[Usefulness of implementing a dysphagia care programme at an intermediate and long stay hospital]. / Utilidad de implantar un programa de atención a la disfagia en un Hospital de Media y Larga Estancia.

OBJECTIVES: To describe the initial results of the implementation of a dysphagia assessment and intervention programme and to know which variables showed significant differences between patients with and without dysphagia detected by this way at an intermediate and long stay hospital. METHODS: Descriptive and retrospective study on the assessment performed to patients suspected of having dysphagia and of the subsequent intervention done on those in whom it was confirmed. A standardized clinical method using different viscosities and volumes was used. After confirming the condition, different dietary, postural, and educational cares were undertaken. Demographical, clinical, and analytical variables were registered. RESULTS: 146 patients were included, 110 of them presenting dysphagia of whom the corresponding assessments and interventions were described. This represented a dysphagia prevalence of 14.8% among all admitted patients. The univariate analysis between patients with and without dysphagia showed that the former presented at the time of admission a higher prevalence of a feeding tube (p = 0.011) and a lower proportion of mild cognitive impairment (p = 0.048); and at the time of hospital discharge, lower functional recovery (p < 0.01) and higher presence of a feeding tube (p = 0.028), hyponutrition(p < 0,01), and mortality (p = 0.02). CONCLUSIONS: Given its frequent presentation and important clinical repercussion, and in order to improve health care quality at ILSH, the implementation of a dysphagia care programme is advisable. The dysphagia detected was correlated with the presence of a feeding tube and had clear implications on the clinical course at a functional and nutritional level and vital prognosis.

[Nutrition of Alzheimer's patients in the family setting]. / La alimentación del enfermo de Alzheimer en el ámbito familiar.

UNLABELLED: Most of the patients diagnosed of Alzheimer's disease are still living at home with their relatives. It is important to know their clinical state, nutritional habits and attitudes toward their illness in order to improve their quality of life. PATIENTS AND METHODS: Patients who are members of the Valencia Association of Alzheimer's Disease Relatives, who live with their relatives. Data collected were: gender, staging of dementia, time since diagnosis, weight, nutritional habits, food consumption, dysphagia, complications presented and information received by relatives. RESULTS: 241 patients, 70% were female, mean age 76 years old, 52% of patients had the diagnosis given between 3-5 years ago, 48% suffer severe dementia (GDS > 6), Weight loss was found in 31% and 98% of patients maintain oral intake of food. A well balanced diet was present in 24% of patients and fluid intake higher than 4 glasses in 28%. Food processing was done at home in 91% of cases, of whom 40% were puree food, 26% presented dysphagia to liquids and 19% to solid food. Regarding caregivers: 5% has received no information related to Alzheimer's Disease, but 50% has no information related to nutrition. CONCLUSIONS: Almost all the patients received oral nutrition and despite of severity of dementia and dysphagia they are receiving a quite well balanced diet. Fluid intake is generally poor and many patients are loosing weight, other complications are not very relevant. There is an important lack of information related to the nutritional bases of these patients and to how food processing can be improved as the disease progresses.

[Management of dysphagia in the institutionalized elderly patient: current situation]. / Manejo de la disfagia en el anciano institucionalizado: situación actual.

UNLABELLED: Elderly patients suffering from dysphagia, institutionalised either in hospital or nursing homes, have been studied. Etiology, characteristics and complications of dysphagia were studied as well as the most frequently used strategies to improve the management of swallowing disorders. SUBJECTS AND METHODS: A retrospective study of the complications of dysphagia found during the last 4 years in our hospital were conducted in addition to a cross-sectional study of the techniques used to manage dysphagia. A postal questionnaire was sent to all the registered nursing homes in the Valencian Community. RESULTS: Inhospital patients: 58% of physicians estimated that no less than 20% of patients under their care presented dysphagia. 13% of the total number of hospital diets were specific for swallowing disorders. All the patients suffering from dysphagia used a liquid thickener. Nursing Homes residents: 107 questionnaires were returned. This represents 7057 residents of which 3.6% were suffering from dysphagia. 54% of nursing homes have a specific diet for the management of dysphagia, 51% used nasogastric feeding and 30% consider PEG. The most frequent complications were 75% lung aspirations, 39% dehydration, 32% malnourishment and 31% pneumonia. CONCLUSIONS: Dysphagia is an important problem in elderly people. In our hospital there is a correct use of a dysphagia diet but it could be more widespread and further measures should be taken. Complications are frequent but are not correctly documented in the medical records. Nursing home residents have frequent and important complications when suffering dysphagia. Interventions towards a better management of dysphagia should be recommended and implemented.

[Assessment of dietary intake in institutionalized elderly patients with dysphagia]. / Valoración de la ingesta en pacientes ancianos institucionalizados con disfagia.

Elderly institutionalised patients are at risk from the nutritional point of view. This fact is even more important in those with swallowing difficulties. To avoid the immediate consequences an inadequate nutrition has in older people's quality of life and prognosis is vital to achieve an adequate diet with a strict control of their food and fluid intake.

[Feeding and nutrition in Alzheimer's disease]. / Alimentación y nutrición en la enfermedad de Alzheimer.

Dementia is an organic brain disease. The most frequent type of dementia is Alzheimer's and it affects mostly elderly people. Due to the increase in life expectancy and to the ageing of the population, Alzheimer's has recently become an area of research of interest. The eating behaviour and nutrition of elderly people has some special characteristics which become particularly relevant during illness. An Alzheimer's patient suffers a progressive decay in their functional and physical abilities, and these renders them at high nutritional risk. Prevention, rapid intervention and ensuring an adequate nutritional intake is essential in each of the dementia stages. This paper reviews the most important nutrients influencing the development or worsening of dementia and the guidelines for food intake throughout the disease.