Changes in Nutrition-Intake Method and Oral Health through a Multidisciplinary Team Approach in Malnourished Older Patients Admitted to an Acute Care Hospital
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Participants
2.2. Study Parameters
2.3. Other Variables
2.4. Statistical Analyses
3. Results
3.1. Participant Characteristics
3.2. Changes in the Nutrition-Intake Method, Swallowing Ability, and Oral Environment Associated with Multidisciplinary Oral Health Management
3.3. Factors Affecting the Changes in Nutrition-Intake Method Elicited by Multidisciplinary Oral Health Management
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Kaiser, M.J.; Bauer, J.M.; Rämsch, C.; Uter, W.; Guigoz, Y.; Cederholm, T.; Thomas, D.R.; Anthony, P.S.; Charlton, K.E.; Maggio, M.; et al. Frequency of malnutrition in older adults: A multinational perspective using the mini nutritional assessment. J. Am. Geriatr. Soc. 2010, 58, 1734–1738. [Google Scholar] [CrossRef] [PubMed]
- Rasmussen, N.M.L.; Belqaid, K.; Lugnet, K.; Nielsen, A.L.; Rasmussen, H.H.; Beck, A.M. Effectiveness of multidisciplinary nutritional support in older hospitalised patients: A systematic review and meta-analyses. Clin. Nutr. ESPEN 2018, 27, 44–52. [Google Scholar] [CrossRef]
- Howard, P. Organizational aspects of starting and running an effective nutritional support service. Clin. Nutr. 2001, 20, 367–374. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Nightingale, J. Nutrition support teams: How they work, are set up and maintained. Frontline Gastroenterol. 2010, 1, 171–177. [Google Scholar] [CrossRef] [PubMed]
- Peter, J.V.; Moran, J.L.; Phillips-Hughes, J. A metaanalysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Crit. Care Med. 2005, 33, 213–220, discussion 260–261. [Google Scholar] [CrossRef] [PubMed]
- Simpson, F.; Doig, G.S. Parenteral vs. enteral nutrition in the critically ill patient: A meta-analysis of trials using the intention to treat principle. Intensive Care Med. 2005, 31, 12–23. [Google Scholar] [CrossRef]
- Furuya, J.; Suzuki, H.; Hidaka, R.; Nakagawa, K.; Yoshimi, K.; Nakane, A.; Yamaguchi, K.; Shimizu, Y.; Itsui, Y.; Saito, K.; et al. Factors related to oral intake of food by hospitalized patients with malnutrition under the care of a nutrition support team. Int. J. Environ. Res. Public Health 2021, 18, 11725. [Google Scholar] [CrossRef]
- Furuya, J.; Suzuki, H.; Tamada, Y.; Onodera, S.; Nomura, T.; Hidaka, R.; Minakuchi, S.; Kondo, H. Food intake and oral health status of inpatients with dysphagia in acute care settings. J. Oral Rehabil. 2020, 47, 736–742. [Google Scholar] [CrossRef]
- Nakayama, E.; Tohara, H.; Sato, M.; Abe, K.; Kimura, M.; Watanabe, M.; Iida, M.; Ueda, K. Relationship between oral intake level and oral health assessment tool scores in the convalescent ward. J. Oral Sci. 2020, 63, 79–82. [Google Scholar] [CrossRef]
- Nomoto, A.; Shimizu, A.; Ohno, T.; Tohara, H.; Hashidume, M.; Hatano, M.; Fujishima, I. Poor oral health and anorexia in older rehabilitation patients. Gerodontology 2022, 39, 59–66. [Google Scholar] [CrossRef]
- Obana, M.; Furuya, J.; Matsubara, C.; Tohara, H.; Inaji, M.; Miki, K.; Numasawa, Y.; Minakuchi, S.; Maehara, T. Effect of a collaborative transdisciplinary team approach on oral health status in acute stroke patients. J. Oral Rehabil. 2019, 46, 1170–1176. [Google Scholar] [CrossRef] [PubMed]
- Furuya, J.; Suzuki, H.; Hidaka, R.; Akatsuka, A.; Nakagawa, K.; Yoshimi, K.; Nakane, A.; Shimizu, Y.; Saito, K.; Itsui, Y.; et al. Oral Health status and its association with nutritional support in malnourished patients hospitalised in acute care. Gerodontology 2021. [Google Scholar] [CrossRef] [PubMed]
- Crary, M.A.; Mann, G.D.; Groher, M.E. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch. Phys. Med. Rehabil. 2005, 86, 1516–1520. [Google Scholar] [CrossRef] [PubMed]
- Nishimura, K.; Kagaya, H.; Shibata, S.; Onogi, K.; Inamoto, Y.; Ota, K.; Miki, T.; Tamura, S.; Saitoh, E. Accuracy of Dysphagia Severity Scale rating without using videoendoscopic evaluation of swallowing. Jpn. J. Compr. Rehabil. Sci. 2015, 6, 124–128. [Google Scholar] [CrossRef]
