Review of relationship between dysphagia and malnutrition following stroke (original) (raw)
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Journal of the American Medical Directors Association, 2019
Objective: This study aimed to clarify the association between malnutrition and improvement of swallowing ability during rehabilitation of stroke patients. Design: This was a retrospective cohort study. Setting and participants: One hundred eighty-eight older adults with oropharyngeal dysphagia after stroke who were admitted to a rehabilitation hospital. Methods: The International Dysphagia Diet Standardization Initiative Functional Diet Scale (IDDSI-FDS) was used to assess swallowing ability. The Global Leadership Initiative on Malnutrition (GLIM) definition was used to diagnose malnutrition. The primary outcome was IDDSI-FDS score at discharge. Results: The mean age of the patients was 78.9 AE 7.7 years, and 36.7% were women. A total of 122 (64.8%) patients were diagnosed with malnutrition. Compared with those without malnutrition, malnourished patients had more severe dysphagia on admission. After adjusting for confounders, malnutrition was an independent contributor to the IDDSI-FDS scores at discharge (standardized coefficient: À0.165, P ¼ .011). Conclusion and implications: In patients with oropharyngeal dysphagia after stroke, malnutrition at admission inversely affected their swallowing ability at discharge. Dysphagia rehabilitation, including early nutritional intervention, may be effective in the recovery of swallowing ability.
Dysphagia Towards Nutrient Intake and Malnutrition Case in Stroke Patients: Literature Review
2020
Dysphagia is one of the most important clinical manifestations of stroke and can pose a greater risk of malnutrition for patients during and after hospitalization. The purpose of this research is to review the literature about dysphagia on nutrient intake and malnutrition case in stroke patients. Type of the research is literature review which consist of journals cited the incidence of stroke patients suffered Dysphagia from 2015–2020 year of national and international publication. The result of dysphagia people can only consumed 10–33% of nutrient intake during 2 weeks and 3 months at home. This condition is insufficient for the energy and nutritional needs of the patient and can effect malnutrition case due to dysphagia which is 6-78%. The enteral formula can be obtained to reach energy and nutrients by focusing to the stroke patient treatment. Dysphagia experienced by stroke patient will affect nutrient intake and the malnutrition case. The suggestion of this paper is pointed to ...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2003
Following stroke, patients may have reduced dietary intake, swallowing impairments (dysphagia) and other neurological deficits that could affect their nutritional and hydration status and lead to aspiration pneumonia. Impaired nutritional status is associated with reduced functional improvement, increased complication rates and prolonged hospital stays. This article is aimed at primary care physicians and others caring for stroke patients. We discuss the need for assessing the nutritional status of stroke patients and provide strategies for the management of dysphagia and patients' food and fluid intakes. In addition, we review clinical and radiological options for the diagnosis of dysphagia as well as oral and enteral feeding alternatives.
Journal of Clinical Medicine, 2021
Background: Dysphagia assessment in postacute stroke patients can decrease the incidence of complications like malnutrition, dehydration, and aspiration pneumonia. It also helps to avoid unnecessary diet restrictions. The aim of this study is to verify if regular reassessment of dysphagia would change the diet management of postacute stroke patients in rehabilitation settings. Methods: This single-center retrospective study included 63 patients referred to an inpatient neurological rehabilitation center between 2018–2019. A standardized clinical swallowing evaluation and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) were performed. Diet level according to Functional Oral Intake Scale (FOIS) was evaluated. As the primary endpoint, the FOIS values based on diagnostic procedures were assessed at hospital discharge, rehabilitation admission, and after FEES. Results: 19 women (30%) and 44 men (70%), with a mean age of 75 y (SD ± 10.08), were enrolled. The intergroup ANOVA reveale...
Neurogenic dysphagia: Nutrition therapy improves rehabilitation
To examine whether augmented nutrition therapy (Volkert et al. 2006, Williams 2006) improves the general rehabilitation outcome of patients with neurogenic dysphagia compared to neurologic patients without dysphagia. S u b j e c t s / m e t h o d s : 127 stroke patients undergoing postacute multidisciplinary neurorehabilitation approach were routinely screened for neurogenic dysphagia and undernutrition. An aspiration free daily input of 1300 to 2500 kcal was assured by means of augmented clinical nutrition including changes of food / fluid consistency, feeding assistance, mealtime supervision, therapeutic swallowing manoeuvres, endoscopic evaluation, tube feeding, and parenteral nutrition (Volkert et al. 2006, Williams 2006, ECRI 1999, Bath et al. 2002). Outcome was defined as difference of neurofunctional scores at admission and discharge. Nutritional status was assessed with Innsbruck Nutrition Scale (Hackl 2004) and Nutritional Risk Screening (NRS 2002; Kondrup et al. 2003). R e s u l t s : 50 % (n = 64) of all patients of the whole sample needed nutritional support. A high amount of cognitive impairment in these swallowing compromised patients (56 out of 64) indicates that most of these patients suffered from neurogenic dysphagia affecting the preoral swallowing phase. Only 31 out of 63 of normal swallowing patients were cognitively normal. Swallowing disordered patients exhibited a highly significant better outcome in rehabilitation compared to not swallowing disturbed patients. C o n c l u s i o n s : Multiple approaches for screening and assessment of dysphagia and undernutrition after stroke and enforced nutrition scenario unmask the underestimated rehabilitation potential of swallowing compromised patients after stroke.
