María Ballesteros-Pomar, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain,
J Nutr Health Aging. 2020;24(6):576-581. doi: 10.1007/s12603-020-1377-5.
This paper provides evidence-based and, when appropriate, expert reviewed recommendations for long-stay residents who are prescribed texture-modified diets (TMDs), with the consideration that these residents are at high risk of worsening oropharyngeal dysphagia (OD), malnutrition, dehydration, aspiration pneumonia, and OD-associated mortality, poorer quality of life and high costs.
Nestlé Health Science funded an initial virtual meeting attended by all authors, in which the unmet needs and subsequent recommendations for OD management were discussed. The opinions, results, and recommendations detailed in this paper are those of the authors, and are independent of funding sources.
OD is common in nursing home (NH) residents, and is defined as the inability to initiate and perform safe swallowing. The long-stay NH resident population has specific characteristics marked by a shorter life expectancy relative to community-dwelling older adults, high prevalence of multimorbidity with a high rate of complications, dementia, frailty, disability, and often polypharmacy. As a result, OD is associated with malnutrition, dehydration, aspiration pneumonia, functional decline, and death. Complications of OD can potentially be prevented with the use of TMDs.
This report presents expert opinion and evidence-informed recommendations for best practice on the nutritional management of OD. It aims to highlight the practice gaps between the evidence-based management of OD and real-world patterns, including inadequate dietary provision and insufficient staff training. In addition, the unmet need for OD screening and improvements in therapeutic diets are explored and discussed.
There is currently limited empirical evidence to guide practice in OD management. Given the complex and heterogeneous population of long-stay NH residents, some 'best practice' approaches and interventions require extensive efficacy testing before further changes in policy can be implemented.
本文提供了循证医学证据，并在适当情况下提供了经专家审查的建议，适用于长期居住在疗养院内且被规定食用质地改良饮食（TMD）的患者。考虑到这些患者存在吞咽功能恶化或口咽性吞咽困难（OD）、营养不良、脱水、吸入性肺炎以及与 OD 相关的死亡率升高、生活质量较差和治疗费用较高的风险较高。
雀巢健康科学公司资助了一次虚拟会议，所有作者均出席了此次会议，会议讨论了 OD 管理方面的未满足需求和后续建议。本文详细介绍的意见、结果和建议均来自作者，且独立于资金来源。
OD 常见于疗养院（NH）居民，其定义为无法开始和安全进行吞咽。长期居住在 NH 的居民人群具有特定特征，其预期寿命比社区居住的老年人更短，患有多种疾病的患病率更高，并发症发生率高，存在痴呆、体弱、残疾和经常服用多种药物的情况。因此，OD 与营养不良、脱水、吸入性肺炎、功能下降和死亡有关。通过使用 TMD 可以预防 OD 并发症。
本报告介绍了关于 OD 营养管理的最佳实践的专家意见和循证医学建议。其旨在突出 OD 基于证据的管理与现实模式之间的实践差距，包括饮食供应不足和员工培训不足。此外，还探讨和讨论了 OD 筛查和治疗饮食改进方面的未满足需求。
目前，OD 管理方面的实践指南主要依赖于有限的经验证据。鉴于长期居住在 NH 的居民人群复杂且具有异质性，一些“最佳实践”方法和干预措施需要在进一步改变政策之前进行广泛的疗效测试。
