住院老年痴呆症患者的口咽吞咽困难：前瞻性队列研究

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association Pub Date : 2024-09-16 DOI:10.1016/j.jamda.2024.105267

Alexander Makhnevich MD , Alexandra Perrin BA , Kristen Porreca MD , Ji Yoon Lee MS , Cristina Sison PhD , Valeria Gromova BS , Kaitlyn Accardi MPH , Isaac David MPH , LaTaviah Burch RN , Vincent Chua BS , Stefani D'Angelo MS , Rebecca Affoo PhD , Michael S. Pulia MD, PhD , Nicole Rogus-Pulia PhD, CCC-SLP , Liron Sinvani MD

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引用次数: 0

摘要

目的：口咽吞咽困难（吞咽困难）在阿尔茨海默病及相关痴呆症（ADRD）住院患者中发病率很高（高达86%）。本研究旨在描述 ADRD 住院患者吞咽困难的处理方法和临床过程：前瞻性观察队列研究：研究在纽约一家大型医疗系统内的 10 家医院进行。参与者为在内科住院并经语言病理学家（SLP）评估确诊为液体吞咽困难的患有 ADRD 的老年人，招募时间为 2023 年 1 月至 6 月：收集基线特征（如痴呆功能评估分期工具[FAST]）、吞咽困难管理（如处方饮食）和临床过程（如吞咽困难改善、呼吸系统并发症）：在患有 ADRD 和吞咽困难的患者（n = 62）中，平均年龄为 86.5 岁，66.1% 属于 FAST 第 7 阶段。入院时，48.4%的患者患有肺炎，79.0%的患者出现谵妄，69.4%的患者因有吸入风险而被定为无吸入（NPO）。在饮食开始后接受SLP重新评估的患者中（n = 25），76%的患者吞咽困难有所改善；75%的FAST 7期患者吞咽困难有所改善。在使用以下饮食的患者中，21.0% 出现了呼吸系统并发症：NPO、鼻胃管喂食、吞咽困难饮食和舒适喂食。在单变量分析中，医院获得性脱水、吞咽困难无改善和谵妄与呼吸系统并发症有关：ADRD 住院患者（甚至是晚期痴呆患者）的吞咽困难有可能得到改善，这凸显了标准化重新评估的迫切需要。还需要进一步研究，以评估与该人群呼吸系统并发症相关的因素。

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Oropharyngeal Dysphagia in Hospitalized Older Adults with Dementia: A Prospective Cohort Study

Objective

Oropharyngeal dysphagia (dysphagia) is highly prevalent (up to 86%) in hospitalized patients with Alzheimer disease and related dementias (ADRD). This study aims to describe the management and clinical course of dysphagia in hospitalized patients with ADRD.

Design

Prospective observational cohort study.

Setting and Participants

The study was conducted across 10 hospitals within a large health system in New York. Participants were older adults with ADRD admitted to the medicine service and diagnosed with dysphagia to liquids on speech-language pathologist (SLP) assessment and were recruited between January and June 2023.

Methods

Baseline characteristics [eg, dementia Functional Assessment Staging Tool (FAST)], dysphagia management (eg, prescribed diet), and clinical course (eg, dysphagia improvement, respiratory complications) were collected.

Results

Of patients with ADRD and dysphagia (n = 62), the average age was 86.5 and 66.1% were FAST Stage 7. On admission, 48.4% had pneumonia, 79.0% had delirium, and 69.4% were made nil per os (NPO) for aspiration risk. Of those who received SLP reassessment after diet initiation (n = 25), 76% demonstrated dysphagia improvement; 75% of patients with FAST stage 7 demonstrated improvement. Respiratory complications occurred in 21.0% of patients on the following diets: NPO, nasogastric tube feeding, dysphagia diets, and comfort feeds. In univariate analyses, hospital-acquired dehydration, no dysphagia improvement, and delirium were associated with respiratory complications.

Conclusions and Implications

The potential for dysphagia improvement in hospitalized patients with ADRD (even those with advanced dementia) highlights the critical need for standardizing reassessment. Further studies are needed to evaluate factors associated with respiratory complications in this population.

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来源期刊

Journal of the American Medical Directors Association 医学-老年医学

CiteScore

11.10

自引率

6.60%

发文量

472

审稿时长

44 days

期刊介绍： JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates. The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality