Preliminary Study of the Effects of a Dysphagia Support Group on Quality of Life.

PURPOSE: Dysphagia (swallowing difficulties) can greatly decrease quality of life for individuals with dysphagia and can lead to caregiver burden and third-party disability. Support groups have been shown to be effective in improving quality of life in a range of conditions, through allowing individuals to form connections with those with shared experiences and sharing and learning about relevant resources and coping skills. However, no research on the effects of dysphagia support groups on quality of life has been conducted. This preliminary study aimed to determine whether a virtual support group, facilitated by speech-language pathologists, could positively affect quality of life in similar ways for adults with dysphagia and their family caregivers. METHOD: Pre- and postsupport group surveys were sent to participants to gain information about their dysphagia, demographics, and support group feedback (e.g., access to resources). Questions were mainly multiple choice, with three open-ended questions related to the support group. RESULTS: Eight individuals participated in the surveys, with four completing both pre- and postsession surveys. Seven of eight individuals reported that they felt a support group could improve their quality of life, with the eighth being unsure. Qualitative data found the support group offered both informational (e.g., resource access) and psychosocial support (e.g., knowledge that they were not alone, emotional support). CONCLUSION: These initial results suggest that a dysphagia support group could fill a gap in the health care system to offer more holistic support to individuals with dysphagia and their family caregivers.

Understanding the Independent Predictors of Dysphagia-Related Quality of Life in Stroke Survivors.

PURPOSE: It is important to pinpoint modifiable factors contributing to reduced dysphagia-related quality of life (QoL) in order to improve treatment outcomes and patient health given that a large proportion of stroke survivors experience dysphagia. The purpose of this exploratory study was to identify the independent predictors of dysphagia-related QoL in community-dwelling stroke survivors. METHOD: A sample of 31 adult stroke survivors with dysphagia (M age = 62 years; 23 males) and their partners (M age = 57 years; seven males) participated in the study. Survivors were > 3 months poststroke and living with their partner. Backward regression analysis methods were employed to determine independent predictors of dysphagia-related QoL using scores from the Swallowing-Related Quality of Life questionnaire. Independent variables tested included age, employment status, receiving dysphagia treatment, number of medical conditions, level of diet modification, Stroke Impact Scale (SIS) scores, relationship with partner, partner age, partner employment status, partner burden, and partner depression. RESULTS: Results indicated that number of survivor medical conditions, degree of diet modification, SIS emotional subscale score, and partner employment status significantly predicted dysphagia-related QoL (p < .001). More specifically, stroke survivors with more medical conditions or a partner who worked outside of the home had worse dysphagia-related QoL, and those with better mental health or a less modified diet had better dysphagia-related QoL. CONCLUSION: Factors related to dysphagia-related QoL are multifactorial and include both survivor and spousal variables. The results of this exploratory study highlight the need for clinicians and researchers to consider patient function and needs more wholistically to maximize perceived QoL.

A Retrospective Analysis of Swallowing Function and Physiology in Patients Living with Dementia.

Dysphagia is commonly diagnosed in patients living with dementia, but we lack understanding of changes in swallowing physiology and the resulting relationship to impairments of safety and efficiency. The purpose of this study was to describe the pathophysiology of dysphagia in a retrospective sample of patients living with dementia. Videofluoroscopy data from 106 adults (mean age: 84) diagnosed with dementia were scored by blinded raters. Raters analyzed 412 thin liquid swallows for safety [Penetration-Aspiration Scale (PAS)], efficiency [% of (C2-C4)2], timing [Pharyngeal Transit Time (PTT), Swallow Reaction Time (SRT), Laryngeal Vestibule Closure Reaction Time (LVCrt), Upper Esophageal Sphincter Opening Duration (UESO)], and kinematics (pharyngeal constriction). Impairment thresholds from existing literature were used to characterize swallowing. Chi-square tests and Pearson's correlations were used to determine associations between swallowing physiology and function. Compared to published norms, we identified significant differences in PTT, SRT, LVCrt, UESO, and degree of maximum pharyngeal constriction. Unsafe swallowing (PAS > 2) was seen in 17% of swallows. Clinically significant residue (i.e., % of (C2-C4)2 > 0.54 vallecular; > 0.34 pyriforms) was seen in most patients. Chi-square tests revealed significant associations between LVCrt and unsafe swallowing. There was a weak positive association between post-swallow residue in the pyriforms and poor pharyngeal constriction. Detailed analysis of swallowing physiology in this sample provides insight into the pathophysiological mechanisms associated with dysphagia in patients living with dementia. Further work is needed to explore additional bolus consistencies and to identify how physiology changes based on type and severity of dementia diagnosis.

