Volume-viscosity Swallow Test Research Articles

Prevalence of Swallowing and Eating Difficulties in an Elderly Postoperative Hip Fracture Population-A Multi-Center-Based Pilot Study.

Elderly patients operated for hip fracture are characterized by high age and high degree of comorbidity and need of care, factors previously found to be associated with swallowing and eating difficulties. The aim of this study was to investigate the prevalence of swallowing and eating difficulties in an elderly postoperative hip fracture population and to identify factors associated with swallowing and eating difficulties. A cross-sectional multi-center pilot study was performed, including patients ≥65 years, operated for hip fracture, and able to participate in a swallowing and eating assessment. A clinical assessment was conducted using Danish versions of the standardized tools Volume-Viscosity Swallow Test and Minimal Eating Observation Form-version II. Demographic data and clinical characteristics were examined. A total of 78 patients (mean age 81.4 years (SD 7.8), 30.8% male) were included. Swallowing and eating difficulties were present in 60 patients (77%). Swallowing and eating difficulties were significantly associated with living in a nursing home before hospital admission (p = 0.014), low habitual New Mobility Score (p = 0.018), and absence of cardiac comorbidity (p = 0.023). The results underline the importance of focusing on swallowing and eating difficulties in elderly patients operated for hip fracture to ensure effectivity and safety and optimize the prognosis for the patient.

High Prevalence of Oropharyngeal Dysphagia in Acutely Hospitalized Patients Aged 80 Years and Older

ObjectivesOropharyngeal dysphagia is a geriatric syndrome that is usually underdiagnosed in older patients. The aim of this study was to determine the prevalence and identify the main risk factors of dysphagia in the oldest old patients admitted to an acute geriatric unit. DesignObservational prospective study. Setting and ParticipantsOlder patients admitted to an acute geriatric unit of a university hospital. Measures329 patients (mean age 93.5 years, range 81-106) were assessed for oropharyngeal dysphagia within 48 hours of hospital admission using the Volume-Viscosity Swallow Test. Demographic characteristics, geriatric assessment, geriatric syndromes, comorbidities, drug treatment, and complications were examined to determine their association with the presence of dysphagia. ResultsOropharyngeal dysphagia was present in 271 (82.4%) of the participants. Multivariate logistic regression showed that malnutrition [odds ratio (OR) 3.62, 95% confidence interval (CI) 1.01-12.93; P = .048], admission for respiratory infection (OR 2.89, 95% CI 1.40-5.94; P = .004), delirium (OR 2.89, 95% CI 1.40-5.94; P = .004), severe dependency (OR 3.23, 95% CI 1.23-8.87; P = .017), and age (OR 1.11, 95% CI 1.01-1.21; P = .03) were significantly associated with dysphagia. The use of a calcium antagonist at the time of admission was associated with a reduced risk of dysphagia (OR 0.39, 95% CI 0.16-0.92; P = .03). Conclusions and ImplicationsThe prevalence of oropharyngeal dysphagia is high in the oldest old patients admitted to an acute geriatric unit when assessed with an objective diagnostic method. Our findings suggest that objective swallowing assessment should be routinely performed on admission in order to start early interventions to avoid complications of dysphagia in this complex population.

Impact of the systematic use of the volume-viscosity swallow test in patients with acute ischaemic stroke: a retrospective study

