A novel dysphagia diet improves the nutrient intake of institutionalized elders.

OBJECTIVES Dysphagia affects 35% to 60% of the institutionalized elderly population. This study aimed at evaluating the nutrient intake of frail institutionalized elderly persons with dysphagia and to assess the impact of Sainte-Anne's Hospital Advanced Nutritional Care program on dietary intake and weight. DESIGN A 12-week intervention study. SUBJECTS/SETTING Ninety-three individuals residing in a Montreal, Canada, long-term care facility who were aged at least 65 years were evaluated. Seventeen subjects with a body mass index (BMI; calculated as kg/m(2)) <24 or weight loss >7.5% within 3 months and with dysphagia were included. INTERVENTION The treated group (n=8; aged 82.5+/-4.41 years, weight 55.9+/-12.1 kg, BMI 22.4+/-3.93) received Sainte-Anne's Hospital reshaped minced- or pureed-texture foods with thickened beverages where required. The control group (n=9; aged 84.6+/-3.81 years, weight 54.3+/-7.49 kg, BMI 21.2+/-2.31) maintained traditional nourishment. MAIN OUTCOME MEASURES Macronutrient and micronutrient intake, weight, and BMI were measured at baseline, 6 weeks, and 12 weeks. STATISTICS Student t tests were performed to evaluate change within and between groups. RESULTS The treatment and control groups were similar at baseline, having a mean age of 82.5+/-4.41 years vs 84.6+/-3.81 years and BMI of 22.4+/-3.93 vs 21.2+/-2.31, respectively. The average weight in the treated group increased compared to the control group (3.90+/-2.30 vs -0.79+/-4.18 kg; P=0.02). Similarly, the treated group presented an increased intake of energy, proteins, fats, total saturated fats, monounsaturated fats, potassium, magnesium, calcium, phosphorus, zinc, vitamin B-2, and vitamin D compared to control subjects (P<0.05). CONCLUSION Institutionalized elderly patients with dysphagia can eat better and increase body weight via a diversified, modified in texture, and appealing oral diet that meets their nutrition needs.

[1]  H. Siebens,et al.  Correlates and Consequences of Eating Dependency in Institutionalized Elderly , 1986, Journal of the American Geriatrics Society.

[2]  D. Rd Nutritional considerations for the pureed diet texture in dysphagic elderly , 2006, Dysphagia.

[3]  Groher Me,et al.  Dysphagia and Dietary Levels in Skilled Nursing Facilities , 1995 .

[4]  J. Rizzo,et al.  Nutrient Intake of Nursing‐Home Residents Receiving Pureed Foods or a Regular Diet , 1995, Journal of the American Geriatrics Society.

[5]  M. S. Kristine A. Layne B.S.N.,et al.  Using the Fleming index of dysphagia to establish prevalence , 2006, Dysphagia.

[6]  M. Groher,et al.  The prevalence of swallowing disorders in two teaching hospitals , 1986, Dysphagia.

[7]  W. Evans,et al.  Higher dietary variety is associated with better nutritional status in frail elderly people. , 2002, Journal of the American Dietetic Association.

[8]  J. O'Gara Dietary adjustments and nutritional therapy during treatment for Oral-Pharyngeal Dysphagia , 1990, Dysphagia.

[9]  A. B. Smit,et al.  Perceptual Ratings for Pureed and Molded Peaches for Individuals with and without Impaired Swallowing , 2001, Dysphagia.

[10]  A. Coulston,et al.  Prevalence of malnutrition in the elderly admitted to long-term-care facilities. , 1993, Journal of the American Dietetic Association.

[11]  M. Groher,et al.  Dysphagia: Diagnosis and Management , 1992 .

[12]  L. Cherney Clinical management of dysphagia in adults and children , 1994 .

[13]  S. Kumanyika,et al.  Body weight as a risk factor in the elderly. , 1990, Archives of internal medicine.

[14]  渡邊 早苗 Manual of clinical dietetics , 2005 .

[15]  R. D. Jane E. Kerstetter Ph.D.,et al.  Nutrition and nutritional requirements for the older adult , 2005, Dysphagia.

[16]  Sue Rodwell Williams Nutrition and diet therapy , 1969 .

[17]  M. Groher,et al.  Development and dissemination of an aspiration risk reduction diet , 2006, Dysphagia.

[18]  G. Blackburn,et al.  Prevalence of malnutrition in general medical patients. , 1976, JAMA.

[19]  C. Greenwood,et al.  Nutrient contribution of infant cereals used as fluid thickening agents in diets fed to the elderly. , 2000, Journal of the American Dietetic Association.

[20]  B. Crawley,et al.  The Importance of Dietary Protein in Healing Pressure Ulcers , 1993, Journal of the American Geriatrics Society.

[21]  S. Keelan,et al.  Enhancing taste, texture, appearance, and presentation of pureed food improved resident quality of life and weight status. , 2009, Nutrition reviews.

[22]  G. Barbour,et al.  Malnutrition in the Hospitalized Geriatric Patient , 1982, Journal of the American Geriatrics Society.

[23]  Cathy A. Pelletier A Comparison of Consistency and Taste of Five Commercial Thickeners , 1997, Dysphagia.

[24]  Ann W. Martin,et al.  Dietary management of swallowing disorders , 1991, Dysphagia.

[25]  L. Ferrucci,et al.  Food intake and mortality in the frail elderly. , 1995, The journals of gerontology. Series A, Biological sciences and medical sciences.

[26]  A. Abbasi,et al.  Undernutrition in the nursing home: prevalence, consequences, causes and prevention. , 2009, Nutrition reviews.

[27]  C. Hensley,et al.  Factors affecting use of food and commercial agents to thicken liquids for individuals with swallowing disorders. , 1992, Journal of the American Dietetic Association.

[28]  M. Kergoat,et al.  Anthropometric Indices and Their Correlates in Cognitively-Intact and Elderly Canadians with Dementia* , 2001, Canadian Journal on Aging / La Revue canadienne du vieillissement.

[29]  D. Rudman,et al.  Protein‐Calorie Undernutrition in the Nursing Home , 1989, Journal of the American Geriatrics Society.

[30]  C. Greenwood,et al.  Malnutrition in Institutionalized Seniors: The Iatrogenic Component , 2003, Journal of the American Geriatrics Society.

[31]  E. Pardoe,et al.  Development of a multistage diet for dysphagia. , 1993, Journal of the American Dietetic Association.

[32]  G. Pinchcofsky-Devin,et al.  Correlation of Pressure Sores and Nutritional Status , 1986, Journal of the American Geriatrics Society.

[33]  H. Robertson,et al.  A strategy for providing food to the patient with neurologically based dysphagia , 1993 .

[34]  J. Logemann,et al.  Evaluation and treatment of swallowing disorders , 1983 .

[35]  H. Keller Malnutrition in Institutionalized Elderly: How and Why? , 1993, Journal of the American Geriatrics Society.