Examining the effect of intensive individual swallowing exercise therapy protocol on swallowing physiology in geriatric patients hospitalized in the thoracic diseases service with a complaint of major swallowing dysfunction with multiple prognoses

Abstract

Objectives: The study aimed to compare the effectiveness of short-term (one month) and long-term (three months) individual swallowing therapy programs in the geriatric individuals diagnosed with dysphagia by instrumental evaluation. Patients and methods: Hospital records of 31 patients (16 females, 15 males; mean age: 66.8±16.4 years; range, 66 to 83 years) were prospectively examined between April 1, 2019, and September 30, 2022. Fiberoptic endoscopic swallowing study recordings were made at the beginning of the study. The recordings were scanned and examined, and individuals with observed problems in swallowing safety and efficacy, having the same severity of dysphagia, were identified. Patients were randomly assigned to long-term (51.2%; n=16; 8 males, 8 females) and short-term (48.8%; n=15; 7 males, 8 females) therapy groups. During fiberoptic endoscopy, patients were given food of different consistencies (thin liquid, honey, nectar, pudding, and solid consistency) according to the International Dysphagia Diet Standardization Initiative protocol, and they were evaluated before therapy and one week, one month, and three months after therapy using the penetration-aspiration scale and the Yale Pharyngeal Residue Severity Scale-Vallecula/Pyriform Sinus. Functional Oral Intake Scale and Turkish Eating Assessment Tool-10 (T-EAT-10) results were compared between the groups. An exercise-based individual swallowing therapy program of one and three months was applied to short-term and long-term therapy groups, respectively. Results: When the post-therapy penetration aspiration scores and pharyngeal residual severity scores of individuals receiving long-term and short-term therapy were compared, a higher score was found in the group receiving shortterm therapy than the long-term group, and a significant difference was found (p<0.001). Pharyngeal phase abnormalities were detected in 27 (88.4%) patients, whereas laryngeal penetration/aspiration status was found in 23 (75.3%) patients, and both variables were found to be significantly higher in the short-term group (p=0.015 and p=0.014, respectively). The T-EAT-10 scores obtained before therapy in the long-term therapy group were significantly higher than T-EAT-10 scores obtained at the third month after therapy (p=0.004, p<0.001, and p<0.05, respectively). Silent aspiration of thin liquid, nectar, and solid consistency was experienced in 78% of patients before therapy. Conclusion: Long-term swallowing therapy program appears to be more effective than short-term in geriatric individuals with dysphagia.