Dysphagia in Hospitalized Persons with Dementia

痴呆症住院患者的吞咽困难

• 批准号: 10459567
• 负责人: Alex Makhnevich
• 金额: $ 16.75万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2023-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10459567
• 关键词: Acute; Adverse event; Affect; Aging; Alzheimer' s disease related dementia; Biometry; Clinical; Clinical Trials; Data; Data Science; Data Set; Databases; Deglutition; Deglutition Disorders; Dehydration; Delirium; Dementia; Diagnosis; Diet; Elderly; Environment; Event; Food; Geriatrics; Health; High Prevalence; Hospital Mortality; Hospitals; Intake; Interdisciplinary Study; Lead; Length of Stay; Liquid substance; Malnutrition; Medicine; Modeling; Oral; Oropharyngeal Dysphagia; Outcome; Patients; Persons; Pneumonia; Population; Positioning Attribute; Quality of life; Research; Risk Factors; Safety; Services; Specific qualifier value; Statistical Methods; Syndrome; Texture; Vulnerable Populations; Work; adverse outcome; clinical database; cohort; cost; dietary restriction; hazard; hospital readmission; improved; improved outcome; innovation; mortality; multidisciplinary; patient population; primary outcome; prospective; respiratory; standard care; standard of care

Project Summary Oropharyngeal dysphagia (OD) is a syndrome that affects up to 84% of hospitalized older adults with Alzheimer's disease and Related Dementias (ADRD), and is associated with malnutrition, dehydration, aspiration events, pneumonia, increased mortality, longer hospital stay, and higher costs. In the hospital setting, where OD is often exacerbated by the acute illness and hospital environment, standard of care entails withholding all oral intake (nil per os, NPO) and dysphagia diets (texture modified food and thickened liquids). Yet, there is insufficient evidence for the clinical benefit of these dietary restrictions. Furthermore, dietary restrictions lead to decreased oral intake and dehydration, which may further exacerbate OD and lead to delirium, respiratory complications, decreased quality of life, and mortality. Therefore, it is critical for us to examine the standard of care assumption that dietary restrictions result in improved clinical outcomes. The overarching aim of this study is to use an existing data set of hospitalized persons with ADRD to evaluate the relationship between dietary restrictions (standard care) and adverse clinical outcomes in the management of OD, as compared to a non-restricted diet (alternative to standard care). Our hypothesis is that dietary restrictions will be associated with increased adverse hospital outcomes (mortality, respiratory complications, dehydration, length of stay, and readmission) as compared to a non-restricted diet. Our data consists of 35,925 hospitalized persons with ADRD admitted to the medicine service across 11 diverse hospitals between 2017 and 2019. In preliminary work using a subset of this data, we demonstrated high prevalence of dietary restrictions in patients with ADRD. Our multidisciplinary research team is well-positioned to accomplish the following 3 Aims: 1) Determine whether NPO is associated with adverse outcomes in hospitalized persons with ADRD and OD, compared to any oral intake (restricted and non-restricted diet); 2) Determine whether a dysphagia diet is associated with adverse outcomes in hospitalized persons with ADRD and OD, compared to a non-restricted diet; and 3) Determine whether dietary restrictions (NPO or dysphagia diet) are associated with delirium in hospitalized persons with ADRD and OD, compared to a non-restricted diet. We will use propensity score matching to evaluate associations between dietary restrictions and adverse outcomes. This line of work is significant, because it will examine the current standard of care of OD in hospitalized patients with ADRD. This research is innovative, because it will be the first study to associate dietary restrictions with meaningful clinical outcomes, using a large hospital database of clinically rich variables. The findings from this proposal will be used to support the application for a large-scale clinical trial to prospectively evaluate the effects of dietary restrictions for OD in hospitalized patients with ADRD. Our findings will lay the essential groundwork needed to examine the current standard of care of OD in patients with ADRD and has the potential to improve important clinical outcomes and quality of life for this vulnerable patient population.

项目概要 口咽吞咽困难 (OD) 是一种综合征，影响高达 84% 的住院老年人 阿尔茨海默氏病和相关痴呆症 (ADRD)，与营养不良、脱水、 误吸事件、肺炎、死亡率增加、住院时间延长以及费用增加。在医院里 在急性疾病和医院环境经常加剧 OD 的环境中，护理标准需要 停止所有口服摄入（无口服，NPO）和吞咽困难饮食（质地改良食物和增稠液体）。 然而，没有足够的证据证明这些饮食限制的临床益处。此外，饮食 限制导致口服摄入量减少和脱水，这可能进一步加剧 OD 并导致 谵妄、呼吸系统并发症、生活质量下降和死亡率。因此，对我们来说至关重要的是 检查饮食限制可以改善临床结果的护理标准假设。这 本研究的总体目标是使用 ADRD 住院患者的现有数据集来评估 饮食限制（标准护理）与管理中不良临床结果之间的关系 OD，与非限制饮食（标准护理的替代方案）相比。我们的假设是饮食 限制将与不良医院结局（死亡率、呼吸系统并发症、 与非限制饮食相比，脱水、住院时间和再次入院）。我们的数据包括 35,925 2017 年期间 11 家不同医院接受医疗服务的 ADRD 住院患者 和 2019 年。在使用这些数据的子集的初步工作中，我们证明了饮食的高患病率 ADRD 患者的限制。我们的多学科研究团队有能力完成 以下 3 个目标： 1) 确定 NPO 是否与住院患者的不良后果相关 ADRD 和 OD，与任何口服摄入（限制和非限制饮食）相比； 2) 判断是否 与 ADRD 和 OD 住院患者相比，吞咽困难饮食与不良后果相关 不限制饮食； 3) 确定饮食限制（NPO 或吞咽困难饮食）是否相关 与非限制饮食相比，患有 ADRD 和 OD 的住院患者出现谵妄的情况。我们将使用 倾向评分匹配来评估饮食限制和不良后果之间的关联。这 这项工作意义重大，因为它将检查住院患者 OD 的当前护理标准 与ADRD。这项研究具有创新性，因为它将是第一项将饮食限制与 有意义的临床结果，使用临床丰富变量的大型医院数据库。由此得出的结论 该提案将用于支持大规模临床试验的申请，以前瞻性地评估 饮食限制对住院 ADRD 患者 OD 的影响。我们的研究结果将奠定重要基础 检查当前 ADRD 患者 OD 护理标准所需的基础工作，并且具有潜力 改善这一弱势患者群体的重要临床结果和生活质量。

项目成果

Oropharyngeal Dysphagia in Hospitalized Older Adults With Dementia: A Mixed-Methods Study of Care Partners.

住院老年痴呆症患者的口咽吞咽困难：护理伙伴的混合方法研究。

• DOI: 10.1044/2022_ajslp-22-00126
• 发表时间: 2023
• 期刊: American journal of speech-language pathology
• 影响因子: 2.6
• 作者: Makhnevich,Alex;Marziliano,Allison;Porreca,Kristen;Gromova,Valeria;Diefenbach,MichaelA;Sinvani,Liron
• 通讯作者: Sinvani,Liron