Geriatric dysphagia and nutritional therapy

Yıl 2022, Cilt: 15 Sayı: 1, 100 - 109, 30.04.2022

Büşra Özyalçın Nevin Şanlıer

https://doi.org/10.26559/mersinsbd.972414

Öz

It is estimated that elderly individuals will constitute 25% of the population in developed countries by 2050. Along with the physiology of aging, dysphagia can emerge as an important health problem in elderly individuals. Dysphagia is swallowing difficulty that may result from neuromuscular disorder or mechanical obstruction. It also brings many complications such as malnutrition, dehydration and aspiration pneumonia. Recently, there has been increasing awareness of the recognition of dysphagia as a geriatric syndrome. Dysphagia in the elderly may go unnoticed as it is considered a normal part of aging. In this case, it leads to the progression of the disease and to its complications. Accurate diagnosis and multidisciplinary approach for dysphagia bring success in treatment. There is no standard approach for the treatment of dysphagia in the elderly. Dysphagia treatments include posture adjustments, nutrient and fluid ratio-amount, diet change, oral health, swallowing rehabilitation, and other approaches such as pharmacological treatment. The use of tissue modified diets is recommended for nutrition in dysphagia. The International Dysphagia Dietary Standardization Initiative was established to define tissue-modified foods and thickened fluids used for all care settings and by individuals of all ages with dysphagia. Some guidelines have nutritional recommendations for patients with dysphagia. However, since there is no certainness for nutrition in dysphagia, this review study was planned and conducted to present information on geriatric dysphagia and nutritional therapy.

Anahtar Kelimeler

Nutrition therapy, dysphagia, geriatrics

Geriatrik disfaji ve beslenme tedavisi

Öz

Yaşlı bireylerin, 2050 yılında gelişmiş ülkelerdeki nüfusun %25'ini oluşturacağı tahmin edilmektedir. Yaşlanmanın fizyolojisi ile birlikte yaşlı bireylerde disfaji, önemli bir sağlık sorunu olarak ortaya çıkabilmektedir. Disfaji, nöromüsküler bozukluk veya mekanik tıkanmadan kaynaklanabilen yutma güçlüğüdür. Malnütrisyon, dehidratasyon ve aspirasyon pnömonisi gibi birçok komplikasyonu da beraberinde getirmektedir. Son dönemde disfajinin, geriatrik sendrom olarak tanınmasına dair artan farkındalık mevcuttur. Yaşlılarda disfaji yaşlanmanın normal bir parçası olarak düşünüldüğü için fark edilmeyebilmektedir. Bu durumda hastalığın ilerlemesine ve beraberinde komplikasyonları getirmesine yol açmaktadır. Disfaji için doğru teşhis ve multidisipliner yaklaşım tedavide başarıyı getirmektedir. Yaşlılarda disfaji tedavisi için standart bir yaklaşım bulunmamaktadır. Disfaji tedavileri arasında duruş ayarlamaları, besin ve sıvı oranı-miktarı, diyet değişikliği, ağız sağlığı, yutma rehabilitasyonu ve farmakolojik tedavi gibi diğer yaklaşımlar yer almaktadır. Disfajide beslenme için dokusu değiştirilmiş diyetlerin kullanımı tavsiye edilmektedir. Tüm bakım ortamları için ve her yaştan disfajili bireyler tarafından kullanılan dokusu değiştirilmiş besinleri ve koyulaştırılmış sıvıları tanımlamak için Uluslararası Disfaji Diyet Standardizasyon Girişimi kurulmuştur. Bazı kılavuzlarda disfaji hastaları için beslenme önerileri mevcuttur. Ancak disfajide beslenme için netlik olmadığından bu derleme çalışma, geriatrik disfaji ve beslenme tedavisine ilişkin bilgileri sunmak amacıyla planlanmış ve yürütülmüştür.

