Oropharyngeal Dysphagia Clinical Trial
Official title:
Evaluation of a Minimal-massive Intervention in Elderly Hospitalized Patients With Oropharyngeal Dysphagia
The purpose of this study is to apply a minimal-massive intervention (minimal recommendations
to maximal number of patients) to elderly (>70 years) hospitalized patients with
oropharyngeal dysphagia (OD). The intervention will consist of early screening and assessment
of OD, malnutrition and oral hygiene. Patients will be given recommendations for adaptation
of volume and viscosity of fluids, nutritional support and good oral hygiene practices and
followed at 3, 6, 9 and 12 months after discharge. In every point of the follow-up period,
patients will be re-evaluated to adjust recommendations and to verify their compliance with
the treatment.
The objectives of the intervention are to have an impact on complications related to OD
(avoid impaired safety alterations and improve nutritional and oral health status and reduce)
and to reduce readmissions, readmissions for pneumonia and morbimortality.
These study aims to evaluate the application of an assistance programme to:
1. Perform a systematic screening of oropharyngeal dysphagia in older hospitalized patients
(≥70 yr) admitted to internal medicine and geriatric unit of Hospital de Mataró.
2. Offer a minimal-massive treatment to older patients with OD based on, rheological
adaptation of fluids (volume and viscosity), nutritional support based on traditional
diet and oral hygiene treatment.
3. To give education and knowledge about the diagnose and treatment of OD to the medical
staff, caregivers and relatives of the patients to improve their management.
Study design:
Experimental pre-post interventional study with 1 year follow-up and 4 control points at 3,
6, 9 and 12 months after discharge. Pre-interventional evaluations will be done on admission
and at discharge; post-interventional evaluations will be performed at 3, 6, 9 and 12 months
after discharge. In every evaluation point the investigators will obtain data about OD
(efficacy and safety of swallow with the Volume-Viscosity Swallowing Test (V-VST)), health
status of the patients (comorbidities, functionality, frailty, anthropometric measurements,
illnesses and medication), nutritional status (MNA-sf and Bioimpedance), oral hygiene (dental
evaluation with the Simplified Oral Hygiene Index (OHI-S)) and respiratory infections and
pneumonia rates. In addition during the follow-up period the investigators will collect
readmissions incidence (all readmissions, respiratory infections and pneumonia),
institutionalization and death. Data collected will be compared with the previous year of the
same patient and with a historical control group of untreated older patients with OD that
will be matched for age, sex, comorbidities and functionality.
The intervention will consist on adaptation of fluids (volume and viscosity) in accordance
with V-VST results, nutritional supplementation with traditional food (based on MNA-sf and
bioimpedance results) and recommendation of good oral hygiene practices (based on dental
evaluation). In every point of the follow-up period, recommendations will be given to
patients.
Objectives:
- The primary objective is to launch and evaluate the effect of the minimal-massive
program in hospitalized older patients with OD.
- To evaluate the effect of the intervention on the signs and symptoms of OD, nutritional
status, oral hygiene, functional status and quality of life of patients included at the
program at 3, 6, 9 and 12 months after discharge.
- To describe readmission rates for any reason, readmission rates for pneumonia,
institutionalization rate and mortality rate in the study population compared to an
historical control group of older patients with OD and no intervention.
;
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