Dysphagia, Nutrition, and Hydration in Ischemic Stroke Patients at Admission and Discharge from Acute Care

Abstract

Dysphagia may predispose stroke patients toward undernutrition and hydration. These comorbidities increase patient risks for reduced functional outcome and short-term mortality. Despite this impact, available information on relationships among dysphagia, nutrition, and hydration status in acute stroke is limited and conflicted. This study evaluated nutrition and hydration status in ischemic stroke patients with versus without clinically significant dysphagia at admission and at discharge from acute care. Sixty-seven patients admitted to the stroke unit in a tertiary-care hospital provided data for this study. On the day of hospital admission and upon discharge or at 7 days post admission, serum biochemical measures were obtained for nutrition (prealbumin) and hydration status (BUN/Cr). Clinical evaluation for dysphagia, nutrition status, and stroke severity were completed an average of 1.4 days following hospital admission. Dysphagia was identified in 37 % of the cohort. At admission 32 % of patients demonstrated malnutrition based on prealbumin levels and 53 % demonstrated evidence of dehydration based on BUN/Cr levels. No differences in nutrition status were attributed to dysphagia. Patients with dysphagia demonstrated significantly higher BUN/Cr levels (greater dehydration) than patients without dysphagia at admission and at discharge. Dehydration at both admission and discharge was associated with dysphagia, clinical nutrition status, and stroke severity. Results of this study support prior results indicating that dysphagia is not associated with poor nutrition status during the first week post stroke. Dehydration status is associated with dysphagia during this period. The results have implications for future confirmatory research and for clinical management of dysphagia in the acute stroke period.

A Descriptive Study of the Fluid Intake, Hydration, and Health Status of Rehabilitation Inpatients without Dysphagia Following Stroke

“…Whilst it is acknowledged that the statistical association in this study was relatively weak and should be interpreted with caution, the finding is in line with previous research documenting a relationship between dehydration and stroke severity and impairment in the acute phase post stroke [11,4]. It is intuitive that measures of stroke severity and functional dependence may be a useful adjunct to other relevant clinical measures to identify patients who require greater assistance and encouragement to drink and close monitoring of fluid intake and hydration levels.…”

“…The percentage of participants with poor hydration measures from this sample was similar to that reported for patients with and without dysphagia in acute hospitals following stroke (36-66%) [11,4]. Of note, a cohort of acute patients without swallowing impairment in a United States hospital had a lower mean BUN/Cr ratio of 16.87 (SD 5.34) seven days following admission, representing better hydration than the present sample, (personal communication, M. Crary from data collected for cited study [11]).…”

“…The percentage of participants with poor hydration measures from this sample was similar to that reported for patients with and without dysphagia in acute hospitals following stroke (36-66%) [11,4]. Of note, a cohort of acute patients without swallowing impairment in a United States hospital had a lower mean BUN/Cr ratio of 16.87 (SD 5.34) seven days following admission, representing better hydration than the present sample, (personal communication, M. Crary from data collected for cited study [11]). This comparison with stroke patients in acute settings raises the question whether fluid intake and hydration levels are adequately monitored in the stroke population as they transition through different care settings, and whether prevention of and interventions for dehydration are implemented in an adequate and timely manner.…”

“…One study comparing the fluid intake of hospitalized patients post-stroke with and without dysphagia found those without dysphagia permitted thin liquids drank significantly more than those with dysphagia prescribed thickened liquids (mean of 1237ml and 947ml, respectively), although only one patient from the total sample of patients met the minimum standard of fluid intake set at 1500ml [10]. Dehydration, based on biochemical analysis, has been demonstrated by 36 -66% of patients presenting with or without dysphagia in the acute phase following stroke [11,4], although patients with dysphagia had significantly worse hydration at discharge compared to their non-dysphagic counterparts [11]. Evaluating a control group of patients without dysphagia following stroke is warranted to determine whether sub-optimal oral fluid intake of the patients with dysphagia [6][7][8] is solely related to their swallowing impairment or other factors.…”

Acessibilidade à atenção fonoaudiológica em serviço de média complexidade

“…to the provision of activities, hours of attendance, making appointments, wait time for attendance, criteria for selecting demands, adequacy of demand for available resources and formal coordenation mechanisms between the assistance levels; and (b) geographical, alluding to the spatial distribution of resources and the displacement (form, time and traveling costs) [13][14][15][16] .…”