Makhnevich Alex, Mehta Prachi, Perrin Alexandra, Porreca Kristen, Saxtein Caitlin, Islam Shahidul, Sison Cristina, Sinvani Liron
Northwell Health, New Hyde Park, NY, USA.
Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
J Gen Intern Med. 2025 Jan 29. doi: 10.1007/s11606-025-09397-7.
Oropharyngeal dysphagia (dysphagia) is a common (up to 86%) and devastating syndrome in hospitalized older adults with dementia.
To describe the perspectives of dysphagia management in hospitalized patients with dementia among hospital medicine providers (i.e., hospitalists, internal medicine residents, and advanced practice providers, APPs).
An anonymous cross-sectional survey study across a large health system in the greater New York metropolitan area PARTICIPANTS: Surveys were distributed to hospitalists, internal medicine residents, and APPs via a multimodal approach. Survey questions were created by an interprofessional team consisting of hospitalists, a geriatrician, and a geriatrics-trained APP.
Survey questions assessed current practices and perceptions of dysphagia management in patients with dementia.
Of 104 surveys completed, 62.1% were hospitalists, 24.3% were APPs, and 13.6% were residents. Nursing report (61.0%) was the most common way providers found out about suspected dysphagia. The vast majority (85.0%) always/often consulted a Speech-Language Pathologist (SLP) for suspected dysphagia evaluation. Over a third (39.8%) rarely/never discussed goals of care before consulting a SLP. Provider perceptions of the risks/benefits of dysphagia diets varied widely: dysphagia diets in patients with dementia improve quality of life (strongly disagree/disagree 33.0%, neither agree or disagree 31.1%, strongly agree/agree 35.9%); dysphagia diets in patients with dementia reduce the risk of mortality (strongly disagree/disagree 33.0%, neither agree or disagree 22.3%, strongly agree/agree 44.7%). Lastly, only 64% thought there was enough evidence to recommend against a PEG in patients with advanced dementia.
Our study highlights the need for standardizing dysphagia management best practices in hospitalized patients with dementia, the importance of addressing goals of care, and provider education on the risks and benefits of dysphagia diets and artificial nutrition via PEG tube.
口咽吞咽困难在患有痴呆症的住院老年人中是一种常见（高达86%）且严重的综合征。
描述医院医学提供者（即住院医师、内科住院医生和高级实践提供者，APPs）对痴呆症住院患者吞咽困难管理的看法。
在大纽约都会区的一个大型医疗系统中进行的一项匿名横断面调查研究
通过多模式方法向住院医师、内科住院医生和APPs分发调查问卷。调查问卷由一个跨专业团队编制，该团队包括住院医师、一名老年病学家和一名接受过老年病学培训的APPs。
调查问卷评估了痴呆症患者吞咽困难管理的当前实践和看法。
在完成的104份调查问卷中，62.1%是住院医师，24.3%是APPs，13.6%是住院医生。护理报告（61.0%）是提供者发现疑似吞咽困难的最常见方式。绝大多数（85.0%）在怀疑吞咽困难评估时总是/经常咨询言语语言病理学家（SLP）。超过三分之一（39.8%）在咨询SLP之前很少/从未讨论过护理目标。提供者对吞咽困难饮食的风险/益处的看法差异很大：痴呆症患者的吞咽困难饮食可改善生活质量（强烈反对/反对33.0%，既不同意也不反对31.1%，强烈同意/同意35.9%）；痴呆症患者的吞咽困难饮食可降低死亡风险（强烈反对/反对33.0%，既不同意也不反对22.3%，强烈同意/同意44.7%）。最后，只有64%的人认为有足够的证据建议对晚期痴呆症患者不使用经皮内镜下胃造口术（PEG）。
我们的研究强调了在痴呆症住院患者中规范吞咽困难管理最佳实践的必要性、解决护理目标的重要性以及对提供者进行吞咽困难饮食和经PEG管人工营养的风险和益处的教育。
