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Clinical Trial
. 2017 Jul 14;17(1):146.
doi: 10.1186/s12877-017-0531-3.

A comprehensive intervention following the clinical pathway of eating and swallowing disorder in the elderly with dementia: historically controlled study

Masahisa Arahata  1 , Makoto Oura  2 , Yuka Tomiyama  3 , Naoe Morikawa  4 , Hatsue Fujii  5 , Shinji Minani  6 , Yukihiro Shimizu  6
Affiliations
Clinical Trial

A comprehensive intervention following the clinical pathway of eating and swallowing disorder in the elderly with dementia: historically controlled study

Masahisa Arahata et al. BMC Geriatr. .

Abstract

Background: Eating problems in patients with advanced dementia are strongly associated with their deteriorating survival. Food and drink intake in people with dementia may be supported by specific interventions, but the effectiveness of such interventions is backed by almost no evidence. However, comprehensive geriatric assessment (CGA) might potentially clarify the etiology of decreased oral intake in people with dementia; thus improving their clinical outcomes.

Methods: This study was a single-arm, non-randomized trial that included historically controlled patients for comparison. We defined elderly patients with both severely decreased oral intake depending on artificial hydration and/or nutrition (AHN) and dementia as "Eating and Swallowing Disorder of the Elderly with Dementia (ESDED)". In the intervention group, participants received CGA through the original clinical pathway with multidisciplinary interventions. This was followed by individualized therapeutic interventions according to assessment of the etiology of their eating problems.

Results: During the intervention period (between 1st April 2013 and 31st March 2015), 102 cases of ESDED were enrolled in the study and 90 patients had completed receiving CGA. Conversely, 124 ESDED patient controls were selected from the same hospital enrolled during the historical period (between 1st April 2011 and 31st March 2012). Most participants in both groups were bedridden with severe cognitive impairment. For the intervention group, an average of 4.3 interventional strategies was recommended per participant after CGA. Serological tests, diagnostic imaging and other diagnostic examinations were much more frequently performed in the intervention group. Recovery rate from ESDED in the intervention group was significantly higher than that in the historical group (51% v.s. 34%, respectively, P = 0.02). The 1-year AHN-free survival in the intervention group was significantly higher than that in the historical group (28% v.s. 15%, respectively, P = 0.01). No significant difference between the two groups was found for 1-year overall survival (37% v.s. 28%, respectively, P = 0.08).

Conclusions: Use of CGA with multidisciplinary interventions could improve the functional status of eating and allow elderly patients with severe eating problems and dementia to survive independently without the need for AHN.

Trial registration: ISRCTN57646445 , this trial was retrospectively registered on 8th December 2015.

Keywords: Clinical pathway; Comprehensive geriatric assessment; Decreased oral intake; Dementia; Elderly; Multidisciplinary team approach.

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Conflict of interest statement

Authors’ information

Not applicable.

Ethics approval and consent to participate

Ethics approval was obtained from The Institutional Review Board of Nanto Municipal Hospital on 21st March 2013; reference number 664.

Written consent to partake in the study was obtained from all participants. If participants suffered from advanced dementia, informed consent was obtained from their proxies.

Consent for publication

Not applicable.

Competing interests

All authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Overview of the clinical pathway for ESDED. During the clinical pathway process, the most disturbed phase of swallowing was identified and the etiology of the disturbance was discussed. Based on the diagnosis, the ESAT designed and informed of various interventional strategies to the attending medical staff. This clinical pathway was started on Monday because the examinations could occur only during the same working week. ADL, Activities of daily living; ESAT, Eating and swallowing assessment team; ESDED, Eating and swallowing disorder of the elderly with dementia; MRI, Magnetic resonance imaging
Fig. 2
Fig. 2
Enrollment of the participants. CGA, Comprehensive geriatric assessment; ESDED, Eating and swallowing disorder of the elderly with dementia
Fig. 3
Fig. 3
Odds ratio in independence from AHN (Logistic regression analysis). AHN, Artificial hydration and/or nutrition; CGA, Comprehensive geriatric assessment; CI, Confidential interval; HDS-R, Hasegawa dementia rating scale - revised; Kcal, kilo-calorie; MMSE, Mini–mental state examination; OR, Odds ratio
Fig. 4
Fig. 4
AHN-free survival and overall survival in patients with ESDED. Kaplan–Meier method was used for analysis of AHNFS (a) and OS (b). AHN, Artificial hydration and/or nutrition; AHNFS, AHN-free survival; ESDED, Eating and swallowing disorder of the elderly with dementia; OS, Overall survival
See this image and copyright information in PMC

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