ABSTRACT
Older adults with oropharyngeal dysphagia (OD) are unable to swallow pills safely, so some of them use liquid-formulated drugs mixed with thickeners to ensure safety. The aim of this study was to analyze the physical compatibility of a group of drugs with a thickener formulated with modified starch (Thick & Easy®). A secondary goal was to evaluate the amount of thickener needed to obtain the thickness levels 2, 3, and 4 defined by IDDSI framework for each drug. For this purpose, the rheological properties of the mixtures obtained were determined. Samples of each drug were prepared and 7, 10, and 12 g of thickener were added. Physical compatibility of the mixtures was observed; the apparent viscosity of the samples was measured using a rotational viscometer, and the results obtained were compared with the reference drug-free sample. We analyzed 45 medicinal products (38 active substances). Three drugs (almagate, ibuprofen, and macrogol) were found to be physically incompatible with the thickener and should not be mixed. Viscosity measurements indicated that clarithromycin and plantago ovata increased the viscosity of the mixture and required lower amount to achieve the target textures (110 cP, 590 cP, and 2620 cP for 7 g, 10 g, and 12 g in drug-free samples, respectively), whereas another subset reduced viscosity and required more thickener. This proved very relevant for acetylcysteine, amoxicillin, calcifediol, ferrous gluconate, fosfomycin, lactitol, lactulose, mepifiline, paracetamol, rivastigmine, sertraline, and tramadol. Measurements were below 1750 cP. Awareness of how each drug behaves when combined with thickeners is essential to avoid potential complications in OD.
Subject(s)
Deglutition Disorders , Food Additives , Aged , Deglutition Disorders/etiology , Humans , Rheology , Starch , ViscosityABSTRACT
El objetivo de este estudio consiste en determinar el estado nutricional de los 83 residentes de un centro sociosanitario y evaluar su evolución tras la aplicación del protocolo de valoración nutricional diseñado a tal efecto desde la Consejería de Bienestar Social de la Comunidad Valenciana. La muestra se clasificó según los hallazgos de índice de masa corporal (IMC), hipoalbuminemia y la aplicación del índice de riesgo nutricional geriátrico. Las intervenciones nutricionales consistieron en efectuar recomendaciones generales y seguimiento en caso de ausencia de desnutrición, la adecuación de dietas adaptadas trituradas en residentes con problemas de masticación-deglución y riesgo de broncoaspiración, la adecuación de nutrición enteral completa en residentes con catéter de alimentación nasogástrica y la instauración de suplementos nutricionales en casos de desnutrición severa. Transcurridos 3 meses se obtuvo un incremento del IMC medio, aunque no de manera significativa (p = 0,168), y se redujo el porcentaje de residentes con desnutrición del 29 al 23%. Además, disminuyó el número de residentes que recibían suplementos nutricionales sin indicación, con un ahorro mensual estimado de 965 euros. La participación activa del equipo multidisciplinario en el seguimiento nutricional de los residentes, de forma coordinada y continua, contribuye a la consecución de un adecuado estado nutricional, mejorando el uso racional de la nutrición artificial en el entorno sociosanitario (AU)
The aim of this study was to determine nutritional status in 83 residents of a nursing home and to evaluate outcomes after the application of a nutritional assessment protocol designed by the Department of Social Welfare of the autonomous community of Valencia (Spain). The sample was classified according to body mass index (BMI), hypoalbuminemia and application of the geriatric nutritional risk index. Nutritional interventions consisted of applying general recommendations and follow-up in residents without malnutrition, providing adequate powdered diets in residents with chewing and swallowing disorders and risk of bronchoaspiration, adjusting total enteral nutrition in residents with nasogastric feeding tubes and initiating vitamin supplementation in residents with severe malnutrition. After 3 months, the mean BMI showed a nonsignificant increase (P=.168), reducing the number of residents with malnutrition from 29% to 23%. The number of residents who received nutritional supplements without indication also decreased, resulting in an estimated saving of 965 euros. Active participation of the multidisciplinary team in the coordinated and continuous follow-up of nutritional status in residents contributed to achieving adequate nutritional status and improved the rational use of artificial nutrition in the nursing home (AU)
