older or elder or elderly or the elderly or elderly people or senior*).mp, (intervention or management or treatment or rehabilitation or therapy or strateg* or program* or practice* or prevent* or control or method* or texture modif* or bolus modif* or diet modif* or food modif* or fluids modif* or viscosity modif* or consistency modif* or texture adapt* or thicken* or swallow* maneuver* or swallow* posture* or chin down or chin tuck or double deglutition or hard swallow* or stimulation).mp, (nursing home* or residential care facilit* or residential facilit* or aged care facilit* or elderly care facilit* or long-term care facilit* or care home or institution*).mp, exp food aspiration/ or exp. Oral hygiene interventions for people with intellectual disabilities. A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson's disease. (2016). 2010;34(2):95109. Effects of oral neuromuscular training on swallowing dysfunction among older people in intermediate care-a cluster randomised, controlled trial. Available from https://reviewersmanual.joannabriggs.org/. A voice change (such as hoarseness or a gurgling noise) after swallowing. The older adult with one of these conditions is at even greater risk for aspiration because the dysphagia is superimposed on the slowed swallowing rate associated with normal aging. Luk suggested that nursing homes should provide a quiet environment without distraction during mealtime [33]. An impaired safety mechanism of swallowing, which can result in airway invasion, may lead to a complication called aspiration [11, 13, 14]. Aslan, M., & Vaezi, M.F. Some people may wheeze, have trouble breathing, or have a hoarse voice after they eat, drink, vomit, or experience heartburn. All rights reserved. https://doi.org/10.1590/2317-6431-2020-2334. After 4 to 6weeks of use, these residents could gradually tolerate food without aspiration [28]. Percutaneous gastrostomy offers no significant protection against aspiration pneuomonia; in fact, it is the commonest cause of death in PEG fed patients (Onur et al., 2013). Oral care has also been indicated as an indirect intervention that can help prevent aspiration pneumonia [58]. For those who are not able to get out of bed, it is important to raise the head of the bed by at least 30 degrees [33]. https://doi.org/10.1097/NAQ.0b013e3181d91718. Signs that a patient with Alzheimer's disease is close to the end of their life include: Inability to speak Inability to eat or drink because they can't swallow Inability to move from a bed to a chair or change their position Bedsores or pressure ulcers caused by sitting or lying in the same position for too long Lu M, Hong L, He LM, Gao F, Xu J, Jiang LN. Bergman H, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, et al. Some patients may find thickened liquids unpalatable and thus drink insufficient fluids (Murray et al., 2013). When introducing the Interdisciplinary collaboration, Mesioye commented that physicians or pharmacists need to carefully review whether residents are taking medications that aggravate swallowing disorders [34]. There is also evidence indicating that aspiration is one of the major health risks for these older adults, which is more likely to result in respiratory infections, aspiration pneumonia and sudden bolus death. Abstract Background: We determined the mortality rate and prognostic factors in old patients with dementia hospitalized due to AP. Mesioye A, Smith J, Zilberstein M, Hart H, Bush-Thomas P, Ward M. Dysphagia rounds: Interdisciplinary collaboration to improve swallowing safety in a VA community living center. PubMed Systematic review and evidence based recommendations on texture modified foods and thickened liquids for adults (above 17 years) with oropharyngeal dysphagia-an updated clinical guideline. Aspiration: What Does It Mean? Plus Causes and Prevention It is time to revamp approaches to managing dysphagia in nursing homes. 1. 2011;19(5):3740. Dementia-like symptoms can result from a fever or other side effects of the body's attempt to fight off an infection. But they usually take a long time with slow effects, and they cannot be used alone in the absence of direct interventions. https://doi.org/10.1016/j.gerinurse.2017.12.016. These included all interventions designed to prevent aspiration for older adults with dysphagia who reside in a nursing home setting. Article Professional interventions provided by speech and language therapists are still limited in the setting of nursing homes. However, they are not the permanent solution. Other symptoms to observe for include fever, chills, pleuritic chest pain and crackles. J Psychosom Res. 8 Signs of Dying from Aspiration Pneumonia - SSCOR The aim of this scoping review is to describe the current spread of interventions to prevent or reduce aspiration in older adults with dysphagia with a specific focus on those who reside in nursing homes. The infection may progress quickly and spread to other areas of the . Nurs Residential Care. BMC Geriatr. Determine the food viscosity that is best tolerated by the individual. About Dementia | Aging - Centers for Disease Control and Prevention In addition, Ebihara reported that the reflex of swallowing was delayed seriously at body temperature [49]. Chinese databases included: CNKI (https://www.cnki.net/), WANGFAN DATA (http://www.wanfangdata.com.cn/index.html) and VIP (http://qikan.cqvip.com/). Nutritional aspects of dysphagia management. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
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