ABSTRACT
OBJECTIVES: This study aimed to examine the interrelationships among occlusal support, dysphagia, malnutrition, and activities of daily living in aged individuals needing long-term care. DESIGN: Cross-sectional study and path analysis. SETTING: Long-term health care facilities, acute care hospitals, and the community. PARTICIPANTS: Three hundred and fifty-four individuals aged ≥ 65 years with dysphagia or potential dysphagia in need of long-term care. MEASUREMENTS: The modified Eichner Index, Dysphagia Severity Scale, Mini Nutritional Assessment Short Form, and Barthel index. RESULTS: The participants included 118 males and 236 females with a mean (standard deviation) age of 83 (8) years. A total of 216 participants had functional occlusal support with or without dentures. Of the total participants, 73 were within normal limits regarding the severity of dysphagia, 119 exhibited dysphagia without aspiration, and 162 exhibited dysphagia with aspiration. Only 34 had a normal nutritional status, while 166 participants were malnourished, and 154 were at risk of malnutrition. The median Barthel index score was 30. Path analysis indicated two important findings: occlusal support had a direct effect on dysphagia (standard coefficient = 0.33), and dysphagia was associated directly with malnutrition (standard coefficient = 0.50). Dysphagia and malnutrition were associated directly with impaired activities of daily living (standard coefficient = 0.57, 0.22). CONCLUSION: In aged individuals needing long-term care, occlusal support is associated directly with dysphagia and indirectly with malnutrition and activities of daily living via dysphagia.
Subject(s)
Activities of Daily Living , Deglutition Disorders/epidemiology , Dentures/statistics & numerical data , Long-Term Care/statistics & numerical data , Malnutrition/epidemiology , Aged , Aged, 80 and over , Cross-Sectional Studies , Deglutition Disorders/complications , Deglutition Disorders/physiopathology , Eating , Female , Geriatric Assessment/methods , Hospitals , Humans , Independent Living , Inpatients , Long-Term Care/methods , Male , Malnutrition/physiopathology , Middle Aged , Nutritional Status , Occlusal Adjustment , Reproducibility of Results , Surveys and QuestionnairesABSTRACT
BACKGROUND: Esophageal cancer is the most common malignancy in Western Kenya and patients present with advanced disease. OBJECTIVE: To determine baseline level of knowledge of esophageal cancer in Bomet District in order to develop targeted and effective educational classes. METHODS: A questionnaire with twelve questions testing knowledge about esophageal cancer and eight questions aimed at determining barriers to healthcare was conducted out of Tenwek Hospital from June to July 2010. RESULTS: Eighty-one questionnaires were completed. 33% thought that cancer is a virus and 35% thought that it is contagious. 47% did not think that family history is a risk factor. 79% accurately claimed dysphagia as the most common symptom for esophageal cancer. 40% thought that herbal therapy is the optimal treatment for esophageal cancer. Cost and fear of diagnosis were cited as the most significant barriers to healthcare. Most participants had a monthly income of less than 3000 Kenyan schillings (37.5 US dollars); for 37% of participants, the cost of transport to the hospital represented a third of their monthly income. CONCLUSION: The questionnaire provided population-specific information on cancer knowledge and aided in targeting barriers to healthcare access. These factors will be incorporated into the cancer education outreach program of Tenwek Hospital.