Mealtime Difficulties in a Home for the Aged: Not Just Dysphagia

Abstract

A mealtime screening tool was administered to 349 residents of a home for the aged to determine the prevalence of mealtime difficulties including, but not limited to, dysphagia. Mealtime difficulties, as assessed during a single meal observation of each resident, were documented in 87% of these individuals. Though 68% exhibited signs of dysphagia, 46% had poor oral intake, 35% had positioning problems, and 40% exhibited challenging behaviors. An increased prevalence of mealtime difficulties was related to both the presence and degree of cognitive impairment. Oral intake was best among residents with severe cognitive impairment, many of whom received partial to total feeding assistance. In contrast, poor oral intake was associated with mild-moderate cognitive impairment, pointing to a need for more aggressive intervention with this group. The results clearly demonstrate that the prevalence of a wide range of eating-related problems far exceeds accepted estimates of dysphagia alone and support a multidisciplinary approach to mealtime interventions for the institutionalized elderly. Additionally, the magnitude of problems identified has implications for both resource and staff-training requirements in long-term care facilities.

Effects of Age on Esophageal Motility: Use of High-resolution Esophageal Impedance Manometry

“…It was reported that 87% of residential care clients who are predominantly elderly had a symptom of dysphagia with mealtime difficulties which is associated with gastroenterological dysfunction. 1 The rate of disordered swallowing was higher in the aged population. 2,3 Several studies showed decreased sphincter relaxations and decreased esophageal contraction and dilatation in the aged people.…”

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“…Swallowing disorders (dysphagia) are common among people who have had strokes (Murry et al, 1999); clinical signs of swallowing difficulty have been observed in as many as 70% of institutionalized older people (Steele et al, 1997). People with dysphagia are at risk for choking, aspiration (entry of material into the airway), and inadequate nutritional intake; airway obstruction, aspiration pneumonia, and malnutrition are serious consequences.…”

Length of stay patterns for patients of an acute care hospital: implications for nutrition and food services

“…Nutrition and food services advancements are required to ensure: menus that consider the needs of the substantial proportion of long stayers, dining environments (eg, bistro or dining room in contrast to bed), meal-time atmosphere, 15,16 proximity of meal choice to delivery, 17 dense meals, [18][19][20] assistance with meals, [21][22][23] nursing staff involvement in meal times, 24 early identification and intervention for those at nutritional risk, 25 and ease of access to nutritional supplements. 26 Supplementation has not been found to reduce other oral intake.…”