Contributors to Poststroke Dysphagia-Related Caregiver Burden.

Purpose Caregiver burden negatively impacts both stroke survivor and caregiver well-being. Thus, it is important to better understand the individual- and dyadic-level variables that may contribute to dysphagia-related caregiver burden. The aim of this preliminary study was to identify survivor-, caregiver-, and dyadic-specific factors associated with burden in couples experiencing poststroke dysphagia. Method Twenty-eight stroke survivors ("care recipients") with dysphagia and their spouses ("caregivers") participated. Care recipients and caregivers completed a survey from which scores for the following variables were derived: dysphagia-related caregiver burden, survivor- and spouse-perceived impact of dysphagia on mealtimes (social, mealtime logistics), dyadic congruence on perceived impact, International Dysphagia Diet Standardisation Initiative Functional Diet Scale, Swallowing-Related Quality of Life Scale, and Stroke Impact Scale (cognitive, emotional, physical, and social domains). Spearman's rho and point biserial correlation coefficients were calculated to determine the factors related to caregiver burden. Results Increased burden was significantly associated with greater care recipient- and spouse-perceived impact of dysphagia on mealtime logistics; however, burden was not associated with measures of dyadic congruence of perceived impact. Notably, increased burden was also associated with increased diet restrictiveness and decreased swallow-specific quality of life. Dysphagia-related caregiver burden was not associated with measures of stroke impact/severity across any domain. Conclusions Factors related to dysphagia-related caregiver burden are multifactorial and include both care recipient (e.g., International Dysphagia Diet Standardisation Initiative Functional Diet Scale, Swallowing-Related Quality of Life Scale, perceived impact of dysphagia on mealtime logistics) and caregiver (e.g., perceived impact of dysphagia on mealtime logistics) variables. The results of this preliminary investigation support the need to incorporate aspects of counseling and family-centered care into our management practices, a growing area of interest for speech-language pathologists.

Creation and Initial Validation of the Caregiver Analysis of Reported Experiences with Swallowing Disorders (CARES) Screening Tool.

Purpose Dysphagia is a debilitating condition with widespread consequences. Previous research has revealed dysphagia to be an independent predictor of caregiver burden. However, there is currently no systematic method of screening for or identifying dysphagia-related caregiver burden. The aim of this study was to develop a set of questions for a dysphagia-related caregiver burden screening tool, the Caregiver Analysis of Reported Experiences with Swallowing Disorders (CARES), and pilot the tool to establish preliminary validity and reliability. Method The questionnaire was developed through an iterative process by a team of clinical researchers with expertise in dysphagia, dysphagia-related and general caregiver burden, and questionnaire design. A heterogenous group of 26 family caregivers of people with dysphagia completed the CARES, along with the Eating Assessment Tool (EAT-10), the International Dysphagia Diet Standardisation Initiative Functional Diet Scale (IDDSI-FDS), and the Zarit Burden Interview (ZBI). Information on construct validity, item fit, convergent validity, internal consistency, and reliability was determined via Rasch analysis model testing, Cronbach's alpha, and Spearman's rho calculations. Results The final CARES questionnaire contained 26 items divided across two subscales. The majority of the questionnaire items fit the model, there was evidence of internal consistency across both subscales, and there were significant relationships between dysphagia-specific burden (CARES) and perceived swallowing impairment (EAT-10), general caregiver burden (ZBI), and diet restrictiveness (IDDSI-FDS). Conclusions Results from the current study provide initial support for the validity and reliability of the CARES as a screening tool for dysphagia-related burden, particularly among caregivers of adults with swallowing difficulties. While continued testing is needed across larger groups of specific patient populations, it is clear that the CARES can initiate structured conversations about dysphagia-related caregiver burden by identifying potential sources of stress and/or contention. This will allow clinicians to then identify concrete methods of reducing burden and make appropriate referrals, ultimately improving patient care.

