Association between Improvement of Oral Health, Swallowing Function, and Nutritional Intake Method in Acute Stroke Patients.

Michiyo Aoyagi,Motoki Inaji,Taketoshi Maehara,Kazuharu Nakagawa,Chiaki Matsubara,Shunsuke Minakuchi,Kanako Yoshimi,Haruka Tohara,Yuji Sato,Junichi Furuya,Ayako Nakane

doi:10.3390/ijerph182111379

Abstract

Stroke and poor oral health are common in older people, and the brain injuries associated with stroke are often accompanied by a decline in oral function. In this study, we investigated the characteristics of stroke patients who could not recover oral ingestion until discharge and the association between improved oral health, swallowing function, and nutritional intake methods in acute care. The subjects were 216 consecutive stroke patients who were admitted to Tokyo Medical and Dental University hospital and received oral health management. Nutritional intake, dysphagia, and oral health were evaluated using the Functional Oral Intake Scale (FOIS), Dysphagia Severity Scale (DSS), and Oral Health Assessment Tool (OHAT), respectively. Patients in the tube feeding group (FOIS level 1–2, N = 68) tended to have a worse general condition, fewer functional teeth, and a worse DSS level than those in the oral nutrition group (FOIS level 3–7, N = 148). Multiple analysis with improvement in FOIS score as the dependent variable showed that number of functional teeth (odds ratio [OR]: 1.08, p = 0.04) and improved DSS (OR: 7.44, p < 0.001) and OHAT values (OR: 1.23, p = 0.048) were associated with improvement in nutritional intake methods in acute care. Therefore, recovery of swallowing function and oral health might be important for stroke patients to recover oral ingestion in acute care.

Highlights

Significant differences were found between the tube feeding group and the oral feeding group in age (p = 0.008), presence of aspiration pneumonia (p < 0.001), duration of hospitalization (p < 0.001), number of oral health management (p < 0.001), and number of functional teeth (p < 0.001)
We investigated the characteristics of stroke patients who did not achieve oral food intake at discharge in acute care to examine oral health management that could be associated with the improvement of nutritional intake methods in acute stroke patients
We found that the number of functional teeth, improvement in oral health and in swallowing function were associated with the improvement of nutritional intake at discharge, even after adjusting for the patient’s general condition and the presence of surgery and aspiration pneumonia

Summary

Introduction

Stroke is a very common disease among older people and is the fourth leading cause of death and the second leading cause for the need of nursing care among Japanese people. Oral function, including swallowing function, is often decreased [1], and often associated with a decline in brain function due to stroke. Deterioration of oral health and dysphagia can affect the development of aspiration pneumonia, the establishment of oral intake, and the patient’s quality of life (QoL); appropriate treatment of oral health from the acute phase is required in patients with stroke. Acute stroke patients are prone to phlegm and retention, xerostomia, and poor oral hygiene due to decreased oral function and disuse [2].

Methods

Results

Discussion

Conclusion