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" (Stone, 2006) Treatment is stated by Stone (2006) to be "diagnosis dependent and may be medical or surgical." Practical modifications include simple steps such as crushing of pills or opening of capsules to ease and facilitate swallowing.
The work of Leibovitz, et al. (2007) entitled: 'Dehydration Among Long-Term Care Elderly Patients with Oropharyngeal Dysphagia" states that long-term care (LTC) residents in the nursing home "especially the orally fed with dysphagia are prone to dehydration. The clinical consequences of dehydration are critical. The validity of the common laboratory parameters of hydration status is far from being absolute, especially so in the elderly." (Leibovitz, et al., 2007) it is related however that "combinations of these indices are more reliable." (Leibovitz, et al., 2007) the study reported by Leibovitz et al. is one that assessed hydration status among elderly LTC residents with oropharyngeal dysphagia and in which a total of 28 orally fed patients with grade-2 feeding difficulties on the functional outcome swallowing scale (FOSS) and 67 naso-gastric tube (NGT)-fed LTC residents entered the study." (Leibovitz, et al., 2007) That utilized as indices of hydration status include: "the common laboratory, serum and urinary tests." (Leibovitz, et al., 2007) Results are stated to have been "considered an indicative of dehydration and used as 'markers of hydration', if they were above the accepted norms."
Stated as results in this study are the following: "...The mean number of dehydration markers was significantly higher in the FOSS-2 group (3.8 ± 1.3 vs. 2 ± 1.4, p = 0.000). About 75% of these FOSS-2 patients http://content.karger.com/ProdukteDB/images/entity/gteq.gif
4 dehydration markers versus 18% of the NGT-fed group (p = 0.000). A low urine output (<800 ml/day) was significantly more common in the FOSS-2 group (39 vs. 12%, p = 0.002). Above normal values of blood urea nitrogen (BUN), BUN/serum creatinine ratio (BUN/SCr), urine/serum osmolality ratio (U/SOsm), and urine osmolality UOsm, were significantly more frequent in the dehydration-prone FOSS-2 group. This combination of 4 indices was present in 65% of low urine output patients. In contrast, it was present in only 36% of the higher urine output patients (p = 0.01). Patients with a 'normal' daily urine output (>800 ml/day) also had a significant number (2 ± 1.5) of positive indices of dehydration." (Leibovitz, et al., 2007) Liebovitz et al. states that dehydration "was found to be common among orally fed FOSS-2 LTC patients. Surprisingly, probable dehydration, although of a mild degree, was not a rarity among NGT-fed patients either. The combination of 4 parameters, BUN, BUN/SCr, U/SOsm and UOsm, offers reasonable reliability to be used as an indication of dehydration status in daily clinical practice." (Leibovitz, et al., 2007)
The work of William Osler (2003) entitled: "Captain of the Men of Death" states that community-acquire pneumonia (CAP) "is a major cause of morbidity and mortality in the elderly, with an estimated annual health-care cost in the United States of $4.4 billion." The incidence of pneumonia has bee shown in epidemiological studies to increase with aging "with the risk being almost six times higher in those ? 75 years old, compared to those < 60 years of age." (Osler, 2003) the work of Marrie (1990) states findings that 33 of 1,000 nursing home residents each year were hospitalized for treatment of pneumonia as compared with 1.14 of 1000 elderly individuals living in the community. Rello, Rodriguez and Jubert (1996) found that COPE, heart disease, malignancy, malnutrition, congestive heart failure and diabetes mellitus has been implicated as risk factors for community acquire pneumonia in the elderly." (as cited in Osler, 2003)
The work of Rothenberg, et al. (2007) entitled: "Texture-Modified Meat and Carrot Products for Elderly People with Dysphagia: Preference in Relation to Health and Oral Status" published in the journal of 'Food & Nutrition' (2007) reports a study in which the preference for texture-modified carrot and meat products in elderly people aiming to meet the needs of people with impaired chewing and/or swallowing was studied. Data is reported to have been collected through use of questionnaires that focused on health, oral status and preference for the products. Participants in the study were 108 elderly individuals in ordinary housing and 50 individuals living in special housing. The results of the study report: "19% had a body mass index ?22, predominantly in SH (24%). Stroke was reported by 20% of the subjects in SH. Among those with subjectively experienced difficulties in swallowing (12%), 58% reported coughing, 21% a gurgly voice in association with food intake and 50% obstruction during swallowing. Only 20% with subjective swallowing difficulties had been specifically examined regarding this problem. All the tested products were easy to masticate and swallow. Compared with OH, people in SH-M found the meat products easier to masticate and swallow. Compared with OH, subjects in SH found the carrot products easier to masticate." (Rothenberg, et al., 2007) This study concludes that there is a need "to develop tasty texture-modified nutritious food products for people with mastication and/or swallowing problems. Possible factors for differences in preference between groups, in this study may be related to health status in generally and specifically mastication and swallowing functions." (Rothenberg, et al., 2007)
SUMMARY & CONCLUSION
Dysphagia in the elderly is a prevalent complication which involves difficulty swallowing. Dysphagia may be one of two types: (1) Oropharyngeal dysphagia; or (2) Esophageal dysphagia. Dysphagia is known to result from: (1) Cerebrovascular accidents; (2) Gastoresophageal reflux disease; and (3) Medication-related side-effects. (Spieker, 2000) it is critically important that health care professionals proactively screen elderly patients for dysphagia so that the needs of these patients insofar as nutrition and avoidance of community acquired pneumonia are addressed and unnecessary risks mitigated.
Spieker, Michael R. (2000) Evaluating Dysphagia. American Family Physician 14 Jun 2000. Online available at http://www.aafp.org/afp/20000615/3639.html
Marik, Paul E. And Kaplan, Danielle (2003) Aspiration Pneumonia and Dysphagia in the Elderly. Chest. July 2003. Vol. 1224, No. 1. Online available at http://www.chestjournal.org/content/124/1/328.full
Bautmans, I., et al. (2008) Dysphagia in elderly nursing home residents with severe cognitive impairment can be attenuated by cervical spine mobilization. J. Rehabil Med. 2008 Oct;40(9):755-60. PubMed Online available at http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=18843429
Stone, Rebecca S. (2006) Dysphagia in the Elderly. Inpatient Times. October 2006. Online available at http://www.bmc.org/geriatrics/RStone_DysphagiaintheElderly.pdf
Liebovitz, a. et al. (2006) Dehydration among Long-Term Care Elderly Patients with Oropharyngeal Dysphagia. Gerontology 2007;53:179-183. Online available at http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext&ProduktNr=224091&Ausgabe=232836&ArtikelNr=99144
Marrie, TJ Epidemiology of community-acquired pneumonia in the elderly. Semin Respir Infect 1990;5,260-268
Rello, J, Rodriguez, R, Jubert, P, et al. Severe community-acquired pneumonia in the elderly: epidemiology and prognosis; Study Group for Severe Community-Acquired Pneumonia. Clin…[continue]
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