A comprehensive intervention following the clinical pathway of eating and swallowing disorder in the elderly with dementia: historically controlled study

BMC Geriatrics

Research Article

Hatsue Fujii¹  Yuka Tomiyama²  Makoto Oura³  Masahisa Arahata³  Shinji Minani⁴  Yukihiro Shimizu⁴  Naoe Morikawa⁵ 

[1] Department of Community-based-Rehabilitation, Nanto Municipal Hospital, 938 Inami, Nanto, 932-0211, Toyama, Japan;Department of Dentistry and Oral Surgery, Nanto Municipal Hospital, 938 Inami, Nanto, 932-0211, Toyama, Japan;Department of General Medicine, Nanto Municipal Hospital, 938 Inami Nanto, 932-0211, Toyama, Japan;Department of Internal Medicine, Nanto Municipal Hospital, 938 Inami, Nanto, 932-0211, Toyama, Japan;Department of Nursing-in-Ward, Nanto Municipal Hospital, 938 Inami, Nanto, 932-0211, Toyama, Japan;

关键词: Comprehensive geriatric assessment;    Decreased oral intake;    Elderly;    Dementia;    Multidisciplinary team approach;    Clinical pathway;   

DOI  :  10.1186/s12877-017-0531-3

 received in 2017-01-05, accepted in 2017-07-04,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundEating 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.MethodsThis 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.ResultsDuring 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).ConclusionsUse 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 registrationISRCTN57646445, this trial was retrospectively registered on 8th December 2015.

【 授权许可】

CC BY   
© The Author(s). 2017