Anahtar Kelimeler

Beslenme Tedavisi, disfaji, geriatri

Kaynakça

• T. C. Aile Çalışma ve Sosyal Hizmetler Bakanlığı. Engelli ve Yaşlı Hizmetleri Genel Müdürlüğü. Erişim adresi: yasli-nufus-demografik-degisimi-2020.pdf (ailevecalisma.gov.tr). Erişim tarihi: 24.06.2021.
• Logrippo S, Ricci G, Sestili M, Cespi M, Ferrara L, Palmieri GF, et al. Oral drug therapy in elderly with dysphagia: between a rock and a hard place! Clin Interv Aging. 2017;12:241. doi:https://doi.org/10.2147/cia.s121905
• Christmas C, Rogus‐Pulia N. Swallowing disorders in the older population. J Am Geriatr Soc. 2019;67(12):2643-2649. doi:https://doi.org/10.1111/jgs.16137
• Mehraban-Far S, Alrassi J, Patel R, Ahmad V, Browne N, Lam W. Dysphagia in the elderly population: A Videofluoroscopic study. Am J Otolaryngol. 2021;42(2):102854. doi:https://doi.org/10.1016/j.amjoto.2020.102854
• Di Pede C, Mantovani ME, Del Felice A, Masiero S. Dysphagia in the elderly: focus on rehabilitation strategies. Aging Clin Exp Res. 2016;28(4):607-617. doi:https://doi.org/10.1007/s40520-015-0481-6
• Furuya H, Kikutani T, Igarashi K, Sagawa K, Yajima Y, Machida R, et al. Effect of dysphagia rehabilitation in patients receiving enteral nutrition at home nursing care: a retrospective cohort study. J Oral Rehabil. 2020;47(8):977-982. doi: https://doi.org/10.1111/joor.13030
• Li M, Wang Z, Han WJ, Lu SY, Fang YZ. Effect of feeding management on aspiration pneumonia in elderly patients with dysphagia. Chinese Nursing Research. 2015;2(2-3):40-44. doi:https://doi.org/10.1016/j.cnre.2015.09.004
• Raheem D, Carrascosa C, Ramos F, Saraiva A, Raposo A. Texture-Modified Food for Dysphagic Patients: A Comprehensive Review. Int J Environ Res Public Health. 2021;18(10):5125. doi:https://doi.org/10.3390/ijerph18105125
• Sunata K, Terai H, Seki H, Mitsuhashi M, Kagoshima Y, Nakayama S, et al. Analysis of clinical outcomes in elderly patients with impaired swallowing function. PLoS One. 2020;15(9):e0239440. doi:https://doi.org/10.1371/journal.pone.0239440
• Gallegos C, Brito-De La Fuente E, Clavé P, Costa A, Assegehegn G. Nutritional aspects of dysphagia management. Adv Food Nutr Res. 2017;81:271-318. doi:10.1016/bs.afnr.2016.11.008
• WHO ICD-11 for Mortality and Morbidity Statistics. Erişim adresi: ICD-11 - ICD-11 for Mortality and Morbidity Statistics (who.int). Erişim tarihi: 15.03.2021.
• Ortega O, Martín A, Clavé P. Diagnosis and management of oropharyngeal dysphagia among older persons, state of the art. J Am Med Dir Assoc. 2017;18(7):576-582. doi: https://doi.org/10.1016/j.jamda.2017.02.015
• Clavé P, Rofes L, Carrión S, Ortega O, Cabré M, Serra-Prat M, et al. Pathophysiology, relevance and natural history of oropharyngeal dysphagia among older people. Nestle Nutr Inst Workshop Ser. 2012;72:57-66. doi:https://doi.org/10.1159/000339986
• World Gastroenterology Organisation Global Guidelines. Dysphagia, Global Guidelines & Cascades. Update September 2014. Erişim adresi: https://www.spg.pt/wp-content/uploads/2015/11/2014-dysphagia.pdf. Erişim tarihi: 20.04.2021.
• Clavé P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015;12(5):259. doi:https://doi.org/10.1038/nrgastro.2015.49
• Olesen MD, Modlinski RM, Poulsen SH, Rosenvinge PM, Rasmussen HH, Holst M. Prevalence of signs of dysphagia and associated risk factors in geriatric patients admitted to an acute medical unit. Clin Nutr ESPEN. 2021;41:208-216. doi:https://doi.org/10.1016/j.clnesp.2020.12.020