BackgroundDysphagia is common after stroke. Patients with dysphagia have a higher risk of stroke-associated pneumonia (SAP) and poor outcomes. Early detection of dysphagia is necessary to identify and manage patients at high risk of aspiration. The aim of the study was to assess the impact of the systematic administration of the volume-viscosity swallow test (V-VST) in patients with acute ischaemic stroke.MethodsThis was a retrospective observational study that enrolled patients with acute ischaemic stroke in two consecutive time periods: pre-V-VST, when the 30-mL water-swallowing test (WST) was systematically administered, and V-VST, when all patients underwent the WST and the V-VST test was systematically administered if the patient failed the WST.ResultsTwo hundred and 42 patients were enrolled. The mean age of the participants was 68.8 ± 10.88 years, 61.2% were male, and the median National Institutes of Health Stroke Scale score was 3 (IQR, 1–6). A total of 147 patients were enrolled during the pre-V-VST period and 95 were enrolled during the V-VST period. There was a significant difference in the occurrence of SAP (21.8% vs. 10.5%, p = 0.024) and the rate of nasogastric tube feeding (25.9% vs. 14.7%, p = 0.040) between the two groups, and no differences were found in the length of hospital stay (p = 0.277) or the total cost of hospitalization (p = 0.846).ConclusionsThe V-VST was a better clinical screening tool, and it can also provide detailed suggestions regarding dietary modifications to prevent aspiration and SAP.

Abstract NS2: Effect of Volume-Viscosity Swallow Test (V-VST) in Acute Ischemic Stroke Patients With Dysphagia: A Hospital-Based Case-Control Study

Background: The dysphagia screening in acute ischemic stroke plays an important role in patients with risk of dysphagia. The aim of this hospital-based case-control study is to explore if V-VST, as a new nurse-driven dysphagia screening tool for AIS patients, might help to reduce the rate of post-stroke pneumonia and early withdraw of feeding tube. Methods: 1598 acute ischemic stroke patients were enrolled in this study. The standard protocol in AIS patients were assessed by WST (before intervention and plus with V-VST after intervention). The V-VST assessment were be trained in two senior nurses and all AIS patients were assessed by V-VST during July 1and Dec 30 th , 2017. Among 299 AIS patients with suspected, all clinical data were analyzed. The comparison of their rate of pneumonia in hospital and withdraw rate of tubefeeding before discharge were performed between patients post-intervention (January 1, 2018-June 30, 2019)and those admitted before the intervention (January 1, 2016-June 30, 2017). Results: The baseline characteristics of the pre- and post- intervention AIS groups were similar in age, gender, NIHSS. The implementation of V-VST have a statistically significant reducing the risk of pneumonia with an adjusted HR (0.60, 95% CI 0.43-0.84, P=0.003). Additionally, follow-up V-VST were likely to be associated the withdraw rate of tube-feeding at discharge (29/168 vs 38/131 P=0.016).There is also a trend of length of tube-feeding decreasing (8.32±12.27 vs 6.84±8.61 P=0.241). Conclusion: In our study, the V-VST is a feasible bedside tool. The implemental might be associated with the reduction of post-stroke pneumonia. Therefore, it meets the requirements of a clinical screening test for dysphagia in acute stroke patients at bedside. Large prospective interventional study is needed to confirm our findings. V-VST: Volume-viscosity Swallow Test WST: Water Swallow Test AIS: Acute Ischemic Stroke HR: hazard ratio

DYSPHAGIA IN NEUROLOGICAL DISORDERS

Introduction: Neurogenic dysphagia is a frequent disorder affecting people with neurological diseases. Many experts work together to diagnose and treat dysphagia. The aim: The article focuses on the specificity of neurogenic dysphagia, its symptoms and treatment possibilities. The speech pathologist can be included in the diagnostic process and can evaluate the intake of liquids and foods based on a variety of consistency tests. In clinical conditions, screening tests such as water swallowing test, multiple consistency tests: GUSS (Gugging Swallowing Screen), V-VST (Volume-Viscosity Swallow Test) and EAT-10 questionnaire can be used successfully. If you have limited ability to perform instrumental tests, they can help you to expand your diagnosis. Review and Discussion:Treatment of swallowing disorders is based on a daily modification of the patient's posture and consistency of the eaten meals. Nursing staff are involved in this adaptation activity, which plays an invaluable role in the diagnosis and treatment of patients in neurological and rehabilitation departments. Conclusions: Despite the knowledge of the problem, difficulty swallowing is still unnoticed. The effects of this neglect are felt both for patients and from the perspective of management within treatment units For people suffering from neurological diseases, swallowing disorders should be diagnosed on a compulsory basis and their assessment should be a permanent part of the standard procedures for assessing patients with neurological deficits.

