Viñas Paula, Clavé Pere, Tomsen Noemí
Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Carretera de Cirera 230, 08304, Barcelona, Mataró, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
Geroscience. 2025 Apr;47(2):2495-2505. doi: 10.1007/s11357-024-01448-x. Epub 2024 Nov 22.
The diagnosis of dehydration among older patients with oropharyngeal dysphagia (OD) remains a clinical challenge. We aimed to assess the prevalence of dehydration in hospitalized older adults with OD and its relationship with other comorbidities. This is a cross-sectional study involving hospitalized older patients (≥ 70 years) with OD, assessed for OD using the Volume-Viscosity Swallowing Test. Treatment for impaired safety of swallow was based on xanthan gum thickened fluids with appropriate bolus viscosity (250 mPa·s or 800 mPa·s). Hydration status was evaluated using three different methodologies: (a) osmolarity equation (> 295 mmol/L), (b) blood urea nitrogen to creatinine ratio (BUN/Cr > 20 and (c) bioimpedance analysis (BIA): phase angle (PA) < 4.5. Nutritional status (Mini Nutritional Assessment-short form), functionality (Barthel Index), frailty (Fried Index), and sarcopenia (European Working Group on Sarcopenia in Older People) were also assessed. We included 218 hospitalized (9.1 ± 7.2 days) patients with OD (87.4 ± 5.5 years), 85.3% with safety impairments. On admission, (a) up to 58.3% needed fluid thickening for safe swallowing (90.6% of them at 250 mPa·s) and 93.6% textured modified diets, (b) According to BUN/Cr ratio, 78.9% were dehydrated and to osmolarity, 81.2% and (c) 61.1% of participants had values of PA < 4.5, and (d) hydration status was significantly worse in patients with lower functional status, frailty, malnutrition, and sarcopenia. Dehydration is a highly prevalent condition among hospitalized older patients with OD. Assessment of hydration status, and promotion and monitoring of safe fluid intake with multimodal hydration interventions, is mandatory in patients with OD.
对于患有口咽吞咽困难（OD）的老年患者，脱水的诊断仍然是一项临床挑战。我们旨在评估住院的患有OD的老年人中脱水的患病率及其与其他合并症的关系。这是一项横断面研究，纳入了住院的老年患者（≥70岁），使用容量 - 粘度吞咽试验评估OD。吞咽安全受损的治疗基于使用黄原胶增稠的液体，其具有适当的团块粘度（250 mPa·s或800 mPa·s）。使用三种不同方法评估水合状态：（a）渗透压公式（>295 mmol/L），（b）血尿素氮与肌酐比值（BUN/Cr>20），以及（c）生物电阻抗分析（BIA）：相角（PA）<4.5。还评估了营养状况（简易营养评估简表）、功能（巴氏指数）、衰弱（弗里德指数）和肌肉减少症（欧洲老年人肌肉减少症工作组）。我们纳入了218名住院（9.1±7.2天）的OD患者（87.4±5.5岁），其中85.3%存在安全受损情况。入院时，（a）高达58.3%的患者需要增稠液体以安全吞咽（其中90.6%为250 mPa·s），93.6%的患者需要质地改良饮食，（b）根据BUN/Cr比值，78.9%的患者脱水，根据渗透压，81.2%的患者脱水，（c）61.1%的参与者PA值<4.5，并且（d）功能状态较低、衰弱、营养不良和肌肉减少症患者的水合状态明显更差。脱水在住院的患有OD的老年患者中是一种高度普遍的情况。对于OD患者，评估水合状态以及通过多模式水合干预促进和监测安全液体摄入是必不可少的。
