Analysis of Quality of Life and Nutritional Status in Elderly Patients with Dysphagia in Order to Prevent Hospital Admissions in a COVID-19 Pandemic

Abstract

(1) Background: Oropharyngeal dysphagia (OD) is currently recognized as one of the geriatric syndromes due to its high frequency in older people and its associated complications, which have a direct impact on quality of life. The main objective is to determine the effectiveness of telehealth consultation for the re-evaluation of nutritional status and quality of life assessment in older people diagnosed with OD associated with active use of thickeners to prevent hospital admissions in a COVID-19 pandemic. (2) Methods: an observational, descriptive, and longitudinal study that included a sample of 33 subjects with age equal or superior to 65 years diagnosed with OD with conserved cognitive capacity. The nutritional status was evaluated through the Mini-Nutritional Assessment (MNA) questionnaire and biochemical parameters and, the quality of life was determined through the Swallowing Quality of Life (SWAL-QOL) questionnaire. (3) Results: Thirty-three older patients with OD were recruited (54.5% women), with a mean age of 83.5 ± 7.6 years. The main cause of OD in the study population was neurodegenerative disease (51.5%), followed by cerebrovascular disease (33.3%), and other causes (15.2%). Sixty point six percent of patients were found to be at risk of malnutrition. The MNA score was significantly correlated to albumin (r: 0.600, p < 0.001) and total proteins (r: 0.435, p = 0.015), but not to total cholesterol (r: −0.116, p = 0.534) or lymphocytes (r: −0.056, p = 0.758). The mean total score of the SWAL-QOL was 75.1 ± 16.4 points. (4) Conclusions: the quality of life of the subjects related to the use of a thickener is good. Although the body mass index (BMI) and average biochemical, nutritional parameters of the subjects are within the range of normality, the MNA has detected a high percentage of subjects with the risk of malnutrition, which suggests the need for continuous re-evaluation in these patients, demonstrating the viability of the telematic route in this research.

The prevalence of dysphagia and changes in the quality of swallowing in patients infected with COVID-19

“…Most of these individuals had complaints related to these domains, such as difficulty in dealing with the change in swallowing, presence of clearing, choking, and chewing difficulties, leftover food in the mouth, uncomfortable for not being able to eat everything, fear of choking, discouragement because they need to be careful when eating, and difficulty in social life due to changes in swallowing. These findings are in agreement with the studies of Fernández et al (2020), who demonstrated that the elderly present a greater change in the quality of the swallowing process because they are a population with a higher incidence of dysphagia (Fernández-Ruiz et al, 2020_. Tracheostomized individuals showed changes in the domains 1, 2, 3, 4, 6, 7, and 8. Most of these individuals had complaints related to these domains, such as difficulty in dealing with the change in swallowing, longer time needed for eating, presence of coughing, throat clearing, choking, and chewing difficulties, leftover food in the mouth, uncomfortable for not being able to eat everything, fear of choking, discouragement because they need to be careful when eating, and difficulty in social life due to changes in swallowing.…”

Dementia wellbeing and COVID‐19: Review and expert consensus on current research and knowledge gaps

“…Published and ongoing studies on the potential of technology to deliver physical, psychoeducational and psychosocial interventions remotely to people with dementia; 122 Alves et al., 2020 124 (Ballard; Manchester Camerata Ltd, NIHR) will offer insight into the acceptability of telehealth for those with more severe cognitive problems. Further research on the remote delivery of social care or befriending initiatives would also be important.…”

Autoavaliação da qualidade de vida, risco para disfagia e alteração de deglutição em pacientes internados com COVID-19

“…Muitos pacientes podem recuperar a função de deglutição normal ou funcional após intubação e traqueostomia com consequente decanulação em resposta efetiva à reabilitação fonoaudiológica 15 . As alterações de deglutição também influenciam inevitavelmente a qualidade de vida dos pacientes 16 , podendo apresentar correlação negativa e significante entre qualidade de vida e a gravidade da disfagia 17 nos pacientes internados com COVID-19.…”