Prevalence of dysphagia in a regional hospital setting: Acute care hospital and a geriatric sociosanitary care hospital: A cross-sectional study

Oropharyngeal Dysphagia (OD) is a symptom commonly found in hospitalized patients and related to a vast array of clinical diagnosis and to high morbidity and mortality that is becoming very important to identify. Our aim was to assess the prevalence of OD in our hospital setting. Cross-sectional randomized study to determine the prevalence of dysphagia in an acute care hospital (ACH) and long term care hospital (LTCH). Multiquestionnaire test performed to assess dysphagia with the bedside validated volume-viscosity swallow test (V-VST test), in those with the validated swallowing ability test, eating assessment tool (EAT-10)>3. Variables; sex, age (>65y), diagnosis, mininutritional assessment (MNA), previous diagnosis of dysphagia (including any recommendations given before), EAT-10, V-VST, presence of dysphagia, type of diet prescribed (basal or therapeutic), use of thickener and diet texture (pureed with liquids allowed, pureed without liquids, soft diet, normal). N=200 patients (100 in each centre). 49% male; Age=81.1 [65-101] years; Diagnostics: medical 70%/surgery 30%. Dysphagia analysis: 42% patients showed an EAT-10>3 so the V-VST test was done in these patients resulting in global prevalence of 28.5% (95% CI: 22.7-35.1). Among centres no significant differences were observed: ACH 30% (95% CI: 14-34) and LTCH 27% (95% CI: 19-36). Highlighting a greater concentration of dysphagia in Orthogeriatric and Neurological patients in the LTCH than in ACH (Pneumology, Internal Medicine and Cardiology). MNA analysis: 27% normal 44% risk 29% malnutrition. Malnutrition present in 50.9% of patients diagnosed with dysphagia, 44% in those at risc (EAT-10+) and 27.6% in those without risc or dysphagia (p=0.020). From the novo patients, 75.4% did not have adequate complete adapted treatment (diet and thickener). Only 13.3% had their thickener prescribed. In those with history of dysphagia 37% had an inappropriate treatment. Prevalence of OD matches with what is described in the literature. There is a high proportion of infradiagnostic and overall inadequate treatment, more than a third of patients do not have their diet adapted correctly. It is important to identify this symptom to treat it properly and to raise awareness among sanitary professionals for best adaptation of treatment.

Natural History of Swallow Function during the Three-Month Period after Stroke.

Oropharyngeal dysphagia is a prevalent complication following stroke (PS-OD), and one that is sometimes spontaneously recovered. This study describes the natural history of PS-OD between admission and three months post-stroke, and the factors associated with its prevalence and development. PS-OD was assessed with the volume-viscosity swallow test (V-VST) in all stroke patients on admission and at the three-month follow-up. We analyzed clinical, demographic, and neuroanatomical factors of 247 older post-stroke patients (National Institute of Health Stroke Scale (NIHSS) = 3.5 ± 3.8), comparing among those with PS-OD the ones with and without spontaneous recovery. PS-OD prevalence on admission was 39.7% (34.0% impaired safety; 30.8%, efficacy) and 41.7% (19.4% impaired safety; 39.3%, efficacy) at three months. Spontaneous swallow recovery occurred in 42.4% of patients with unsafe and in 29.9% with ineffective swallow, associated with younger age and optimal functional status. However, 26% of post-stroke patients developed new signs/symptoms of ineffective swallow related to poor functional, nutritional and health status, and institutionalization. PS-OD prevalence on admission and at the three-month follow-up was very high in the study population. PS-OD is a dynamic condition with some spontaneous recovery in patients with optimal functional status, but also new signs/symptoms can appear due to poor functionality. Regular PS-OD monitoring is needed to identify patients at risk of nutritional and respiratory complications.