Speech-Language Pathology Management for Adults With COVID-19 in the Acute Hospital Setting: Initial Recommendations to Guide Clinical Practice.

Purpose This document outlines initial recommendations for speech-language pathology management of adult patients with COVID-19 in the acute hospital setting. Method The authors initially developed these recommendations by adapting those developed for physical therapists working with patients with COVID-19 by Thomas et al. (2020). The recommendations then underwent review by 14 speech-language pathologists and rehabilitation-focused academics representing seven countries (Belgium, Brazil, Canada, Ireland, Japan, New Zealand, the United States). The authors consolidated and reviewed the feedback in order to decide what should be included or modified. Applicability to a global audience was intended throughout the document. Results The authors had 100% agreement on the elements of the recommendations that needed to be changed/modified or added. The final document includes recommendations for speech-language pathology workforce planning and preparation, caseload management, service delivery and documentation, as well as recommendations for the selection of appropriate personal protective equipment and augmentative and alternative communication equipment in the acute care hospital setting. Conclusions Speech-language pathologists play a critical role in the assessment, management, and treatment of patients with COVID-19. Several important considerations need to be made in order to meet the needs of this unique patient population. As more is learned about the impact of the virus on swallowing and communication, the role of the speech-language pathologist on interdisciplinary care teams will remain paramount.

Establishing a method for quantifying spinal curvature during videofluoroscopic swallow studies: Applying the modified Cobb angle to healthy young and older adults.

The Cobb angle is traditionally used for quantifying the degree of spinal curvature through evaluation of the full spinal cord. When conducting measurements on videofluoroscopy swallowing studies (VFSS), the Cobb angle can measure degree of cervical vertebrae curvature, which may have implications for swallowing. Given that this measure may have utility in dysphagia research, the reliability of this measure taken from C2-C4 and establishing the presence of changes with age were the focus of the current, proof-of-principle study. VFSS from 19 healthy young adults and 39 healthy older adults were retrospectively analyzed. The C2-C4 Cobb angle was measured between cervical vertebrae two and four on frames of laryngeal vestibule closure (LVC) and post-swallow rest. Results revealed excellent levels of inter- and intra-rater reliability for frame of post-swallow rest (ICCs = 0.788 and 0.793), and fair to good levels of agreement for frame of LVC (ICCs = 0.667 and 0.621). Significant differences in the C2-C4 Cobb angle were found between the healthy young and old data (p < 0.01). Healthy younger adults had a mean angle of 5.8±9.0 degrees at LVC and 7.7±4.5 degrees at swallow rest, whereas healthy older adults had a mean angle of 12.5±9.0 degrees at LVC and 12.4±9.7 degrees at rest. Consistent with the existing spine literature, the curvature of cervical vertebrae appears to increase with age. With established reliability, we propose that the C2-C4 Cobb angle may be used to determine the degree of spinal curvature in a variety of patient populations in order to determine impacts on swallowing function.

Swallowing Impairments Increase Emotional Burden in Spousal Caregivers of Older Adults.

Objective: The aim of this study was to determine the type and extent of caregiver burden uniquely experienced by spousal caregivers of older adults with dysphagia. Method: Using the Round 1 surveys from the National Health and Aging Trends Study and the National Study of Caregiving, we analyzed data on 422 community-dwelling older adults and their spousal caregivers. Results: Approximately 17% of care recipients reported swallowing difficulties. Logistic regression analysis revealed that caregivers of spouses with dysphagia were significantly more likely to experience emotional burden, p = .038; odds ratio (OR) = 2.06; 95% confidence interval (CI): [1.04, 4.09]. Of those spouses caring for partners with dysphagia who reported emotional burden, nearly 70% rated the burden moderate to severe. Discussion: Dysphagia in community-dwelling older adults is associated with increased emotional burden among spousal caregivers. Given the intricate relationship between the health and well-being of both members of the caregiving dyad, these findings support the need for interventions that prioritize dyadic health.