• Maeda K, Akagi J. Decreased tongue pressure is associated with sarcopenia and sarcopenic dysphagia in the elderly. Dysphagia. 2015;30(1):80-87. doi:https://doi.org/10.1007/s00455-014-9577-y
• Shimizu A, Fujishima I, Maeda K, Wakabayashi H, Nishioka S, Ohno T, et al. Effect of low tongue pressure on nutritional status and improvement of swallowing function in patients with sarcopenic dysphagia. Nutrition. 2021;90:111295. doi:https://doi.org/10.1016/j.nut.2021.111295
• Namasivayam-MacDonald AM, Morrison JM, Steele CM, Keller H. How swallow pressures and dysphagia affect malnutrition and mealtime outcomes in long-term care. Dysphagia. 2017;32(6):785-796. doi:https://doi.org/10.1007/s00455-017-9825-z
• Nawaz S, Tulunay-Ugur OE. Dysphagia in the older patient. Otolaryngol Clin North Am. 2018;51(4):769-777. doi:https://doi.org/10.1016/j.otc.2018.03.006
• Wirth R, Dziewas R, Beck AM, Clave P, Hamdy S, Heppner HJ, et al. Oropharyngeal dysphagia in older persons–from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging. 2016;11:189-208. doi:https://doi.org/10.2147/cia.s97481
• Robbins J, Humpal NS, Banaszynski K, Hind J, Rogus-Pulia N. Age-related differences in pressures generated during isometric presses and swallows by healthy adults. Dysphagia. 2016;31(1):90-96. doi:https://doi.org/10.1007/s00455-015-9662-x
• Park D, Lee HH, Lee ST, Oh Y, Lee JC, Nam KW, et al. Normal contractile algorithm of swallowing related muscles revealed by needle EMG and its comparison to videofluoroscopic swallowing study and high resolution manometry studies: a preliminary study. J Electromyogr Kinesiol. 2017;36:81-89. doi:https://doi.org/10.1016/j.jelekin.2017.07.007
• Carrión S, Cabré M, Monteis R, Roca M, Palomera E, Serra-Prat M, et al. Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of older patients admitted with an acute disease to a general hospital. Clin Nutr. 2015;34(3):436-442. doi:https://doi.org/10.1016/j.clnu.2014.04.014
• Tulunay-Ugur OE, Eibling D. Geriatric dysphagia. Clin Geriatr Med. 2018;34(2):183-189. doi:https://doi.org/10.1016/j.cger.2018.01.007
• Baijens LW, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, et al. European Society for Swallowing Disorders–European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging. 2016;11:1403. doi:https://doi.org/10.2147/cia.s107750
• Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919-924. doi:https://doi.org/10.1177/000348940811701210
• Mañas-Martínez AB, Bucar-Barjud M, Campos-Fernández J, Gimeno-Orna JA, Pérez-Calvo J, Ocón-Bretón J. Association of positive screening for dysphagia with nutritional status and long-term mortality in hospitalized elderly patients. Endocrinol Diabetes Nutr (Engl Ed). 2018;65(7):402-408. doi:https://doi.org/10.1016/j.endinu.2018.02.004
• Rofes L, Arreola V, Almirall J, Cabré M, Campins L, García-Peris P, et al. Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterol Res Pract. 2010;2011. doi:https://doi.org/10.1155/2011/818979
• Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019;38(1):10-47. doi:https://doi.org/10.1016/j.clnu.2018.05.024
• Carrión S, Roca M, Costa A, Arreola V, Ortega O, Palomera E, et al. Nutritional status of older patients with oropharyngeal dysphagia in a chronic versus an acute clinical situation. Clin Nutr. 2017;36(4):1110-1116. doi:https://doi.org/10.1016/j.clnu.2016.07.009