Lesion location and other predictive factors of dysphagia and its complications in acute stroke

Early detection of dysphagia is crucial in stroke patients as a result of increased morbidity and mortality due to malnutrition and respiratory tract infections. The aim of this study was to identify possible predictors of the onset of dysphagia following stroke in order to be able to act precociously. Observational, prospective study in which a Volume-Viscosity Swallow Test (V-VST) was carried out in the first 72h following admission to assess dysphagia in acute stroke patients with a previous result of <3 in the Eating Assessment Tool-10. Lesions were analysed by computed tomography and/or magnetic resonance, using the ABC/2 formula to calculate their volume. Likewise, 3-month follow-up was carried out for the evaluation of the occurrence of respiratory tract infections and deaths. Out of 106 patients admitted for acute stroke, 60 (56.60%) presented dysphagia (44.40% showing alterations in the effectiveness of swallowing and 33.30% in its safety). The factors that were related to dysphagia were: older age (76.40±11.50 vs 66.37±13.85 years, p=0.0001), stroke severity as measured on the National Institute of Health Stroke Scale (6.81±5.83 vs 3.38±3.46, p=0.001) and greater volume of the lesion (23.47±47.15 vs 7.50±14.53ml, p=0.042). The variables that were influenced by a greater lesion size were the presence of cough, oxygen desaturation and impaired labial seal. Dysphagia was not affected by the lateralization of the lesion or by the type of stroke (ischaemic/haemorrhagic). Despite the fact that 68.80% of the patients with a temporoparietal lesion presented dysphagia, no significant differences were observed regarding the location of the lesion in the regions studied. 27.3% of the patients with frontal lesions presented respiratory infections after discharge (p=0.018), a condition which was also observed in 20.0% of patients with dysphagia (p=0.044). Mortality during the 3-month follow-up period was 20.0% for patients with a positive V-VST (p=0.005), due to respiratory infection in 66.6% of the cases (p=0.0001). Post-stroke dysphagia was associated with the occurrence of respiratory tract infection and mortality. Our study also provides more information about how certain demographic and clinical factors, as well as neuroimaging patterns, influence dysphagia. This fact may help to identify at an early stage those patients with a greater risk of developing swallowing alterations.

Effects of capsaicin on swallowing function in stroke patients with dysphagia: A randomized controlled trial

Background/AimsDysphagia is a common complication after acute stroke. While there are several innovative treatments being tested to improve the swallowing function of stroke patients with dysphagia, our aim is to explore the use of readily available natural capsaicin in stroke patients with dysphagia. Study designA randomized, double-blind study. MethodsSixty-nine hospitalized stroke patients were enrolled in this study. The capsaicin intervention group received thermal tactile stimulation with supplementation of natural capsaicin and additional nectar viscosity boluses. The control group received stimulation and boluses with placebo. Swallowing function was evaluated before and after the 3-week treatment, using Volume-Viscosity Swallow Test, Eating Assessment Tool, Standardized Swallowing Assessment, and Water Swallow Test. ResultsThe score decreases in the Eating Assessment Tool and Standardized Swallowing Assessment of the capsaicin intervention group were significantly greater than that of the placebo control group (P < .01). Among the 60 patients, the capsaicin intervention group exhibited effectiveness in a higher number of patients (n = 27, 90%) than the placebo group (n = 9, 30%, P < .001). ConclusionsRegular use of natural capsaicin could promote the recovery of swallow function in stroke patients with dysphagia. The ample availability of natural capsaicin could provide a low cost, easily accessible, and safe alternative method to address dysphagia in stoke patients.