Dysphagia after stroke: an overview
Current Physical Medicine and Rehabilitation Reports, 2013
Dysphagia affects the vast majority of acute stroke patients. Although it improves within 2 weeks for most, some face longstanding swallowing problems that place them at risk for pneumonia, malnutrition, dehydration, and significantly affect quality of life. This paper discusses the scope, the disease burden, and the tools available for screening and formal evaluation of dysphagia. The most common and recently developed treatment interventions that might be useful in the treatment of this population are discussed.
Dysphagia Related Health Consequences among Patients with Acute Stroke in Cairo, Egypt
The Medical Journal of Cairo University, 2018
Background: Dysphagia is a common complication of stroke; it places the patient with acute stroke at risk for poor nutrition and dehydration. In addition to other dangerous complications as post stroke pneumonia. Aim of Study: To explore dysphagia related health consequences (post stroke pneumonia, length of ICU stay and death) among patients with acute stroke in Cairo, Egypt. Research Design: A descriptive exploratory research design was utilized. Research Question: What are the dysphagia related health consequences as indicated by post stroke pneumonia, length of ICU stay and death) among patients with acute stroke in Cairo, Egypt? Setting: The current study was carried out at a stroke unit affiliated to a selected hospital in Cairo, Egypt. Sample: A purposive sample consisting of 70 adult male and female patients with acute stroke. Tools of Data Collection: Three tools were used by the investigator to collect data pertinent to the study: Tool 1: Personal background and medical data, Tool 2: Gugging Swallowing Screen test (GUSS) Tool 3: Post stroke Pneumonia assessment tool. Results: 30% of the studied sample was in the age group of 61-70 years old, 54% of the study sample was female, and about half (45.7%) of the studied sample had a moderate degree of dyaphagia. 37.1% of the studied sample stayed from 5 to 7 days in the Intensive Care Unit. (7.1%) of the studied sample had died. More than half (57.1%) of the studied sample didn't develop post stroke pneumonia. There was a significant statistical relationship between degree of dysphagia and (post stroke pneumonia, death and length of ICU stay). Conclusion: Dysphagia following the acute stroke is very important issue to be considered during handling, caring and management of patients with it. Recommendation: Replication of this study on a representative sample for such group of patients all over the Arab
Long-term outcome after stroke: does dysphagia matter?
Age and Ageing, 2006
Background: swallowing problems (dysphagia) are common following acute stroke and are independent predictors of short-term outcome. It is uncertain as to whether these swallowing problems are associated with outcome in the longer-term. Aim: insert to determine whether dysphagia present in the first week of acute stroke is associated with long-term outcome. Methods: a population-based long-term follow-up of people with first in a life-time stroke. Dysphagia was assessed within 1 week of stroke and patients were followed up at 3 months and yearly for 5 years by face-to-face interview. Outcome was defined by survival and place of residence, using multinomial logistic regression. Barthel Scores were divided into the two groups 15-20 and 0-14, and modelled using multiple logistic regression. Results: there were 567 patients with dysphagia (mean age 74.3 years) and 621 with a safe swallow (mean age 69.6 years). Following multinomial logistic regression, residence in a nursing home was more likely to occur in those who failed the swallow test during the first week of their stroke; however, this only reached statistical significance at 3 months (relative risk ratio (RRR) = 1.73; 95% confidence interval (CI) 1.02 to 2.95), and years 4 (RRR 3.35, 1.37-8.19) and 5 (RRR 3.06, 1.06-8.83). There was also a significant association with increased mortality only during the first three months (RRR 2.03, 1.12 to 3.67). Conclusion: this study confirms that the presence of dysphagia during the acute phase of stroke is associated with poor outcome during the subsequent year, particularly at 3 months, and is associated with increased institutionalisation rate in the long term.
Predictors of prolonged dysphagia following acute stroke
Journal of Clinical Neuroscience, 2003
Dysphagia following acute stroke frequently necessitates prolonged enteral feeding. There is evidence that early enteral feeding via percutaneous endoscopic gastrostomy (PEG) is both beneficial and safe. The aim of this study was to identify predictors of prolonged dysphagia. The subjects were 149 consecutive patients admitted with acute stroke. Clinical findings and imaging results were prospectively collected, and subsequent progress recorded. Subjects were divided into 3 groups for analysis: no dysphagia; transient dysphagia (O14 days); or prolonged dysphagia (>14 days). Validity of the water swallow test as a predictor of aspiration pneumonia was confirmed. Significant associations for prolonged dysphagia were seen with stroke severity, dysphasia and lesions of the frontal and insular cortex on brain imaging. These results indicate that it may be possible to predict patients who will develop prolonged significant dysphagia following acute stroke thereby facilitating referral for insertion of PEG at an earlier time point. ª