The influence of swallowing impairments as an independent risk factor for burden among caregivers of aging parents: A cross-sectional study.

Informal caregivers can experience high levels of burden, negatively impacting both the caregiver and care recipient. The presence of dysphagia (swallowing impairments) in care recipients is suggested to contribute to increased caregiver burden. The purpose of this study was to describe the type and severity of caregiver burden experienced by adults caring for community-dwelling older parents reporting symptoms of dysphagia. Using surveys from the National Health and Aging Trends Study and the National Study of Caregiving, data from 895 adults providing care for an aging parent were analyzed. Binary logistic regression analyses revealed that swallowing difficulties reported by a parent is a significant independent predictor of increased physical and emotional burden in their caregivers. Forty percent or more of these caregivers reported moderate to severe physical and/or emotional burden. Suggestions are provided to identify dysphagia early on and to provide supports for caregivers.

Perception Versus Performance of Swallow Function in Residents of Long-Term Care.

Purpose The purpose of this study was to determine if older adults residing in long-term care were able to accurately self-report their swallowing status by comparing subjective complaints of dysphagia and objective methods of swallowing screening. Method Data were collected from 397 residents of long-term care (M age = 86.8 years ± 7.8; 263 female). Cognitive impairment scores were collected, and each resident was asked (a) if they thought they had a swallowing problem, (b) if they coughed/choked when they ate, and (c) if they coughed/choked when they drank. These responses were compared to results of a swallowing screening tool and mealtime observations of coughing and choking. Results Residents who reported swallowing difficulties (10%, n = 41) were 8 times more likely to fail the swallowing screening (p < .001); however, 80% of residents who failed the swallowing screening did not previously report that swallowing was an issue. There was no significant association between self-reports of coughing and choking at meals and observations. There was no difference in level of cognition between residents who accurately reported swallowing status and those who were inaccurate. Conclusions Residents are largely unable to accurately self-report swallowing difficulties and also have difficulty accurately reporting incidences of coughing and choking. These findings suggest that concerted efforts are required to implement regular, formal swallowing screening protocols in long-term care to objectively identify those at risk.

Presbyphagia to Dysphagia: Multiple Perspectives and Strategies for Quality Care of Older Adults.

The aging population is rapidly growing, requiring speech-language pathologists to better manage a caseload that includes older adults who have a variety of needs. The purpose of this review is to summarize and discuss the current available evidence that will allow speech-language pathologists to make informed clinical decisions when working with older adults. To facilitate this, this article first establishes an understanding of both normal and disordered swallowing physiology in older adults, including how to differentiate between functional changes to swallowing (presbyphagia) and dysphagia. Other important factors to consider, such as caregiver burden, are also discussed so that clinicians can learn how to best support aging in place. Best practices for screening both community-dwelling older adults and residents of long-term care are identified as part of a framework introduced to guide decision making. The critical components of clinical swallow assessments are reviewed, including the adoption of an ethnographic approach and why nutritional status, urinary tract infections, and delirium are important considerations when working with older adults. Factors contributing to, and associated with, aspiration and aspiration pneumonia are also discussed so that clinicians better understand how to take a comprehensive approach to care, as well as consider the impact and influence of a temporary dysphagia versus a more chronic presentation. Finally, the evidence for management of dysphagia in this specialized population is reviewed, highlighting the importance of identifying physiological deficits, feedback, and taking a multidisciplinary approach to care.

Reference Values for Healthy Swallowing Across the Range From Thin to Extremely Thick Liquids.