A research on improving the food intake assessment method in acquired brain injury patients

Objective To apply repetitive saliva swallowing test and standardized swallowing assessment combined with the volume-viscosity swallow test on patients with acquired brain injury, we aim to identify the potential risks of oral intake during the patients′ recovery stage, and improve the strategy of aspiration prevention. Methods Totally 142 patients with acquired brain injury were selected as the observation group during November 2016 and November 2017, and 153 patients with acquired brain injury were selected as the control group during October 2015 and October 2016. The control group was assessed by water swallow test, while a combination of the Repetitive Saliva Swallowing Test, the Standardized Swallowing Assessment and Volume-Viscosity Swallow Test was used to assess the observation group till discharging. The detection rate of aspiration risk and the incidence of aspiration pneumonia was compared between the two groups. Results The detection rate of aspiration risk was 36.6% (52/142) in the observation group and 7.8% (12/153) in the control group, the difference was statistically significant (χ2=35.899, P < 0.05). The incidence of aspiration pneumonia was 1.4% (2/142) in the observation group and 12.4% (19/153) in the control group, the difference was statistically significant (χ2=13.502, P < 0.05). Conclusions The combined application of the Repetitive Saliva Swallowing Test, the Standardized Swallowing Assessment and the Volume-Viscosity Swallow Test can improve the detection rate of aspiration risk in the acquired-brain-injury patients with suspicious swallowing dysfunction, reduce the incidence of aspiration pneumonia, increase the nursing safety, and improve the health outcomes of neurosurgical patients. Key words: Acquired brain injury; Repetitive saliva swallowing test; Standardized swallowing assessment; Volume-viscosity swallow test; Aspiration

Protocolo diagnóstico de la disfagia de causa neurológica

Dysphagia a symptom defined as an abnormality in the process of swallowing. Aspiration pneumonia, malnutrition and dehydration are potentially life-threatening complications; thus, early diagnosis and adequate treatment are essential. The dysphagia of neurological origin tends to appear during the swallow of liquids. Many neurological disorders, both central nervous system and peripheral diseases, present with dysphagia. Clinical history and volume-viscosity swallow test (V-VST) are basics in the diagnosis. Instrumental diagnostic tests are required in selected cases.

Abstract WP479: Bedside Modified Volume-Viscosity Swallow Test Might be Reliably to Predict Risk of Aspiration Pneumonia After Stroke

Background: Dysphagia is a common complication after stroke, which could lead to aspiration. Early and reliable bedside detection and intervention of dysphagia is necessary to prevent dysphagia-related aspiration pneumonia. Compared to water swallow test (WST) , modified volume-viscosity swallow test(V-VST) provides more detail information of management. To predict the risk of aspiration pneumonia from dysphagia tool in acute stroke patients, we developed modified V-VST and validated its predictability of risk of aspiration pneumonia. Methods: This was a prospective observational study enrolled acute stroke within 14 days. Only patients with Glasgow Coma Scale score higher than 10 were included into analyze. All patients had bedside WST and if failed would have a V-VST after admission was documented. Modified V-VST assessment, includes tongue movement to V-VST, including tongue rolling, extending to front, left and right. The primary outcome was the rate of pneumonia, which was diagnosed by either chest CT or chest X-ray. Multiple logistic regression models were performed in patients who failed the tests. The area under curves (AUCs) were compared among all tests. Results: From 7/2017-6/2018, 562 hospital-based acute stroke patients were enrolled. The overall incidence of pneumonia after acute stroke was 15.9 % (95%CI 13.0-19.2%). Of 157 patients who failed WST, 101 had a positive V-VST, and 173 had a positive modified VVST. The modified VVST was the most powerful to predict the risk of pneumonia (OR 6.156 in WST, 3.058 in VVST, 18.076 in modified VVST, P&lt;.001), after adjusted age, sex, NIHSS score, length of stay, interval of onset to admission and smoke status. The AUC of modified V-VST was 0.851(95% 0.806-0.897) Conclusions: Bedside modified V-VST is an easy and sensitive tool to predict post-stroke aspiration pneumonia. A large prospective interventional study is needed to confirm our findings.