• Homem SG, Moreira EAM, da Silva AF, Barni GC, da Rosa JS, de Lima Oliveira D, et al. Relationship between oropharyngeal dysphagia, nutritional status, antioxidant vitamins and the inflammatory response in adults and elderly: A cross-sectional study. Clin Nutr ESPEN. 2020;38:211-217. doi:https://doi.org/10.1016/j.clnesp.2020.04.011
• Reyes-Torres CA, Castillo-Martínez L, Reyes-Guerrero R, Ramos-Vázquez AG, Zavala-Solares M, Cassis-Nosthas L, et al. Design and implementation of modified-texture diet in older adults with oropharyngeal dysphagia: a randomized controlled trial. Eur J Clin Nutr. 2019;73(7):989-996. doi:https://doi.org/10.1038/s41430-019-0389-x
• O’Keeffe ST. Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? BMC Geriatr. 2018;18(1):167. doi:https://doi.org/10.1186/s12877-018-0839-7
• Andersen UT, Beck AM, Kjaersgaard A, Hansen T, Poulsen I. Systematic review and evidence based recommendations on texture modified foods and thickened fluids for adults (≥18 years) with oropharyngeal dysphagia. e-SPEN Journal. 2013;8(4):e127-e134. doi:http://dx.doi.org/10.1016/j.clnme.2013.05.003
• Beck AM, Kjaersgaard A, Hansen T, Poulsen I. Systematic review and evidence based recommendations on texture modified foods and thickened liquids for adults (above 17 years) with oropharyngeal dysphagia-An updated clinical guideline. Clin Nutr. 2018;37(6):1980-1991. doi:https://doi.org/10.1016/j.clnu.2017.09.002
• Howard MM, Nissenson PM, Meeks L, Rosario ER. Use of textured thin liquids in patients with dysphagia. Am J Speech Lang Pathol. 2018;27(2):827-835. doi:https://doi.org/10.1044/2018_ajslp-16-0140
• Ullrich S, Crichton J. Older people with dysphagia: transitioning to texture-modified food. Br J Nurs. 2015;24(13):686-692. doi:https://doi.org/10.12968/bjon.2015.24.13.686
• Sestili M, Logrippo S, Cespi M, Bonacucina G, Ferrara L, Busco S, et al. Potentially inappropriate prescribing of oral solid medications in elderly dysphagic patients. Pharmaceutics. 2018;10(4):280. doi:https://doi.org/10.3390/pharmaceutics10040280
• The National Dysphagia Diet Task Force, The National Dysphagia Diet: standardization for optimal care. American Dietetic Association. 2002.
• Academy of Nutrition and Dietetics (AND). Erişim adresi: https://www.eatrightpro.org/practice/practice-resources/post-acute-long-term-care-management/international-dysphagia-diet-standardization-initiative. Erişim tarihi: 04.05.2021.
• International Dysphagia Diet Standardisation Initiative (IDDSI). Erişim adresi: https://iddsi.org/IDDSI/media/images/Complete_IDDSI_Framework_Final_31July2019.pdf. Erişim tarihi: 23.04.2021.
• Brewsaugh AM, Brust LJ, Hartman J. Implementing the International Dysphagia Diet Standardization Initiative: Opportunities for Change. J Acad Nutr Diet. 2021. doi:https://doi.org/10.1016/j.jand.2021.02.012
• Burgos R, Bretón I, Cereda E, Desport JC, Dziewas R, Genton L, et al. ESPEN guideline clinical nutrition in neurology. Clin Nutr. 2018;37(1):354-396. doi:https://doi.org/10.1016/j.clnu.2017.09.003
• Volkert D, Berner YN, Berry E, Cederholm T, Bertrand PC, Milne A, et al. ESPEN guidelines on enteral nutrition: geriatrics. Clin Nutr. 2006;25(2):330-360. doi:https://doi.org/10.1016/j.clnu.2006.01.012