Division of Geriatric Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
J Pain Symptom Manage. 2011 Sep;42(3):366-78. doi: 10.1016/j.jpainsymman.2010.11.017. Epub 2011 Mar 31.
Speech-language pathologists (SLP) are often called on to evaluate eating difficulties in patients with dementia.
To assess factors associated with SLPs' knowledge and recommendations about feeding tubes in patients with advanced dementia.
A mail survey was administered to a probability sample of 1500 SLPs from the American Speech-Language-Hearing Association mailing list; 731 usable surveys were received (response rate=53.7%). Self-perceived preparedness, knowledge, and care recommendations were measured. Knowledge items were scored as "evidence based" or not according to the best evidence in the literature.
Only 42.1% of SLP respondents felt moderately/well prepared to manage dysphagia. Only 22.0% of respondents recognized that tube feeding is unlikely to reduce risk of aspiration pneumonia whereas a slight majority understood that tube feeding would not likely prevent an uncomfortable death (50.2%), improve functional status (54.5%), or enhance quality of life (QOL) (63.2%). A majority (70.0%) was willing to consider recommending oral feeding despite high risk of aspiration. Logistic regression analyses indicated that those willing to consider this recommendation gave the most evidence-based responses to knowledge questions about tube feeding outcomes: aspiration pneumonia (odds ratio [OR]=1.75, 95% confidence interval [CI]=1.07-2.87), functional status (OR=1.43, 95% CI=1.0-2.06), QOL (OR=2.19, 95% CI=1.52-3.17), and prevent uncomfortable death (OR=1.97, 95% CI=1.37-2.88). Logistic regression analyses also indicated that those with more experience evaluating patients with dementia gave the most evidence-based response to two knowledge questions: aspiration pneumonia (OR=2.64, 95% CI=1.48-4.72) and prevent uncomfortable death (OR=2.03, 95% CI=1.35-3.05) whereas those with higher self-perceived preparedness in managing dysphagia in dementia had less knowledge in two areas: aspiration pneumonia (OR=0.57, 95% CI=0.38-0.84) and QOL (OR=0.72, 95% CI=0.51-1.01).
Misperceptions among SLPs about tube feeding in advanced dementia are common, especially in relation to risk of aspiration. Knowledge about tube feeding outcomes was positively associated with experience and inversely associated with self-perceived higher preparedness in evaluating patients with dementia.
言语语言病理学家（SLP）经常被要求评估痴呆患者的进食困难。
评估与 SLP 对晚期痴呆患者喂养管的知识和建议相关的因素。
对美国言语语言听力协会邮寄名单中的 1500 名 SLP 进行了一项邮件调查；收到了 731 份可用的调查（回复率=53.7%）。自我感知的准备程度、知识和护理建议。根据文献中的最佳证据，将知识项目评为“基于证据”或非基于证据。
只有 42.1%的 SLP 受访者认为自己在处理吞咽困难方面有中等/良好的准备。只有 22.0%的受访者认识到管饲不太可能降低吸入性肺炎的风险，而大多数人则明白管饲不太可能预防不舒服的死亡（50.2%）、改善功能状态（54.5%）或提高生活质量（QOL）（63.2%）。尽管存在高吸入风险，大多数（70.0%）愿意考虑推荐口服喂养。逻辑回归分析表明，那些愿意考虑这一建议的人对管饲结果的知识问题给出了最基于证据的回答：吸入性肺炎（比值比[OR]=1.75，95%置信区间[CI]=1.07-2.87）、功能状态（OR=1.43，95%CI=1.0-2.06）、生活质量（OR=2.19，95%CI=1.52-3.17）和预防不舒适死亡（OR=1.97，95%CI=1.37-2.88）。逻辑回归分析还表明，那些评估痴呆患者经验较多的人对两个知识问题的回答最基于证据：吸入性肺炎（OR=2.64，95%CI=1.48-4.72）和预防不舒适死亡（OR=2.03，95%CI=1.35-3.05），而那些在管理痴呆症吞咽困难方面自我感知准备程度较高的人在两个方面的知识较少：吸入性肺炎（OR=0.57，95%CI=0.38-0.84）和生活质量（OR=0.72，95%CI=0.51-1.01）。
SLP 对晚期痴呆患者管饲的误解很常见，尤其是与吸入风险有关。关于管饲结果的知识与经验呈正相关，与评估痴呆患者时自我感知的较高准备程度呈负相关。
