Dysphagia in Hospitalized Persons with Dementia

项目摘要 口咽吞咽困难(OD)是一种综合征，影响高达84%的住院老年人 阿尔茨海默病和相关痴呆症(ADRD)，与营养不良、脱水、 吸入性事件、肺炎、死亡率增加、住院时间延长和费用增加。在医院里 环境，在急性病和医院环境往往加重的情况下，护理标准需要 停止所有的口服摄入(无口服，NPO)和吞咽困难饮食(质地改变的食物和增稠的液体)。 然而，没有足够的证据表明这些饮食限制的临床益处。此外，饮食 限制摄入会导致口服摄入量减少和脱水，这可能会进一步加剧过量饮食并导致 精神错乱、呼吸道并发症、生活质量下降和死亡率。因此，对我们来说至关重要的是 检查饮食限制可改善临床结果的护理标准假设。这个 这项研究的主要目的是使用现有的ADRD住院患者的数据集来评估 饮食限制(标准护理)与管理中不良临床结局的关系 与非限制性饮食(标准护理的替代方案)相比，OD。我们的假设是饮食 限制措施将增加医院的不良后果(死亡率、呼吸道并发症、 脱水、住院时间和再入院)与非限制饮食相比。我们的数据由35,925个 2017年间，患有ADRD的住院患者在11家不同的医院接受了药物服务 和2019年。在使用这些数据的子集的初步工作中，我们证明了饮食习惯的高流行率 对ADRD患者的限制。我们的多学科研究团队处于有利地位，可以实现 以下3个目标：1)确定非营利组织是否与住院患者的不良后果有关 ADRD和OD，与任何口服摄入量(限制和非限制饮食)进行比较；2)确定 与住院的ADRD和OD患者相比，吞咽困难的饮食与不良结局有关 非限制性饮食；以及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，ADRD和OD住院患者出现精神错乱。我们将使用 倾向评分匹配，以评估饮食限制和不良结果之间的关联。这 这项工作意义重大，因为它将检查住院患者目前的服药过量护理标准 和ADRD在一起。这项研究具有创新性，因为它将是第一个将饮食限制与 有意义的临床结果，使用临床丰富变量的大型医院数据库。由此得出的结论是 建议将用于支持大规模临床试验的申请，以前瞻性地评估 限制饮食对ADRD住院患者OD的影响。我们的发现将奠定必要的基础 检查ADRD患者目前的OD护理标准所需的基础工作，并有可能 以改善这一脆弱患者群体的重要临床结果和生活质量。

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.