Valoración de la disfagia con el test método exploración clínica volumen-viscosidad en pacientes ingresados tras un accidente cerebrovascular

ObjectiveThe objective of this study is to describe the frequency of dysphagia and the associated factors in stroke patients hospitalised in the Neurology Unit of the Hospital Clínico Universitario Lozano Blesa, in Zaragoza, as well as to analyse the PPV and NPV of the volume-viscosity swallow test (V-VST). MethodsA cross-sectional descriptive study was conducted on stroke patients in order to assess the detectability of dysphagia using the V-VST and to track their progress for 7 days. ResultsThe large majority (87.7%) of the patients did not have dysphagia. The study population included 81 subjects, of which 65.4% were men with a mean age of 72.84 years. The stroke was ischaemic type in 59.3% of cases, with no previous history of stroke in 86.4%, and with a slight dependence in48.1% measured with Barthel index. The test was performed in the first 24h in 79% of the population, with preventive dietary measures being introduced in 56.8% of patients. Some signs of lack of security were observed in 7 patients (8.6%) in the first week. Significant statistical relationships were found between the dysphagia and the dependence, signs of lack of security during the intake in the following days, and the type of diet. The PPV and NPV for V-VST in our patients was 14.28 and 94.11%, respectively. ConclusionsThe majority of patients did not have swallowing disorders due to their early detection with the V-VST, along with the dietary measures that appeared to reduce the risk of complications associated with dysphagia.

Assessment of dysphagia with the V-VST in patients hospitalised after a stroke

ObjectiveThe objective of this study is to describe the frequency of dysphagia and the associated factors in stroke patients hospitalised in the Neurology Unit of the Hospital Clínico Universitario Lozano Blesa, in Zaragoza, as well as to analyse the PPV and NPV of the volume-viscosity swallow test (V-VST). MethodA cross-sectional descriptive study was conducted on stroke patients in order to assess the detectability of dysphagia using the V-VST and to track their progress for 7 days. ResultsThe large majority (87.7%) of the patients did not have dysphagia. The study population included 81 subjects, of which 65.4% were men with a mean age of 72.84 years. The stroke was ischaemic type in 59.3% of cases, with no previous history of stroke in 86.4%, and with a slight dependence in 48.1% measured with Barthel index. The test was performed in the first 24h in 79% of the population, with preventive dietary measures being introduced in 56.8% of patients. Some signs of lack of security were observed in 7 patients (8.6%) in the first week. Significant statistical relationships were found between the dysphagia and the dependence, signs of lack of security during the intake in the following days, and the type of diet. The PPV and NPV for V-VST in our patients was 14.28 and 94.11%, respectively. ConclusionsThe majority of patients did not have swallowing disorders due to their early detection with the V-VST, along with the dietary measures that appeared to reduce the risk of complications associated with dysphagia.

Validation of the eat-10 score to detect dysphagia in older people

In Chile, comprehensive geriatric assessment does not include the identification of dysphagia, despite being considered a geriatric syndrome. The Eating Assessment Tool 10 (EAT-10) questionnaire is a 10-question instrument that specifically describes the perception of dysphagia and has a Spanish translation. To validate and test the reliability of the EAT-10 questionnaire in Chilean older people living in the community. The EAT-10 score was applied to 80 participants aged 75 ± 14 years (51 women). Other observer, blinded to the result of the score, performed the volume-viscosity swallow test as the gold standard to assess dysphagia. The translated version of the EAT-10 had a strong internal consistency (Cronbach alfa =0.89) and interobserver consistency (100%). Using a score of seven as cutoff point, the EAT-10 had a sensitivity of 75%, specificity of 86% to detect dysphagia, when compared with the volume-viscosity swallow test. The EAT-10 questionnaire is valid and reliable and can be used as a clinical instrument in primary care in our country to identify older people with dysphagia.

