Dysphagia related comorbidities

Dysphagia and Mortality
Scharma et al (2001)
Patients with no dysphagia have higher survival than the same patient with stroke and dysphagia

Pneumonia and dysphagia
Martino et al (2005)
Shows dose effect
• Individuals with dysphagia – 3x more likely to have pneumonia
• Individuals with aspiration – 11x more likely to have pneumonia

Pneumonia and dysphagia
Langmore et al (1998)
• Inpatient veterans who got pneumonia and who didn’t – 189 patients (mostly male)
• Regression analysis – which variables were predictors for who would get pneumonia

Biggest predictors for pneumonia:
• Dependency for oral care
• Tube feeding before the pneumonia

Biggest predictors for pneumonia for oral feeders:
• Dependent for feeding
• Now smoking
• Number of medications

Dentate subjects:
Multiple diagnoses
Number of decayed teeth

Excluding tubefed and edentulous subjects:
Dependent for feeding
Multiple medical diagnoses

Pneumonia and dysphagia
Langmore et al (1998)
Significant predictors of aspiration pneumonia
Dependent for oral care
Number of decayed teeth
Number of medications
Tube feeding
-> Dependent of feeding
->now smoking
multiple diagnoses
-> pneumonia

Pneumonia and dysphagia
Martin-Harris et al (2013)
• Swallowing happens after exhaling, during an apneic period
• This maximizes airway protection

Pneumonia and dysphagia
Martin-Harris et al (2013)
Cross-system respiratory – swallowing impairment
• Swallowing and respiration – both controlled by medulla.
• Two systems overlap.
• COPD, asthma, etc. are at high risk for swallowing problem

Dysphagia and Malnutrition
Sitzmann et al (1990)
• Monitored 90 consecutive patients admitted to hospital with primary diagnosis of dysphagia
• At some point during one year, all were malnourished

Dysphagia and Malnutrition
Davalos et al (1996)
• The longer patients hospitalized – more malnourished
• Patients with dysphagia – significantly more malnourished

Dysphagia and Malnutrition
Foley et al (2009)
• Systematic review showed that patients hospitalized with stroke and dysphagia -> malnourished
• Malnourished -> unable to recover as well

Dysphagia and Malnutrition
Finestone et al (2000 & 2001)
• Patients with dysphagia at heightened risk for dehydration
• Especially if fluid supplement not provided

Dysphagia and Malnutrition:
Differences in concerns
•Clinician experts and Caregivers: 1) Pulmonary 2) Nutrition 3) Psychology
•Patients: 1) Psychology 2) Nutrition 3) Pulmonary

Differences in concerns – Acute vs Chronic patients
•Acute patients -> More concerned about choking to death
•Chronic -> Depression/embarrassment – bigger issue

VFS-Based Measures
MBS-IMP
Domains scored along a 3-5 point scale
Inter-rate reliability – ≥ 80% agreement
Correlated with nutrition, aspiration pneumonia, QOL, oral diet, etc.

Patient reported outcomes
SSQ
Patient’s report of their symptoms
Doesn’t diagnose dysphagia – report of impact of dysphagia

VFS Based Measures
Functional Oral Intake Scale
Targets swallowing function
Completed by clinician
Level of nutrition, diet level & modifications
Good reliability, validity, sensitivity to change
Stroke patients (302)

Patient reported outcomes
MD Anderson Dysphagia Index
Targets swallowing function
Completed by clinician
Level of nutrition, diet level & modifications
Good reliability, validity, sensitivity to change

Dysphagia in Treated Nasopharyngeal Cancer
Hughes et al (2000)
38/50 (56%) – reported dysphagia on a questionnaire
46/50 (92%) actually had dysphagia
11/50 (22%) silently aspirating

The Dysphagia Diet is a specialized diet developed for people suffering from dysphagia. Dysphagia is a medical condition in which swallowing food becomes difficult and poses a danger to the patient. Dysphagia can be a result of trauma or injury …

Patients who have dsyphagia and bradykinesia need appetizing foods that are easily chewed and swallowed. The diet should contain adequate roughage ad fruit to avoid constipation. Food should be cut into bite size pieces before it is served and it …

Objectives: To determine the prevalence of malnutrition and whether the malnourished participants were being identified and documented as malnourished. To evaluate the impact of poor documentation on financial reimbursement to the hospital. Subjects: Three hundred and twenty-four inpatients from a …

The patient can be assessed frequently and also the evaluation of the nursing or nutritional therapy can be performed. Any form of ineffective clinical management can be assessed using the self-monitoring skills of the patient. Studies have demonstrated that nutritional …

Preventing Aspiration in Older Adults with Dysphagia is an evidence based article published by Janice Palmer and Norma Metheny, talented professionals and the active contributors of nursing center. com. The progressive idea of the publication is focused on practical presentation …

pneumonia (def) an acute or chronic disease marked by inflammation of the lungs caused by viruses, bacteria, or other microorganisms and sometimes by physical chemical irritants symptoms of pneumonia fever/temp up to 105 excessive sweating/chills difficulty breathing chest pain productive/phlegmy …

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