Purpose Thickened liquids are frequently used as an intervention for dysphagia, but gaps persist in our understanding of variations in swallowing behavior based on incremental thickening of liquids. The goal of this study was to establish reference values for measures of bolus flow and swallowing physiology in healthy adults across the continuum from thin to extremely thick liquids. Method A sex-balanced sample of 38 healthy adults underwent videofluoroscopy and swallowed 20% weight-to-volume concentration barium prepared in thin and slightly, mildly, moderately, and extremely thick consistencies using a xanthan gum thickener. Participants took comfortable sips and swallowed without a cue; sip volume was measured based on presip and postsip cup weights. A standard operating procedure (the ASPEKT method: Analysis of Swallowing Physiology: Events, Kinematics and Timing) was used to analyze videofluoroscopy recordings. Results The results clarify that, for thin liquid sips (10-14 ml), a single swallow without clearing swallows is typical and is characterized by complete laryngeal vestibule closure, complete pharyngeal constriction, and minimal postswallow residue. Aspiration was not seen, and penetration was extremely rare. Bolus position at swallow onset was variable, extending as low as the pyriform sinuses in 37% of cases. With thicker liquids, no changes in event sequencing, laryngeal vestibule closure, pharyngeal constriction, or postswallow residue were seen. The odds of penetration were significantly reduced. A longer timing interval until onset of the hyoid burst movement was seen, with an associated higher bolus position at swallow onset. Other timing measures remained unaffected by changes in bolus consistency. Conclusion The results include new reference data for swallowing in healthy adults across the range from thin to extremely thick liquids.

Quantifying Airway Invasion and Pharyngeal Residue in Patients with Dementia.

Previous research has begun to elucidate the physiological impairments associated with dysphagia in patients with dementia, but in order to select the most appropriate targets of intervention we need to better understand consequences of dysphagia. The purpose of this study was to quantify penetration, aspiration, and residue in people with dementia, and confirm if residue was associated with airway invasion on subsequent swallows. Videofluoroscopy clips of sips of thin and extremely thick liquid barium from 58 patients with dementia were retrospectively analyzed. Ratings of swallowing safety, using the Penetration⁻Aspiration Scale (PAS), and efficiency, using Normalized Residue Ratio Scale in the valleculae (NRRSv) and pyriform sinuses (NRRSp), were made on all swallows. Over 70% of both thin and extremely thick liquid swallows were found to be safe (PAS < 3). Results also revealed that residue was generally more common in the valleculae. However, the proportion of thin liquid swallows with significant NRRSp that were unsafe on the subsequent swallow was significantly greater than the proportion of swallows with significant NRRSp that were safe on the subsequent swallow. As such, there was a 2.83 times greater relative risk of penetration⁻aspiration in the presence of thin liquid pyriform sinus residue. Future research should determine the impaired physiology causing aspiration and residue in this population.

The Relationship between Texture-Modified Diets, Mealtime Duration, and Dysphagia Risk in Long-Term Care.

Many long-term care (LTC) residents have an increased risk for dysphagia and receive texture-modified diets. Dysphagia has been shown to be associated with longer mealtime duration, and the use of texture-modified diets has been associated with reduced nutritional intake. The current study aimed to determine if the degree of diet modification affected mealtime duration and to examine the correlation between texture-modified diets and dysphagia risk. Data were collected from 639 LTC residents, aged 62-102 years. Nine meal observations per resident provided measures of meal duration, consistencies consumed, coughing and choking, and assistance provided. Dysphagia risk was determined by identifying residents who coughed/choked at meals, were prescribed thickened fluids, and/or failed a formal screening protocol. Degree of texture modification was derived using the International Dysphagia Diet Standardization Initiative Functional Diet Scale. There was a significant association between degree of diet modification and dysphagia risk (P < 0.001). However, there was no association between diet modifications and mealtime duration, even when the provision of physical assistance was considered. Some residents who presented with signs of swallowing difficulties were not prescribed a texture-modified diet. Swallowing screening should be performed routinely in LTC to monitor swallowing status and appropriateness of diet prescription. Physical assistance during meals should be increased.

Creation and Initial Validation of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale.