Increased levels of substance P in patients taking beta-blockers are linked with a protective effect on oropharyngeal dysphagia.

We have recently found a potential protective effect of beta-blockers on oropharyngeal dysphagia (OD). The action mechanism by which beta-blockers could wield this protective effect is unknown, but the neurotransmitter substance P (SP) could play a key role. The aim of this study was to analyze serum and saliva SP levels in patients taking beta-blockers (TBB), and to explore its relationship with OD. Adult (>50year) patients TBB were randomly recruited from the primary care setting and 1:1 matched by age, sex, and Barthel Index (BI) with patients not taking beta-blockers (NTBB). Serum and saliva samples were taken and analyzed for their SP levels using an enzyme-linked immunosorbent assay (ELISA). Socio-demographic and clinical variables were collected. Dysphagia was evaluated in all patients using the clinical volume-viscosity swallow test (V-VST). We studied 28 patients TBB (64.96±7.31years, 57.1% women, BI 99.6±1.31, carvedilol-equivalent dose 24.11±18.12mg) and 28 patients NTBB (65.61±6.43years, 57.1% women, BI 99.6±1.31). SP serum levels were significantly higher in patients TBB (260.68±144.27 vs 175.46±108.36pg/mL, P=.009) as were SP saliva levels (170.34±146.48 vs 102.73±52.28pg/mL, P<.001) compared with patients NTBB. The prevalence of OD was 32.1% in patients TBB and 67.9% in patients NTBB (P=.015). Moreover, patients with OD had significantly lower SP saliva levels in comparison with patients without clinical signs of OD (98.39±43.25 vs 174.69±147.21pg/mL) P<.001. We have found that serum and saliva SP levels are greater in patients TBB. This increase in SP levels could be the action mechanism by which beta-blockers protect patients from OD.

Sensibilidade e especificidade do V-VST na avaliação clínica de sujeitos com DPOC

Objetivo: avaliar a sensibilidade e a especificidade do protocolo Volume-Viscosity Swallow Test (V-VST) para detectar a presença de disfagia em pacientes com doença pulmonar obstrutiva crônica (DPOC) em relação à videofluoroscopia. Método: estudo transversal, descritivo, analítico, com amostra de conveniência de indivíduos de ambos os sexos, ingressantes no Programa Multiprofissional de Reabilitação Pulmonar. Os participantes realizaram avaliação fonoaudiológica clínica da deglutição através do protocolo V-VST e avaliação instrumental pela videofluoroscopia da deglutição, sendo através dos resultados dessas calculado o valor de sensibilidade e especificidade do V-VST. Resultados: foram avaliados 29 sujeitos com média de idade de 63,9±8,6 anos (intervalo de 40 a 78 anos), a maioria do gênero masculino (51,7%). A avaliação segundo o protocolo V-VST demonstrou que a maioria dos participantes tinha deglutição sem alterações (55,2%). A análise do V-VST apresentou baixa sensibilidade (39,10%) e baixa especificidade (33,30%) em relação à videofluoroscopia com valor preditivo positivo de 69,20%. Conclusão: A aplicação do protocolo V-VST para avaliação clínica da deglutição apresentou baixa sensibilidade e especificidade em relação à videofluoroscopia para identificar a presença de disfagia em sujeitos com DPOC.

