Clinical and Scintigraphic Assessment of Swallowing of Older Patients Admitted to a Tertiary Care Geriatric Ward

Background and Purpose: Oropharyngeal dysphagia is a common manifestation in acute stroke. Aspiration resulting from difficulties in swallowing is a symptom that should be considered due to the frequent occurrence of aspiration pneumonia that could influence the patient’s recovery as it causes clinical complications and could even lead to the patient’s death. The early clinical evaluation of swallowing disorders can help define approaches and avoid oral feeding, which may be detrimental to the patient. This study aimed to create an algorithm to identify patients at risk of developing dysphagia following acute ischemic stroke in order to be able to decide on the safest way of feeding and minimize the complications of stroke using the National Institutes of Health Stroke Scale (NHISS). Methods: Clinical assessment of swallowing was performed in 50 patients admitted to the emergency unit of the University Hospital, Faculty of Medicine of Ribeirão Preto, São Paulo, Brazil, with a diagnosis of ischemic stroke, within 48 h after the beginning of symptoms. Patients, 25 females and 25 males with a mean age of 64.90 years (range 26–91 years), were evaluated consecutively. An anamnesis was taken before the patient’s participation in the study in order to exclude a prior history of deglutition difficulties. For the functional assessment of swallowing, three food consistencies were used, i.e. pasty, liquid and solid. After clinical evaluation, we concluded whether there was dysphagia. For statistical analysis we used the Fisher exact test, verifying the association between the variables. To assess whether the NIHSS score characterizes a risk factor for dysphagia, a receiver operational characteristics curve was constructed to obtain characteristics for sensitivity and specificity. Results: Dysphagia was present in 32% of the patients. The clinical evaluation is a reliable method of detection of swallowing difficulties. However, the predictors of risk for the swallowing function must be balanced, and the level of consciousness and the presence of preexisting comorbidities should be considered. Gender, age and cerebral hemisphere involved were not significantly associated with the presence of dysphagia. NIHSS, Glasgow Coma Scale, and speech and language changes had a statistically significant predictive value for the presence of dysphagia. Conclusions: The NIHSS is highly sensitive (88%) and specific (85%) in detecting dysphagia; a score of 12 may be considered as the cutoff value. The creation of an algorithm to detect dysphagia in acute ischemic stroke appears to be useful in selecting the optimal feeding route while awaiting a specialized evaluation.

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“…In contrast, other authors considered age as a predictor of dysphagia [18,25,26], with an increased risk of aspiration with advancing age [27]. …”

Section: Discussionmentioning

confidence: 97%

Using the National Institute of Health Stroke Scale to Predict Dysphagia in Acute Ischemic Stroke

Okubo

Fábio²,

Domenis³

et al. 2012

Cerebrovasc Dis

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“…Clearance was the total exposure of an ROI to the bolus, which represents the interval between the arrival of the bolus head in the ROI and the departure of the bolus tail from the ROI. The definitions of these ROIs and of the measurements performed have been described and depicted previously [9][10][11][12].…”

Section: Methodsmentioning

confidence: 99%

Oral, pharyngeal, and esophageal transit of an acidic bolus in healthy subjects

2013

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Background The swallowing function is influenced by chemical and sensory stimuli. The aim of this investigation was to evaluate the effect of an acidic sour bolus on its oral, pharyngeal, and esophageal transit in healthy volunteers. Method Scintigraphic evaluation of the transit was performed in 43 healthy subjects aged 23-71 years. Each subject swallowed, in a random sequence, 5 mL of two liquid boluses: acidic (50 mL of water with 3 g of concentrated lemon juice, pH 3.0) and neutral (water, pH 6.8), both labeled with 37 MBq of technetium-99m phytate. A series of images of each swallow were acquired at 20 frames/s for 20 s with the subjects sitting in front of the collimator of the gamma camera. Results There was no difference between neutral and acidic boluses in terms of their transit and clearance durations and in the amount of residues when passing through the mouth and pharynx. In the proximal esophagus, the transit and clearance were longer with the neutral bolus (clearance 1.40 ± 0.11 s) than with the acidic bolus (1.17 ± 0.07 s, p = 0.04). In the distal esophagus, the transit and clearance were longer with the acidic bolus (clearance 10.66 ± 0.87 s) than with the neutral bolus (6.60 ± 0.58 s, p = 0.01). The amount of residues in the middle and distal esophagus was greater with the acidic bolus. There was no correlation between distal esophageal clearance duration and the amount of residues with the neutral bolus, but there was a positive correlation with the acidic bolus. Conclusion An acidic bolus causes slower bolus transit in the distal esophageal body as compared to a neutral bolus.

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“…However, a follow-up survey at acute care hospitals and inhome care centers found that, while not significant, one predictor variable of aspiration pneumonia was sex, with women seeming to have a slight disadvantage over men [28]. In addition, a study of swallowing function among volunteers and general acute phase patients reported that younger volunteer had significantly better swallowing function [29]. On the other hand, many studies of patients with cerebrovascular disorders have reported no significant differences in swallowing function [18][19][20], which indicates some variability due to disease and patient background.…”

Section: Discussionmentioning

confidence: 92%

Screening tests for predicting the prognosis of oral intake in elderly patients with acute pneumonia

et al. 2016

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Many elderly patients with pneumonia have aspiration pneumonia. Therefore they must temporarily abstain from oral intake. However, it is difficult to predict whether or not they will be able to start oral intake. The reason is the standard method to evaluate deglutition about pneumonia patients has not been established. In this study we aimed to develop a simple and convenient method that predicts the prognosis of oral intake as nutrition among elderly patients with acute stage pneumonia. Participants were 77 inpatients fasting due to aspiration risk with acute pneumonia. (86.0 ± 7.7 years; range 68-105 years; men: n = 34, women: n = 43) during September 2011 and August 2013. Their consciousness levels were determined by Glasgow coma scale (GCS) and swallowing function and cough reflex were evaluated by repetitive saliva swallowing test (RSST), modified water swallow test, simple swallowing provocation test and cough test. Oral intake status at discharge was considered as the objective variable, and these tests were considered as explanatory variables. Then receiver operating characteristic (ROC) curve and the area under the curve (AUC) for each was done. From the ROC curve analysis, GCS ≥14 had the largest AUC (0.79) with a sensitivity and specificity of 0.71 and 0.80. That was followed by RSST ≥1, AUC (0.77) with a sensitivity and specificity of 0.81 and 0.67. These results suggest that GCS and RSST could be useful screening tests for prognostic prediction of oral intake capability in elderly patients with acute pneumonia.

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Clinical and Scintigraphic Assessment of Swallowing of Older Patients Admitted to a Tertiary Care Geriatric Ward

Cited by 15 publications

References 13 publications

Using the National Institute of Health Stroke Scale to Predict Dysphagia in Acute Ischemic Stroke

Using the National Institute of Health Stroke Scale to Predict Dysphagia in Acute Ischemic Stroke

Oral, pharyngeal, and esophageal transit of an acidic bolus in healthy subjects

Screening tests for predicting the prognosis of oral intake in elderly patients with acute pneumonia

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