Northwell, New Hyde Park, NY, USA; Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell, Manhasset, NY, USA.
Northwell, New Hyde Park, NY, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell, Manhasset, NY, USA.
J Am Med Dir Assoc. 2024 Nov;25(11):105267. doi: 10.1016/j.jamda.2024.105267. Epub 2024 Sep 16.
Oropharyngeal dysphagia (dysphagia) is highly prevalent (up to 86%) in hospitalized patients with Alzheimer disease and related dementias (ADRD). This study aims to describe the management and clinical course of dysphagia in hospitalized patients with ADRD.
Prospective observational cohort study.
The study was conducted across 10 hospitals within a large health system in New York. Participants were older adults with ADRD admitted to the medicine service and diagnosed with dysphagia to liquids on speech-language pathologist (SLP) assessment and were recruited between January and June 2023.
Baseline characteristics [eg, dementia Functional Assessment Staging Tool (FAST)], dysphagia management (eg, prescribed diet), and clinical course (eg, dysphagia improvement, respiratory complications) were collected.
Of patients with ADRD and dysphagia (n = 62), the average age was 86.5 and 66.1% were FAST Stage 7. On admission, 48.4% had pneumonia, 79.0% had delirium, and 69.4% were made nil per os (NPO) for aspiration risk. Of those who received SLP reassessment after diet initiation (n = 25), 76% demonstrated dysphagia improvement; 75% of patients with FAST stage 7 demonstrated improvement. Respiratory complications occurred in 21.0% of patients on the following diets: NPO, nasogastric tube feeding, dysphagia diets, and comfort feeds. In univariate analyses, hospital-acquired dehydration, no dysphagia improvement, and delirium were associated with respiratory complications.
The potential for dysphagia improvement in hospitalized patients with ADRD (even those with advanced dementia) highlights the critical need for standardizing reassessment. Further studies are needed to evaluate factors associated with respiratory complications in this population.
在患有阿尔茨海默病和相关痴呆症（ADRD）的住院患者中，口咽吞咽困难（吞咽困难）的患病率很高（高达 86%）。本研究旨在描述住院 ADRD 患者吞咽困难的管理和临床过程。
前瞻性观察队列研究。
该研究在纽约一家大型医疗系统的 10 家医院进行。参与者为患有 ADRD 的老年人，他们因吞咽困难被语言病理学家（SLP）评估诊断为吞咽困难，并在 2023 年 1 月至 6 月期间招募。
收集基线特征（例如，痴呆功能评估分期工具（FAST））、吞咽困难管理（例如，规定饮食）和临床过程（例如，吞咽困难改善、呼吸并发症）。
患有 ADRD 和吞咽困难的患者（n=62）平均年龄为 86.5 岁，66.1%为 FAST 第 7 期。入院时，48.4%患有肺炎，79.0%患有谵妄，69.4%因吸入风险而禁食（NPO）。在开始饮食后接受 SLP 重新评估的患者中（n=25），76%的患者吞咽困难改善；75%的 FAST 第 7 期患者改善。21.0%的患者出现呼吸并发症：NPO、鼻胃管喂养、吞咽困难饮食和舒适喂养。在单变量分析中，医院获得性脱水、吞咽困难无改善和谵妄与呼吸并发症相关。
即使是患有晚期痴呆症的 ADRD 住院患者，也有改善吞咽困难的潜力，这突出表明需要标准化重新评估。需要进一步研究来评估该人群中与呼吸并发症相关的因素。