Deglutição orofaríngea, nutrição e qualidade de vida no indivíduo com doença pulmonar crônica

Describe efficacy and safety of deglutition, nutritional risk, and quality of life in deglutition, and associate nutritional risk with quality of life in individuals with chronic pulmonary disease. The participants were 17 individuals with chronic pulmonary disease evaluated using the following instruments: Volume-Viscosity Swallow Test (V-VST), Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire, Mini Nutritional Assessment (MNA), and body mass index (BMI). Changes in efficacy were observed in nine (52.94%) individuals and impairments in efficacy and safety were found in two (11.77%) individuals. All individuals were considered eutrophic by the nutritional assessment. Correlation was observed between nutritional risk and domains 3 (r=-0.803; p=0.05) and 5 (r=0.636; p=0.026) of the SWAL-QOL questionnaire. Changes in efficacy and safety of deglutition were observed; however, no nutritional risk was evidenced in the sample evaluated. Correlation between nutritional risk and quality of life in deglutition was also observed.

Oropharyngeal Dysphagia in Community-Dwelling Older Patients with Dementia: Prevalence and Relationship with Geriatric Parameters

ObjectivesTo define the prevalence of oropharyngeal dysphagia (OD) in community-dwelling older persons with dementia, using V-VST (Volume-Viscosity Swallow Test), the reference clinical screening test for swallowing disorders, to assess the feasibility of the V-VST in an ambulatory care setting, to search for associations between geriatric parameters and OD, and to identify a relationship between severities of cognitive impairment and OD. DesignProspective, monocentric study. SettingPopulation from a geriatric outpatients clinic. ParticipantsPatients older than 70 with a diagnosis of dementia (NINCDS-ADRDA criteria), effective cough, and ability of voluntary swallowing for testing. MeasurementsOD screening was realized using V-VST during consultation. Severity of cognitive impairment was estimated by the MMSE and severity of OD by the Dysphagia Outcome Severity Scale (DOSS). Six geriatric domains were evaluated (comorbidities, functional abilities, cognition, nutrition, mood disorders, frailty). Results117 patients participated in the study (77 women, mean age = 84.5 ± 5.1 years). Prevalence of OD was 86.6%. Among the 97 patients with OD, 3 (3.1%) had only safety impairment, 52 (53.6%) had only efficacy impairment and 42 (43.3%) had both. The mean time necessary to realize V-VST was 8.7 ± 2.7 minutes with a rate of success of 96%. Dependency was independently associated with OD [odds ratio (OR) 4.8; 95% confidence interval (CI) 1.5-15.9; P < .05], and age and grip strength were associated with safety impairment (OR 1.1; 95% CI 1.0-1.2 and OR 1.9; 95% CI 1.2-3.2 respectively; both P < .05). No significant relationship was found between severity of OD and severity of cognitive impairment. ConclusionOD is very frequent in community-dwelling older persons with dementia and is associated with dependency and frailty. The V-VST is an easy-to-perform and well tolerated screening test in this population and therefore should be systematically included in the geriatric assessment of older persons with dementia. The role of V-VST in therapeutic strategies of OD remains to be evaluated.

The Prevalence of Oropharyngeal Dysphagia in Acute Geriatric Patients.

Oropharyngeal dysphagia (OD) is underdiagnosed and undertreated in many geriatric centers. The aim of this study is to explore the prevalence of OD in acute geriatric patients. The outcome was mortality during hospitalization, mortality, and rehospitalization within 0–30 and 31–180 days of discharge. A total of 313 consecutive acute geriatric patients (44.1% male, mean age 83.1 years (SD 7.8)) hospitalized from 1 March to 31 August 2016 in the North Denmark Regional Hospital were included in this study. The volume-viscosity swallow test and the Minimal Eating Observation Form-II were conducted for each patient in order to screen for OD. A total of 50% patients presented with OD. In the group of patients with OD, significantly more lived in nursing homes; had a lower weight, DEMMI score, and handgrip strength; and smaller circumference of arms and legs compared with non-dysphagia patients. Patients with OD presented an increased length of stay in hospital of one day (p = 0.70). Intra-hospital mortality was 5.8% vs. 0.7%, (p < 0.001) compared with patients with no symptoms of OD. OD is prevalent in acute geriatric patients, and the mortality is 34% within six months of hospitalization. Screening for OD should be given more attention and included in geriatric guidelines.