A comprehensive intervention following the clinical pathway of eating and swallowing disorder in the elderly with dementia: historically controlled study
| Autor: | Hatsue Fujii, Masahisa Arahata, Makoto Oura, Naoe Morikawa, Shinji Minani, Yuka Tomiyama, Yukihiro Shimizu |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Psychological intervention Nutritional Status lcsh:Geriatrics Comprehensive geriatric assessment Feeding and Eating Disorders 03 medical and health sciences 0302 clinical medicine Clinical pathway Elderly Swallowing Internal medicine Intervention (counseling) Early Medical Intervention medicine Dementia Humans 030212 general & internal medicine Geriatric Assessment Multidisciplinary team approach Aged Retrospective Studies Aged 80 and over Rehabilitation business.industry Decreased oral intake Historically Controlled Study medicine.disease lcsh:RC952-954.6 Physical therapy Etiology Critical Pathways Female Geriatrics and Gerontology business Deglutition Disorders 030217 neurology & neurosurgery Follow-Up Studies Research Article |
| Zdroj: | BMC Geriatrics BMC Geriatrics, Vol 17, Iss 1, Pp 1-11 (2017) |
| ISSN: | 1471-2318 |
| Popis: | Background Eating problems in patients with advanced dementia are strongly associated with their deteriorating survival. Food and drink intake in people with dementia may be supported by specific interventions, but the effectiveness of such interventions is backed by almost no evidence. However, comprehensive geriatric assessment (CGA) might potentially clarify the etiology of decreased oral intake in people with dementia; thus improving their clinical outcomes. Methods This study was a single-arm, non-randomized trial that included historically controlled patients for comparison. We defined elderly patients with both severely decreased oral intake depending on artificial hydration and/or nutrition (AHN) and dementia as “Eating and Swallowing Disorder of the Elderly with Dementia (ESDED)”. In the intervention group, participants received CGA through the original clinical pathway with multidisciplinary interventions. This was followed by individualized therapeutic interventions according to assessment of the etiology of their eating problems. Results During the intervention period (between 1st April 2013 and 31st March 2015), 102 cases of ESDED were enrolled in the study and 90 patients had completed receiving CGA. Conversely, 124 ESDED patient controls were selected from the same hospital enrolled during the historical period (between 1st April 2011 and 31st March 2012). Most participants in both groups were bedridden with severe cognitive impairment. For the intervention group, an average of 4.3 interventional strategies was recommended per participant after CGA. Serological tests, diagnostic imaging and other diagnostic examinations were much more frequently performed in the intervention group. Recovery rate from ESDED in the intervention group was significantly higher than that in the historical group (51% v.s. 34%, respectively, P = 0.02). The 1-year AHN-free survival in the intervention group was significantly higher than that in the historical group (28% v.s. 15%, respectively, P = 0.01). No significant difference between the two groups was found for 1-year overall survival (37% v.s. 28%, respectively, P = 0.08). Conclusions Use of CGA with multidisciplinary interventions could improve the functional status of eating and allow elderly patients with severe eating problems and dementia to survive independently without the need for AHN. Trial registration ISRCTN57646445, this trial was retrospectively registered on 8th December 2015. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0531-3) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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