Observational Variables for Considering a Switch from a Normal to a Dysphagia Diet among Older Adults Requiring Long-Term Care: A One-Year Multicenter Longitudinal Study

Abstract

This one-year multicenter longitudinal study aimed to assess whether older adult residents of long-term care facilities should switch from a normal to a dysphagia diet. Using the results of our previous cross-sectional study as baseline, older adults were subdivided into those who maintained a normal diet and those who switched to a dysphagia diet. The explanatory variables were age, sex, body mass index (BMI), Barthel Index, clinical dementia rating (CDR), and 13 simple and 5 objective oral assessments (remaining teeth, functional teeth, oral diadochokinesis, modified water swallowing test, and repetitive saliva swallowing test), which were used in binomial logistic regression analysis. Between-group comparison showed a significantly different BMI, Barthel Index, and CDR. Significant differences were also observed in simple assessments for language, drooling, tongue movement, perioral muscle function, and rinsing and in objective assessments. In multi-level analysis, switching from a normal to a dysphagia diet was significantly associated with simple assessments of tongue movement, perioral muscle function, and rinsing and with the objective assessment of the number of functional teeth. The results suggest that simple assessments can be performed regularly to screen for early signs of discrepancies between food form and eating/swallowing functions, which could lead to the provision of more appropriate food forms.

Can oral diadochokinesis be used as an assessment tool of oral function in older adults requiring care in nursing home?

“…Almost all studies that assessed OD as an oral function in older adults in nursing homes reported only participants who were able to perform OD. 18,19 The cut-off values for older people who could not perform OD were patients classified as level 4 or higher in need of care and degree III or higher in dementia. This study had some limitations.…”

“…Although these rates were somewhat higher than the present study results, approximately 30%–50% of older adults in nursing homes are unable to perform OD. Almost all studies that assessed OD as an oral function in older adults in nursing homes reported only participants who were able to perform OD 18,19 …”

Association between Death or Hospitalization and Observable Variables of Eating and Swallowing Function among Elderly Residents in Long-Term Care Facilities: A Multicenter Prospective Cohort Study

“…In a previous cross-sectional study, we found that coughing and rinsing were associated with distinguishing between regular and adjusted diets during simple assessments. A longitudinal study [ 8 ] suggested that tongue movement, perioral muscle function, and rinsing could help predict a change from a regular diet to an adjusted diet. Therefore, subjects with poor perioral muscle function and rinsing function are likely to have impaired eating and swallowing functions.…”

“…While our prior study included 431 residents who participated in both the 2018 and 2019 surveys, this study examined and analyzed outcomes up to 1 year later for 986 residents who participated in the 2019 survey. There were 394 duplicate residents and 323 residents from nine additional sites in addition to those of the previous study [ 8 ]. Thus, although the data on the subjects analyzed are different, both have significant results for similar endpoints, indicative of the reproducibility and validity of the results.…”

“…Next, we hypothesized that simple observational items, such as rinsing, tongue movement, and perioral muscle function, can predict a change from a normal diet (ND) to a dysphagia diet (DD) and conducted a 1-year prospective, multicenter, longitudinal study of residents in long-term care insurance facilities in Japan to identify factors that can predict an adjusted diet. Our findings suggested that tongue movement, perioral muscle function, and mouth rinsing predict a change from ND to DD [ 8 ]. It has been shown that a change in food form is associated with weight loss [ 9 ].…”