Study protocol for the SOFIA project: Swallowing function, Oral health, and Food Intake in old Age: a descriptive study with a cluster randomized trial

Abstract

BackgroundExtensive studies have shown that older people are negatively impacted by impaired eating and nutrition. The abilities to eat, enjoy food, and participate in social activities associated with meals are important aspects of health-related quality of life (HRQoL) and recovery after illness. This project aims to (i) describe and analyze relationships between oral health and oral HRQoL, swallowing ability, eating ability, and nutritional risk among older individuals admitted to short-term care; (ii) compare the perceptions that older individuals and staff report on care quality related to oral hygiene and eating; and (iii) study the feasibility and effects of a training program for people with impaired swallowing (i.e., dysphagia).Methods/DesignThis project consists of two parts, which will be performed in five Swedish counties. It will include approximately 400 older individuals and 200 healthcare professionals. Part 1 is a cross-sectional, descriptive study of older people admitted to short-term care. Subjects will be assessed by trained professionals regarding oral health status, oral HRQoL, eating and nutritional risk, and swallowing ability. Swallowing ability will be measured with a teaspoon test and a swallowing capacity test (SCT). Furthermore, subjects and staff will complete a questionnaire regarding their perceptions of care quality.Part 2 is a cluster randomized intervention trial with controls. Older participants with dysphagia (i.e., SCT <10 ml/s, measured in part 1) will be recruited consecutively to either the intervention or control group, depending on where they were admitted for short-term care. At baseline, all subjects will be assessed for oral health status, oral HRQoL, eating and nutritional risk, swallowing ability, and swallowing-related QoL. Then, the intervention group will receive 5 weeks of training with an oral screen for neuromuscular training focused on orofacial and pharyngeal muscles. After completing the intervention, and at six months post-intervention, all assessments will be repeated in both study groups.DiscussionThe results will make important contributions to rehabilitation knowledge, including approaches for improving swallowing function, oral health, and food intake and for improving the quality of oral care for older people.Trial registrationThis trial was retrospectively registered at ClinicalTrials.gov, on July 4, 2016, identifier: NCT02825927.

Oral health‐related quality of life and associated factors among older people in short‐term care

“…This descriptive cross‐sectional study was carried out within the framework of an ongoing Swedish research study in short‐term care: Swallowing Function, Oral Health, and Food Intake in Old Age (SOFIA) . Short‐term care staff comprise licensed practical nurses, nurse aides, registered nurses and occupational therapists…”

“…The study included 36 short‐term care units covering both rural and urban areas. All short‐term care units were selected by convenience, based on their geographical location, number of beds and estimated numbers of discharges per month …”

“…Inclusion criteria were being ≥65 years, having stayed at the short‐term care unit for at least 3 days, being able to understand Swedish and having sufficient cognitive ability (based on patient records and judged by registered nurses) to give informed consent and to participate in data collection. Persons receiving end‐of‐life care were excluded . Of the 931 people assessed for eligibility, 477 (51%) did not meet the inclusion criteria.…”

“…Data were collected via clinical oral assessment including questions about self‐perceived oral and general health, the Katz Index of Activities of Daily Living (Katz‐ADL), the Revised oral assessment guide (ROAG) and the OHIP‐14 …”

“…The registered dental hygienists (RDHs) assessed need for dental care based on both the clinical assessment and ROAG. One question was asked about the person's ability to brush their teeth, with response options 1=“yes, completely,” 2=“receive some help” and 3=“no, receive help entirely” …”