OBJECTIVE: To assess consensual validity, interrater reliability, and criterion validity of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale, a new functional outcome scale intended to capture the severity of oropharyngeal dysphagia, as represented by the degree of diet texture restriction recommended for the patient. DESIGN: Participants assigned International Dysphagia Diet Standardisation Initiative Functional Diet Scale scores to 16 clinical cases. Consensual validity was measured against reference scores determined by an author reference panel. Interrater reliability was measured overall and across quartile subsets of the dataset. Criterion validity was evaluated versus Functional Oral Intake Scale (FOIS) scores assigned by survey respondents to the same case scenarios. Feedback was requested regarding ease and likelihood of use. SETTING: Web-based survey. PARTICIPANTS: Respondents (N=170) from 29 countries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Consensual validity (percent agreement and Kendall τ), criterion validity (Spearman rank correlation), and interrater reliability (Kendall concordance and intraclass coefficients). RESULTS: The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed strong consensual validity, criterion validity, and interrater reliability. Scenarios involving liquid-only diets, transition from nonoral feeding, or trial diet advances in therapy showed the poorest consensus, indicating a need for clear instructions on how to score these situations. The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed greater sensitivity than the FOIS to specific changes in diet. Most (>70%) respondents indicated enthusiasm for implementing the International Dysphagia Diet Standardisation Initiative Functional Diet Scale. CONCLUSIONS: This initial validation study suggests that the International Dysphagia Diet Standardisation Initiative Functional Diet Scale has strong consensual and criterion validity and can be used reliably by clinicians to capture diet texture restriction and progression in people with dysphagia.

Inadequate fluid intake in long term care residents: prevalence and determinants.

Dehydration is estimated to be present in half of long term care residents, as many do not consume the recommended levels of fluid intake. This study aims to describe fluid intake in long term care residents and identify the factors associated with fluid intake. Data were collected from 622 long term care residents, with a mean age of 86.8 ± 7.8. Total fluid intake was estimated over three non-consecutive days. Potential resident and unit-level variables risk factors for low fluid intake were collected, such as dementia status, activities of daily living, and eating challenges. Average daily fluid intake ranged from 311-2390 mL (1104.1 ± 379.3). Hierarchical regression analysis revealed that fluid intake was negatively associated with increased age, cognitive impairment, eating challenges and increased dining room staffing. Being male and requiring more physical assistance were positively associated with intake. Variables identified to predict intake could help inform strategies and targeted interventions to improve fluid intake.

The Burden of Dysphagia on Family Caregivers of the Elderly: A Systematic Review.

With the rapid increase in the elderly population, there is a simultaneous increased need for care provided by family caregivers. Research in the field of head and neck cancer has indicated that caring for patients with dysphagia can impact a caregiver's quality of life. Given that many older adults present with dysphagia, one can assume that their caregivers are equally, if not more greatly, affected. The purpose of this systematic review was to examine all relevant literature regarding the caregiver burden in caregivers of community-dwelling older adults with dysphagia. A review of relevant studies published through April 2018 was conducted using search terms related to dysphagia, caregiver burden, and older adults. The search yielded 2331 unique abstracts. Of the 176 abstracts that underwent full review, four were accepted. All reported an increase in caregiver burden due to presence of dysphagia in care recipients. Worsening feeding-related behaviors were associated with burden, and the use of feeding tubes was more frequently associated with "heavy burden". The presence of dysphagia in community-dwelling older adults is a factor leading to an increased burden among caregivers. Although aspects of dysphagia play a role in the caregiver burden, the specific reasons for the increased burden are unknown. Clinicians should be aware of dysphagia as a source of the burden, and future studies should further define the relationship between dysphagia and the caregiver burden in order to develop comprehensive approaches to care.

A review of swallow timing in the elderly.

