Nestle Supplement 2

NUTRITION AND THE OLDER PERSON cy alterations and correct safety may have a family-supervised restriction-free diet; 2) in patients with moderate alterations, dietary changes will be introduced aiming at decreasing the volume and increasing the viscosity of the alimentary bolus; 3) patients with severe alterations will require additional strategies based upon increased viscosity and the introduction of postural techniques, active maneuvers, and oral sensorial enhancement; and 4) there is a group of patients with alterations so severe they cannot be treated despite using rehabilitation techniques—in these patients, VFS allows to objectively demonstrate the inability of the oral route and the need to perform a percutaneous endoscopic gastrostomy (PEG).2 However, there is little evidence that nonoral feeding reduces the risk of aspiration.23 Even though no absolute criteria exist, a number of teams tend to indicate gastrostomy in 1) patients with severe alterations of efficacy during the oral or pharyngeal stages or with malnutrition; 2) patients with safety alterations during the pharyngeal stage that do not respond to rehabilitation; and 3) patients with significant silent aspirations, particularly in neurodegenerative conditions. For long-term nutritional support, PEG should be preferred to nasogastric tubes, since it is associated with less treatment failures and better nutritional status, and it may also be more convenient for the patient.28 In patients with severe neurological dysphagia, tube feeding has to be initiated as soon as possible.13 For most patients requiring gastrostomy, a small percentage of food may still be safely administered through the oral route.2 CONCLUSION Oropharyngeal dysphagia is a major complaint among older people. Complications of dysphagia, such as malnutrition, dehydration, aspiration, and pneumonia, can lead to death.Videofluoroscopy is the gold standard method for diagnosis. Treatment with dietetic changes in bolus volume and viscosity and rehabilitation procedures can improve deglutition and prevent nutritional and respiratory complications. I Acknowledgments The author thanks the patients for their cooperation and all the members of the dysphagia team who have participated in this study. The Dysphagia Team at the Hospital de Mataró, Barcelona, Spain, consisted of Mrs V Arreola, Mrs MJ Romea, Mrs L Medina, Dr M Cabré (Geriatrics), Dr J Almirall (Intensive Care Unit), and Dr Mateu Serra (Research Unit). Grant support: Supported by grants from the Filial del Maresme de la Acadèmia de Ciències Mediques de Catalunya i Balears, from the Ministerio de Sanidad y Consumo (FIS PI/051554, CIBEREHD), and from Novartis Medical Nutrition S.A. 16 • DECEMBER 2007 References 1. Clavé P,Verdaguer A, Arreola V. [Oral-pharyngeal dysphagia in the elderly]. Med Clin (Barc). 2005;124(19):742–748. 2. Clavé P,Terré R, de Kraa M, Serra M. Approaching oropharyngeal dysphagia. Rev Esp Enferm Dig. 2004;96(2):119–131. 3. Ekberg O, Hamdy S,Woisard V,Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17(2):139–146. 4. Robbins J, Langmore S, Hind JA, Erlichman M. Dysphagia research in the 21st century and beyond: proceedings from Dysphagia Experts Meeting, August 21, 2001. J Rehabil Res Dev. 2002;39(4):543–548. 5. Flacker JM.What is a geriatric syndrome anyway? J Am Geriatr Soc. 2003;51(4):574–576. 6. Kahrilas PJ, Lin S, Chen J, Logemann JA. Oropharyngeal accommodation to swallow volume. Gastroenterology. 1996;111(2):297–306. 7. Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev. 2001;81(2):929–969. Nagaya M, Sumi Y. Reaction time in the submental muscles of nor8. mal older people. J Am Geriatr Soc. 2002;50(5):975–976. 9. Clavé P, de Kraa M, Arreola V, et al.The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther. 2006;24(9):1385–1394. 10. Kahrilas PJ, Lin S, Rademaker AW, Logemann JA. Impaired deglutitive airway protection: a videofluoroscopic analysis of severity and mechanism. Gastroenterology. 1997;113(5):1457–1464. 11. Nicosia MA, Robbins JA. The fluid mechanics of bolus ejection from the oral cavity. J Biomech. 2001;34(12):1537–1544. 12. Kahrilas PJ, Logemann JA, Lin S, Ergun GA. Pharyngeal clearance during swallowing: a combined manometric and videofluoroscopic study. Gastroenterology. 1992;103(1):128–136. 13. Robbins J, Gangnon RE,Theis SM, Kays SA, Hewitt AL, Hind JA. The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc. 2005;53(9):1483–1489. 14. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003;124(1):328–336. 15. Almirall J, Cabré M, Clavé P. [Aspiration pneumonia]. Med Clin (Barc). 2007;129(11):424–432. 16. Clavé P, Almirall J, Esteve M,Verdaguer A, Berenguer J, Serra-Prat M. Dysphagia—a team approach to prevent and treat complications. Hospital Healthcare Europe 2005/2006. N5-N8, 2005. 17. Gordon C, Hewer RL,Wade DT. Dysphagia in acute stroke. Br Med J (Clin Res Ed). 1987;295(6595):411–414. 18. DePippo KL, Holas MA, Reding MJ.Validation of the 3-oz water swallow test for aspiration following stroke. Arch Neurol. 1992;49(12):1259–1261. 19. Nathadwarawala KM, Nicklin J, Wiles CM. A timed test of swallowing capacity for neurological patients. J Neurol Neurosurg Psychiatry. 1992;55(9):822–825. 20. Westergren RN. Detection of eating difficulties after stroke: a systematic review. Int Nurs Rev. 2006;53(2):143–149. 21. Smithard DG, O’Neill PA, Park C, et al; North West Dysphagia Group. Can bedside assessment reliably exclude aspiration following acute stroke? Age Ageing. 1998;27(2):99–106. 22. Palmer LB,Albulak K, Fields S, Filkin AM, Simon S, Smaldone GC. Oral clearance and pathogenic oropharyngeal colonization in the elderly. Am J Respir Crit Care Med. 2001;164(3):464–468. 23. Cook IJ, Kahrilas PJ. AGA technical review on management of oropharyngeal dysphagia. Gastroenterology. 1999;116(2):455–478. 24. Logemann JA. Manual for the Videofluorographic Study of Swallowing. 2nd ed. Austin,TX: Pro-ed; 1993. 25. Baine WB,Yu W, Summe JP. Epidemiologic trends in the hospitalization of elderly Medicare patients for pneumonia, 1991–1998. Am J Public Health. 2001;91(7):1121–1123. 26. Loeb MB, Becker M, Eady A,Walker-Dilks C. Interventions to prevent aspiration pneumonia in older adults: a systematic review. J Am Geriatr Soc. 2003;51(7):1018–1022. 27. Schmidt J, Holas M, Halvorson K, Reding M. Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke. Dysphagia. 1994;9(1):7–11. 28. Addington WR, Stephens RE, Gilliland KA.Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke: an

Table of Contents Feed for the Digital Edition of Nestle Supplement 2

Nestle Supplement Table of Contents Introduction to Weight Loss in Older Persons Diagnosis and Management of Oropharyngeal Dysphagia in the Elderly The Danger of Weight Loss in the Elderly Nutrients and Frailty

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