Geriatria, Accettazione geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Via della Montagnola 81, 60127, Ancona, Italy.
Clinical Nutrition Unit, IRCCS INRCA Ancona, Via della Montagnola 81, 60127, Ancona, Italy.
BMC Geriatr. 2022 Aug 31;22(1):719. doi: 10.1186/s12877-022-03402-y.
Dysphagia is a frequent condition in older nursing home residents (NHRs) which may cause malnutrition and death. Nevertheless, its prevalence is still underestimated and there is still debate about the appropriateness and efficacy of artificial nutrition (AN) in subjects with severe dysphagia. The aim is to assess the prevalence of dysphagia in European and Israeli NHRs, its association with mortality, and the relationship of different nutritional interventions, i.e. texture modified diets and AN-with weight loss and mortality.
A prospective observational study of 3451 European and Israeli NHRs older than 65 years, participating in the SHELTER study from 2009 to 2011, at baseline and after 12 months. All residents underwent a standardized comprehensive evaluation using the interRAI Long Term Care Facility (LTCF). Cognitive status was assessed using the Cognitive Performance Scale (CPS), functional status using Activities of Daily Living (ADL) Hierarchy scale. Trained staff assessed dysphagia at baseline by clinical observation. Data on weight loss were collected for all participants at baseline and after 12 months. Deaths were registered by NH staff.
The prevalence of dysphagia was 30.3%. During the one-year follow-up, the mortality rate in subjects with dysphagia was significantly higher compared with that of non-dysphagic subjects (31.3% vs 17.0%,p = 0,001). The multivariate analysis showed that NHRs with dysphagia had 58.0% higher risk of death within 1 year compared with non-dysphagic subjects (OR 1.58, 95% CI, 1.31-1.91). The majority of NHRs with dysphagia were prescribed texture modified diets (90.6%), while AN was used in less than 10% of subjects. No statistically significant difference was found concerning weight loss and mortality after 12 months following the two different nutritional treatments.
Dysphagia is prevalent among NHRs and it is associated with increased mortality, independent of the nutritional intervention used. Noticeably, after 12 months of nutritional intervention, NHRs treated with AN had similar mortality and weight loss compared to those who were treated with texture modified diets, despite the clinical conditions of patients on AN were more compromised.
吞咽困难是老年疗养院居民（NHR）常见的病症，可能导致营养不良和死亡。然而，其患病率仍被低估，并且对于严重吞咽困难患者使用人工营养（AN）的适当性和疗效仍存在争议。目的是评估欧洲和以色列 NHR 吞咽困难的患病率，其与死亡率的关系，以及不同营养干预措施（即质地改良饮食和 AN）与体重减轻和死亡率的关系。
对 2009 年至 2011 年期间参加 SHELTER 研究的 3451 名年龄在 65 岁以上的欧洲和以色列 NHR 进行前瞻性观察研究，在基线和 12 个月时进行。所有居民均接受了使用 interRAI 长期护理设施（LTCF）的标准化综合评估。认知状况使用认知表现量表（CPS）进行评估，功能状况使用日常生活活动（ADL）等级量表进行评估。经过培训的工作人员在基线时通过临床观察评估吞咽困难。为所有参与者收集了基线和 12 个月时的体重减轻数据。NH 工作人员登记了死亡人数。
吞咽困难的患病率为 30.3%。在为期 1 年的随访期间，吞咽困难患者的死亡率明显高于非吞咽困难患者（31.3%比 17.0%，p=0.001）。多变量分析显示，与非吞咽困难患者相比，吞咽困难的 NHR 患者在 1 年内死亡的风险高 58.0%（OR 1.58，95%CI，1.31-1.91）。大多数吞咽困难的 NHR 都开了质地改良饮食（90.6%），而只有不到 10%的患者使用了 AN。在接受两种不同营养治疗后 12 个月，体重减轻和死亡率没有统计学差异。
吞咽困难在 NHR 中很常见，与死亡率升高有关，与使用的营养干预无关。值得注意的是，在接受 12 个月的营养干预后，接受 AN 治疗的 NHR 的死亡率和体重减轻与接受质地改良饮食治疗的 NHR 相似，尽管接受 AN 的患者的临床状况更差。
