Abstract
ObjectivesThis paper provides evidence-based and, when appropriate, expert reviewed recommendations for long-stay residents who are prescribed texture-modified diets (TMDs), with the consideration that these residents are at high risk of worsening oropharyngeal dysphagia (OD), malnutrition, dehydration, aspiration pneumonia, and OD-associated mortality, poorer quality of life and high costs.DesignNestlé Health Science funded an initial virtual meeting attended by all authors, in which the unmet needs and subsequent recommendations for OD management were discussed. The opinions, results, and recommendations detailed in this paper are those of the authors, and are independent of funding sources.SettingOD is common in nursing home (NH) residents, and is defined as the inability to initiate and perform safe swallowing. The long-stay NH resident population has specific characteristics marked by a shorter life expectancy relative to community-dwelling older adults, high prevalence of multimorbidity with a high rate of complications, dementia, frailty, disability, and often polypharmacy. As a result, OD is associated with malnutrition, dehydration, aspiration pneumonia, functional decline, and death. Complications of OD can potentially be prevented with the use of TMDs.ResultsThis report presents expert opinion and evidence-informed recommendations for best practice on the nutritional management of OD. It aims to highlight the practice gaps between the evidence-based management of OD and real-world patterns, including inadequate dietary provision and insufficient staff training. In addition, the unmet need for OD screening and improvements in therapeutic diets are explored and discussed.ConclusionThere is currently limited empirical evidence to guide practice in OD management. Given the complex and heterogeneous population of long-stay NH residents, some ‘best practice’ approaches and interventions require extensive efficacy testing before further changes in policy can be implemented.
Highlights
The context of the nursing home (NH) The long-stay NH resident population has specific characteristics marked by a shorter life expectancy relative to community-dwelling older adults, high prevalence of multimorbidity with a high rate of complications, dementia, frailty, disability, and often polypharmacy
Oropharyngeal dysphagia (OD), defined as the inability to initiate and perform safe swallowing [1, 2], alongside poor coordination and propulsion, may result in aspiration from the passing of food, a liquid bolus, or regurgitated gastric contents into the respiratory tract, and is believed to be common among this population [3]. This population has a significantly greater risk of malnutrition, resulting from a variety of challenges including the oral processing of food [4]
The aim of this paper is to present an expert-reviewed report on evidence-based optimal practice and positions on the nutritional management of OD where this evidence is available, and a collective opinion on better practices to manage OD in NH residents where empirical evidence is absent
Summary
The context of the NH The long-stay NH resident population has specific characteristics marked by a shorter life expectancy relative to community-dwelling older adults, high prevalence of multimorbidity with a high rate of complications, dementia, frailty, disability, and often polypharmacy. Potential ways to improve nutritional care in nursing home residents Perform screening and periodic reassessments of both dysphagia and the risk of malnutrition, and dehydration [23, 24] Plan and conduct multimodal interventions and rehabilitation [25, 25] Support the communication between the multidisciplinary team and dysphagia clinician regarding the recommendations and nutritional treatment plans [17] Involve a dietitian and food service manager to plan and provide a diet that meets nutritional needs. Unmet need: Minimal training requirements To ensure that NH residents are given the required nutritional support, the minimum training requirements outlined (Supplementary Table 4) are recommended by the committee for NH staff. Residents recommended by their dysphagia clinician to follow a TMD should be referred to a nutritional professional [23, 24]. Staff should consider patient wishes, and give priority to the quality of life for residents
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