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

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.

High Prevalence of Oropharyngeal Dysphagia in Acutely Hospitalized Patients Aged 80 Years and Older.

OBJECTIVES: Oropharyngeal dysphagia is a geriatric syndrome that is usually underdiagnosed in older patients. The aim of this study was to determine the prevalence and identify the main risk factors of dysphagia in the oldest old patients admitted to an acute geriatric unit. DESIGN: Observational prospective study. SETTING AND PARTICIPANTS: Older patients admitted to an acute geriatric unit of a university hospital. MEASURES: 329 patients (mean age 93.5 years, range 81-106) were assessed for oropharyngeal dysphagia within 48 hours of hospital admission using the Volume-Viscosity Swallow Test. Demographic characteristics, geriatric assessment, geriatric syndromes, comorbidities, drug treatment, and complications were examined to determine their association with the presence of dysphagia. RESULTS: Oropharyngeal dysphagia was present in 271 (82.4%) of the participants. Multivariate logistic regression showed that malnutrition [odds ratio (OR) 3.62, 95% confidence interval (CI) 1.01-12.93; P = .048], admission for respiratory infection (OR 2.89, 95% CI 1.40-5.94; P = .004), delirium (OR 2.89, 95% CI 1.40-5.94; P = .004), severe dependency (OR 3.23, 95% CI 1.23-8.87; P = .017), and age (OR 1.11, 95% CI 1.01-1.21; P = .03) were significantly associated with dysphagia. The use of a calcium antagonist at the time of admission was associated with a reduced risk of dysphagia (OR 0.39, 95% CI 0.16-0.92; P = .03). CONCLUSIONS AND IMPLICATIONS: The prevalence of oropharyngeal dysphagia is high in the oldest old patients admitted to an acute geriatric unit when assessed with an objective diagnostic method. Our findings suggest that objective swallowing assessment should be routinely performed on admission in order to start early interventions to avoid complications of dysphagia in this complex population.

[Functional decline during hospitalization in elderly patients. Benefits of admission to the geriatrics service]. / Deterioro funcional durante la hospitalización en ancianos. Beneficios del ingreso en el servicio de geriatría.

INTRODUCTION: In some elderly individuals, hospital admission for acute illness represents a possible loss of autonomy not always related to the reason for hospitalization. The importance of this problem and the possible existence of differences among services are not sufficiently well known. OBJECTIVE: To compare the incidence of functional decline and associated risk factors during hospitalization between an acute care geriatric unit (GU) and an internal medicine (IM) ward. MATERIAL AND METHODS: We performed a prospective, cohort study. Sociodemographic characteristics, comorbidity, cause of admission, severity, use of several hospital practices, mortality rate and functional decline were analyzed. Functional decline was defined as the loss of independence to perform at least one of the basic activities of daily living with respect to preadmission status. The influence of the admitting service was evaluated by a multiple logistic regression model. RESULTS: A total of 379 patients were included (140 in the GU and 239 in IM). Compared with IM, patients in the GU were older (87 vs 81.5; P< .001), had a greater prevalence of dementia and visual alterations and worse previous functional status. The proportion of patients who spent > 48 hours in bed and who received nocturnal medication was lower in the GU. The functional decline rate was greater in IM than in the GU (60.2% vs 48%; P=.04). Length of hospital stay was similar in both groups (7.7 vs 8.1 days; P=.37). Functional decline was associated with age, delirium, lack of mobilization, bed rest for > 48 h, psychotropic drugs, nocturnal medication and physical restraints. In the multivariate analysis, admission to IM was associated with a greater risk of functional decline. CONCLUSIONS: Functional decline during hospitalization for acute diseases is frequent among frail patients. Many modifiable clinical practices are associated with this complication. In patients at risk of delirium, admission to geriatric wards may be associated with less functional deterioration than admission to internal medicine wards.

Deterioro funcional durante la hospitalización en ancianos. Beneficios del ingreso en el servicio de geriatría / Functional decline during hospitalization in elderly patients. Benefits of admission to the geriatrics service

Introducción: el ingreso hospitalario por enfermedad aguda suponepara determinados ancianos de riesgo una pérdida de autonomíano siempre relacionada con la enfermedad causante dedicha hospitalización. La importancia de este problema en nuestromedio sanitario, y si existen diferencias según el servicio enque se produzca el ingreso, no se conocen suficientemente.Objetivo: estudiar la incidencia de deterioro funcional, factoresasociados y diferencias entre los servicios de medicina interna ygeriatría, en ancianos hospitalizados por enfermedad aguda.Material y métodos: estudio prospectivo de cohortes. Analizamoslas características sociodemográficas, la comorbilidad motivode ingreso y gravedad, el uso de varias prácticas hospitalarias,la tasa de mortalidad y de pérdida funcional durante elingreso. Se definió deterioro funcional como la pérdida de autonomíapara al menos una de las actividades básicas de la vidadiaria, con respecto a la situación previa al ingreso. La influenciadel servicio se analizó mediante un modelo de regresión logísticamúltiple.Resultados: estudiamos a 379 pacientes (140 en el servicio degeriatría [SG] y 239 en medicina interna [MI]). Los pacientes ingresadosen SG eran mayores (87 frente a 81,5 años; p < 0,001),había en ellos mayor porcentaje de demencia y alteraciones visualesy eran más dependientes. La proporción de pacientes quepermanecían en cama más de 48 h o recibían medicación nocturnaera menor en el SG. La incidencia de deterioro funcional fuemayor en MI que en el SG (el 60,2 frente al 48%; p = 0,04), conuna estancia hospitalaria similar (7,7 frente a 8,1; p = 0,37). Laedad, el síndrome confusional, la ausencia de movilización, el encamamiento> 48 h, el uso de psicofármacos y sujeciones o demedicación nocturna se asociaron a deterioro funcional. En elanálisis multivariable, el ingreso en MI se asoció a mayor riesgode deterioro funcional...(AU)

Introduction: in some elderly individuals, hospital admission foracute illness represents a possible loss of autonomy not alwaysrelated to the reason for hospitalization. The importance of thisproblem and the possible existence of differences among servicesare not sufficiently well known.Objective: to compare the incidence of functional decline andassociated risk factors during hospitalization between an acutecare geriatric unit (GU) and an internal medicine (IM) ward.Material and methods: we performed a prospective, cohortstudy. Sociodemographic characteristics, comorbidity, cause ofadmission, severity, use of several hospital practices, mortalityrate and functional decline were analyzed. Functional decline wasdefined as the loss of independence to perform at least one of thebasic activities of daily living with respect to preadmission status.The influence of the admitting service was evaluated by a multiplelogistic regression model.Results: a total of 379 patients were included (140 in the GU and239 in IM). Compared with IM, patients in the GU were older(87 vs 81.5; P<.001), had a greater prevalence of dementia andvisual alterations and worse previous functional status. The proportionof patients who spent > 48 hours in bed and who receivednocturnal medication was lower in the GU. The functional declinerate was greater in IM than in the GU (60.2% vs 48%; P=.04).Length of hospital stay was similar in both groups (7.7 vs8.1 days; P=.37). Functional decline was associated with age, delirium, lack of mobilization,bed rest for > 48 h, psychotropic drugs, nocturnal medicationand physical restraints. In the multivariate analysis, admissionto IM was associated with a greater risk of functionaldecline...(AU)