Namasivayam-MacDonald Ashwini M, Morrison Jill M, Steele Catriona M, Keller Heather
Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, Office 12-019, Toronto, ON, M5G 2A2, Canada.
Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
Dysphagia. 2017 Dec;32(6):785-796. doi: 10.1007/s00455-017-9825-z. Epub 2017 Jul 21.
Malnutrition is a major cause of hospitalization for residents of long-term care facilities (LTC). Dysphagia is thought to contribute to malnutrition. Tongue weakness is suggested to predict poor food intake, longer meals, and dysphagia. We explored the relationships between tongue strength, dysphagia, malnutrition and mealtime outcomes in LTC residents. Data were collected from 639 LTC residents (199 male), aged 62-102 (mean 87). Maximum isometric tongue pressures (MIPs) and saliva swallow pressures (MSPs) were measured using the Iowa Oral Performance Instrument. Participants also completed the Screening Tool for Acute Neuro Dysphagia. Nutrition status was assessed using the Patient-Generated Subjective Global Assessment. A series of repeated meal observations provided measures of meal duration and calories consumed. Mean MIPs were 33 kPa (95% CI 29-37) and MSPs were 26 kPa (95% CI 23-29). The odds of showing signs of dysphagia were 3.7 times greater in those with MSPs less than 26 kPa (p < 0.05). The odds of being malnourished were almost double in those showing signs of dysphagia. Co-occurrence of dysphagia and malnutrition was seen in 29%. Residents with low MSPs also had significantly longer mealtime durations (MTD) (p < 0.05). Moreover, those with both low swallowing pressures and suspected dysphagia consumed fewer calories/minute (p < 0.05) and had significantly longer MTDs (p < 0.05). This study confirms associations between tongue weakness, signs of dysphagia, mealtime outcomes and malnutrition among LTC residents. These findings suggest that saliva swallow pressure measures may be helpful for early identification of dysphagia and nutritional risk in this population.
营养不良是长期护理机构（LTC）居民住院的主要原因。吞咽困难被认为是导致营养不良的一个因素。舌肌无力被认为可预测食物摄入量少、用餐时间长和吞咽困难。我们探讨了LTC居民的舌肌力量、吞咽困难、营养不良与用餐结果之间的关系。数据收集自639名LTC居民（199名男性），年龄在62 - 102岁之间（平均87岁）。使用爱荷华口腔功能仪器测量最大等长舌压（MIP）和唾液吞咽压力（MSP）。参与者还完成了急性神经性吞咽困难筛查工具。使用患者主观整体评估法评估营养状况。一系列重复的用餐观察提供了用餐时间和摄入热量的测量数据。平均MIP为33kPa（95%置信区间29 - 37），MSP为26kPa（95%置信区间23 - 29）。MSP低于26kPa的人出现吞咽困难迹象的几率高3.7倍（p < 0.05）。出现吞咽困难迹象的人营养不良的几率几乎翻倍。29%的人同时存在吞咽困难和营养不良。MSP低的居民用餐时间也明显更长（MTD）（p < 0.05）。此外，吞咽压力低且疑似吞咽困难的人每分钟摄入的热量更少（p < 0.05），MTD明显更长（p < 0.05）。本研究证实了LTC居民中舌肌无力、吞咽困难迹象、用餐结果和营养不良之间的关联。这些发现表明，唾液吞咽压力测量可能有助于早期识别该人群的吞咽困难和营养风险。