Many studies evaluate dysphagia in elderly patients and compare their swallowing to younger controls to assess the degree of swallowing impairment. Previous research suggests that changes should be expected in swallowing due to aging, and these changes need to be considered when performing swallowing assessments. A systematic review was conducted to elucidate the timing of swallowing in healthy. A comprehensive multiengine literature search was conducted to find articles studying swallowing in the healthy elderly, which yielded 22,852 articles of which 11 were judged to be relevant. Only articles using videofluoroscopy as an assessment method for swallowing timing were included. The articles underwent detailed review for study quality and data extraction. The eleven studies contained data for 32 different parameters, and 10 of the 11 studies compared elderly subjects to a younger group. Timing measures from the studies were compiled for analysis. In general, bolus transit times do not appear to change with age. Of note, elderly subjects tended to have a significantly delayed swallow response times and longer duration of upper esophageal sphincter opening. Results showed a large degree of variability across studies for each of the timing measures. Confidence intervals for timing in healthy older participants were computed across studies. Potential sources of variation were identified, including methodological, stimulus-related and participant-related sources. The results suggests that aging affects only a few very specific swallowing timing parameters, and many parameters appear to be unaffected by aging. Therefore, significant differences from a young reference sample should be interpreted as dysphagia rather than normal changes due to aging.

Effects of Tongue Strength Training on Mealtime Function in Long-Term Care.

PURPOSE: The primary aim of this study was to determine the feasibility and effectiveness of an 8-week tongue-strengthening intervention protocol for seniors with mild to moderately severe cognitive impairment in the long-term care setting. Outcome measures of interest included tongue strength, mealtime duration, and food intake. METHOD: In this pre-post group study of treatment outcomes, data were collected from 7 adults (aged 84-99 years). Participants were observed across a series of mealtimes to determine mealtime duration and intake before and after 16 treatment sessions. During therapy, participants performed isometric strength exercises and tongue pressure accuracy tasks using the Iowa Oral Performance Instrument (model number 2.1, IOPI Medical). Differences in tongue strength as a function of treatment were explored between the first 3 and final 3 sessions using univariate repeated-measures analysis of variance. Single-subject methods were used to explore baseline and posttreatment data for measures of mealtime function. RESULTS: Anterior and posterior tongue strength increased significantly with therapy. There were no changes in mealtime function. CONCLUSIONS: This study shows proof of concept that some older adults with cognitive impairment are able to participate in a tongue-strengthening intervention and achieve improvements in tongue strength. Failure to find evidence of associated changes of mealtime function suggests that mealtime measures may not be directly sensitive to changes in tongue strength.

How Swallow Pressures and Dysphagia Affect Malnutrition and Mealtime Outcomes in Long-Term Care.

Malnutrition is a major cause of hospitalization for residents of long-term care facilities (LTC). Dysphagia is thought to contribute to malnutrition. Tongue weakness is suggested to predict poor food intake, longer meals, and dysphagia. We explored the relationships between tongue strength, dysphagia, malnutrition and mealtime outcomes in LTC residents. Data were collected from 639 LTC residents (199 male), aged 62-102 (mean 87). Maximum isometric tongue pressures (MIPs) and saliva swallow pressures (MSPs) were measured using the Iowa Oral Performance Instrument. Participants also completed the Screening Tool for Acute Neuro Dysphagia. Nutrition status was assessed using the Patient-Generated Subjective Global Assessment. A series of repeated meal observations provided measures of meal duration and calories consumed. Mean MIPs were 33 kPa (95% CI 29-37) and MSPs were 26 kPa (95% CI 23-29). The odds of showing signs of dysphagia were 3.7 times greater in those with MSPs less than 26 kPa (p < 0.05). The odds of being malnourished were almost double in those showing signs of dysphagia. Co-occurrence of dysphagia and malnutrition was seen in 29%. Residents with low MSPs also had significantly longer mealtime durations (MTD) (p < 0.05). Moreover, those with both low swallowing pressures and suspected dysphagia consumed fewer calories/minute (p < 0.05) and had significantly longer MTDs (p < 0.05). This study confirms associations between tongue weakness, signs of dysphagia, mealtime outcomes and malnutrition among LTC residents. These findings suggest that saliva swallow pressure measures may be helpful for early identification of dysphagia and nutritional risk in this population.