Short-Term Therapeutic Adherence of Hospitalized Older Patients with Oropharyngeal Dysphagia after an Education Intervention: Analysis of Compliance Rates, Risk Factors and Associated Complications

Abstract

Oropharyngeal dysphagia (OD) is associated with adverse outcomes that require a multidisciplinary approach with different strategies. Our aim was to assess the adherence of older patients to dysphagia management recommendations during hospitalization, after a specific nurse guided dysphagia education intervention and to identify short term complications of OD and their relationship with short-term adherence. We carried out a prospective observational study in an acute and an orthogeriatric unit of a university hospital over ten months with a one-month follow-up. Four hundred and forty-seven patients (mean age 92 years, 70.7% women) were diagnosed with dysphagia using Volume-Viscosity Swallow Test (V-VST). Compensatory measures and individualized recommendations were explained in detail by trained nurse. Therapeutic adherence was directly observed during hospital admission, after an education intervention, and self-reported after one-month. We also recorded the following reported complications at one month, including respiratory infection, use of antibiotics, weight loss, transfers to the emergency department, or hospitalization). Postural measures and liquid volume were advised to all patients, followed by modified texture food (95.5%), fluid thickeners (32.7%), and delivery method (12.5%). The in-hospital compliance rate with all recommendations was 37.1% and one-month after hospital discharge was 76.4%. Both compliance rates were interrelated and were lower in patients with dementia, malnutrition, and safety signs. Higher compliance rates were observed for sitting feeding and food texture, and an increase in adherence after discharge in the liquid volume and use of thickeners. Multivariate logistic regression analysis showed that adherence to recommendations during the month after discharge was associated with lower short-term mortality and complications (i.e., respiratory infection, use of antibiotics, weight loss, transfers to the emergency department, or hospitalization). One-third of our participants followed recommendations during hospitalization and three-quarters one month after admission, with higher compliance for posture and food texture. Compliance should be routinely assessed and fostered in older patients with dysphagia.

Thick Liquids and Clinical Outcomes in Hospitalized Patients With Alzheimer Disease and Related Dementias and Dysphagia

“…Data were summarized before and after matching using mean and SD for continuous variables and frequency and percentage for categorical variables. The absolute standardized difference was used to assess covariate imbalance between groups before (unmatched sample) and after (matched sample) matching procedures were completed . An absolute standardized difference greater than 0.10 (small effect size) was used as a cutoff to indicate imbalance between the groups.…”

Dysphagia and dementia: a ‘double dilemma’

“…Currently there is no cure for dementia, though potential pharmacological options for the treatment of OPD in Alzheimer's have been reported by Ji et al in 2021 [4 ▪ ]. Recent reports of variables negatively associated with OPD in patients with mild-moderate dementia include poor oral health [16], increased frailty [17], poorer compliance with therapy recommendations [18], and a possible genetic relationship between Alzheimer's and several gastrointestinal disorders [19,20 ▪ ].…”

Nutritional Management in Adult Patients With Dysphagia: Position Paper From Japanese Working Group on Integrated Nutrition for Dysphagic People

“…38 Unfortunately, liquid viscosity modification has led to intake dissatisfaction and decreased adherence. 39 Nonetheless, through educational interventions by trained nurses, patients' adherence regarding food web 4C=FPO Fig. 1.…”

“…Ueshima texture and thickener use improved. 39 Therefore, diet form and liquid viscosity modification combined with educational interventions by health care providers is recommended. The RDs should regularly assess the swallowing function and aim to make a regular diet for patients if a TMD is possibly unnecessary.…”