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Effect of a Minimal-Massive Intervention in Hospitalized Older Patients with Oropharyngeal Dysphagia: A Proof of Concept Study

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The journal of nutrition, health & aging

Abstract

Background

Oropharyngeal dysphagia (OD) is a newly defined geriatric syndrome that causes nutritional and respiratory complications in older hospitalized patients. Following hospital discharge, OD also causes hospital readmission and mortality in this population.

Objective

Our aim was to assess the effect of a minimal-massive intervention (MMI) in reducing nutritional and respiratory complications in older hospitalized patients with OD.

Design and participants

An open label trial was performed on 186 hospitalized older patients (>70y) with OD; 62 of these patients with OD were treated with the MMI and paired by sex, age, functionality, comorbidities and body mass index with two controls.

Intervention

The MMI consisted of: a) fluid thickening and texture-modified foods, b) caloric and protein supplementation; and c) oral health and hygiene recommendations during hospitalization and following discharge. The control group followed the standard clinical practice without MMI.

Measurements

Main study outcomes were hospital readmissions, respiratory infections, nutritional status and survival after 6 months follow up.

Results

Both groups had similar advanced age (84.87±6.02MMI and 84.42±5.31 years), poor functionality (Barthel 59.51±26.76 MMI and 58.84±26.87), and high comorbidities (Charlson 3.00±1.60 MMI and 3.06±1.45). Main results showed that MMI improved nutritional status (MNA 9.84±2.05 pre-MMI vs. 11.31±2.21 post-MMI; p=0.0038) and functionality (Barthel 62.34±25.43 pre-MMI vs. 73.44±25.19 post-MMI; p=0.007). In addition MMI decreased hospital readmissions (68.8 readmissions/100 persons-year (28.1–109.38) MMI vs. 190.8 (156.0–225.7); p=0.001), respiratory infections (12.50 readmissions/100 persons-year (0–29.82) MMI vs. 74.68 (52.86–96.50); p=0.002), and increased 6-month survival (84.13% MMI vs. 70.96%; p=0.044).

Conclusions

Our results suggest that a MMI in hospitalized older patients with OD improves nutritional status and functionality and reduces hospital readmissions, respiratory infections and mortality. MMI might become a new simple and cost-effective strategy to avoid OD complications in the geriatric population admitted with an acute disease to a general hospital.

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Authors and Affiliations

  1. GI Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, Barcelona, Spain

    A. Martín, O. Ortega & Pere Clavé Civit

  2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain

    O. Ortega & Pere Clavé Civit

  3. Department of Dietetics and Nutrition, Hospital de Mataró, Barcelona, Spain

    M. Roca & M. Arús

  4. Fundació Institut de Investigació Germans Trias i Pujol, Badalona, Spain

    Pere Clavé Civit

  5. Universitat Autònoma de Barcelona, Barcelona, Spain

    Pere Clavé Civit

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Martín, A., Ortega, O., Roca, M. et al. Effect of a Minimal-Massive Intervention in Hospitalized Older Patients with Oropharyngeal Dysphagia: A Proof of Concept Study. J Nutr Health Aging 22, 739–747 (2018). https://doi.org/10.1007/s12603-018-1043-3

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