Assistant Professor, Section of Geriatrics, Department of Medicine, Boston University School of Medicine; Physician, Department of Geriatrics, Boston Medical Center.
Assistant Professor, Section of Geriatrics, Department of Medicine, Boston University School of Medicine.
MedEdPORTAL. 2022 Mar 2;18:11223. doi: 10.15766/mep_2374-8265.11223. eCollection 2022.
Nearly six million American adults live with dementia, and dysphagia is a common comorbidity impacting their nutrition and quality of life. There is a shortfall in the number of geriatricians available to care for older adults. Thus, primary care physicians should be equipped with the knowledge to adequately care for the geriatric population. Modified diets are routinely prescribed for patients with dementia despite limited evidence that they protect patients from the sequelae of dysphagia and some suggestion of poor side-effect profiles.
We created a onetime, interactive, case-based session to educate medical residents on how to evaluate and treat dementia-associated dysphagia and address the discrepancy between the limited evidence for dietary modifications and their routine use. The session had a mixture of small-group discussion and didactic learning as well as a participatory component during which learners were able to sample thickened liquids.
The session was implemented in an established primary care curriculum. Based on survey responses, which were obtained from 15 out of 17 participants, the session significantly improved participants' knowledge of dysphagia-associated dementia and increased their comfort with caring for patients with dysphagia.
Dementia-associated dysphagia, although an increasingly common clinical problem, remains an underexamined area of medicine. We successfully implemented a session on this topic for internal medicine residents on the primary care track. Limitations included generalizability due to the small number of residents in the course and inability to gather sufficient data to see if knowledge learned was sustained over time.
近 600 万美国成年人患有痴呆症,而吞咽困难是影响他们营养和生活质量的常见合并症。能够照顾老年人的老年病医生人数不足。因此,初级保健医生应该具备足够的知识来照顾老年人群。尽管有有限的证据表明这些饮食改变可以保护患者免受吞咽困难的后遗症的影响,并且有一些不良副作用的迹象,但仍经常为痴呆症患者开具修改后的饮食处方。
我们创建了一次性、互动式、基于案例的课程,以教育住院医师如何评估和治疗与痴呆相关的吞咽困难,并解决饮食改变证据有限与常规使用之间的差异。该课程结合了小组讨论和教学学习,以及参与式组件,学习者可以在其中品尝增稠液体。
该课程在已建立的初级保健课程中实施。根据从 17 名参与者中的 15 名获得的调查回应,该课程显著提高了参与者对与吞咽困难相关的痴呆症的知识,并增加了他们对吞咽困难患者护理的舒适度。
与痴呆相关的吞咽困难虽然是一个越来越常见的临床问题,但仍然是医学领域中一个研究不足的领域。我们成功地为初级保健轨道上的内科住院医师实施了关于该主题的课程。由于课程中的住院医师人数较少,并且无法收集足够的数据来了解所学知识是否随着时间的推移而持续,因此存在一定的局限性。