- Chalmers, J.M.; King, P.L.; Spencer, A.J.; Wright, F.A.; Carter, K.D. The oral health assessment tool—Validity and reliability. Aust. Dent. J. 2005, 50, 191–199. [Google Scholar] [CrossRef] [PubMed]
- Charlson, M.E.; Pompei, P.; Ales, K.L.; MacKenzie, C.R. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J. Chronic Dis. 1987, 40, 373–383. [Google Scholar] [CrossRef]
- Ohta, T.; Kikuchi, H.; Hashi, K.; Kudo, Y. Nizofenone administration in the acute stage following subarachnoid hemorrhage. Results of a multi-center controlled double-blind clinical study. J. Neurosurg. 1986, 64, 420–426. [Google Scholar] [CrossRef]
- Oken, M.M.; Creech, R.H.; Tormey, D.C.; Horton, J.; Davis, T.E.; McFadden, E.T.; Carbone, P.P. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am. J. Clin. Oncol. 1982, 5, 649–655. [Google Scholar] [CrossRef]
- Hafsteinsdóttir, T.B.; Mosselman, M.; Schoneveld, C.; Riedstra, Y.D.; Kruitwagen, C.L. Malnutrition in hospitalised neurological patients approximately doubles in 10 days of hospitalisation. J. Clin. Nurs. 2010, 19, 639–648. [Google Scholar] [CrossRef]
- Lindmark, U.; Ernsth Bravell, M.; Johansson, L.; Finkel, D. Oral Health is essential for quality of life in older adults: A Swedish National Quality Register Study. Gerodontology 2021, 38, 191–198. [Google Scholar] [CrossRef]
- Matsuo, K.; Sekimoto, Y.; Okamoto, M.; Shibata, S.; Otaka, Y. Association between oral health status and oral food intake level in subacute stroke patients admitted to a convalescent rehabilitation unit. Gerodontology 2022, 39, 67–73. [Google Scholar] [CrossRef]
- Carrión, S.; Cabré, M.; Monteis, R.; Roca, M.; Palomera, E.; Serra-Prat, M.; Rofes, L.; Clavé, P. Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of older patients admitted with an acute disease to a general hospital. Clin. Nutr. 2015, 34, 436–442. [Google Scholar] [CrossRef]
- Maeda, K.; Mori, N. Poor oral health and mortality in geriatric patients admitted to an acute hospital: An observational study. BMC Geriatr. 2020, 20, 26. [Google Scholar] [CrossRef]
- Sura, L.; Madhavan, A.; Carnaby, G.; Crary, M.A. Dysphagia in the elderly: Management and nutritional considerations. Clin. Interv. Aging 2012, 7, 287–298. [Google Scholar] [CrossRef]
- Shimazu, S.; Yoshimura, Y.; Kudo, M.; Nagano, F.; Bise, T.; Shiraishi, A.; Sunahara, T. Frequent and personalized nutritional support leads to improved nutritional status, activities of daily living, and dysphagia after stroke. Nutrition 2021, 83, 111091. [Google Scholar] [CrossRef]
- Gibney, J.M.; Wright, F.A.; D’Souza, M.; Naganathan, V. Improving the oral health of older people in hospital. Australas. J. Ageing 2019, 38, 33–38. [Google Scholar] [CrossRef]
- Matsuo, H.; Yoshimura, Y.; Ishizaki, N.; Ueno, T. Dysphagia is associated with functional decline during acute-care hospitalization of older patients. Geriatr. Gerontol. Int. 2017, 17, 1610–1616. [Google Scholar] [CrossRef]
- Yoshimi, K.; Nakagawa, K.; Momosaki, R.; Yamaguchi, K.; Nakane, A.; Tohara, H. Effects of oral management on elderly patients with pneumonia. J. Nutr. Health Aging 2021, 25, 979–984. [Google Scholar] [CrossRef]
- Aoyagi, M.; Furuya, J.; Matsubara, C.; Yoshimi, K.; Nakane, A.; Nakagawa, K.; Inaji, M.; Sato, Y.; Tohara, H.; Minakuchi, S.; et al. Association between improvement of Oral Health, swallowing function, and nutritional intake method in acute stroke patients. Int. J. Environ. Res. Public Health 2021, 18, 11379. [Google Scholar] [CrossRef]
- Minakuchi, S.; Tsuga, K.; Ikebe, K.; Ueda, T.; Tamura, F.; Nagao, K.; Furuya, J.; Matsuo, K.; Yamamoto, K.; Kanazawa, M.; et al. Oral hypofunction in the older population: Position paper of the Japanese Society of Gerodontology in 2016. Gerodontology 2018, 35, 317–324. [Google Scholar] [CrossRef]
Mean ± SD | Median | n | % | ||
---|---|---|---|---|---|
Age | 71.9 ± 12.5 | 74 | 117 | 100.0 | |
Sex | Male | 66 | 56.4 | ||
Female | 51 | 43.6 | |||
Height (cm) | 158.5 ± 9.3 | 158.7 | 117 | 100.0 | |
Weight (kg) | 50.6 ± 13.6 | 48.3 | 117 | 100.0 | |
BMI (kg/m2) | 20.0 ± 4.5 | 19.6 | 117 | 100.0 | |
Length of hospitalization (days) | 76.2 ± 64.0 | 51 | 117 | 100.0 | |
Length of NST intervention (days) | 33.1 ± 35.3 | 22 | 117 | 100.0 | |
CCI | 2.8 ± 2.5 | 2 | 117 | 100.0 | |
Level of consciousness (JCS score) | 0 | 33 | 28.2 | ||
I | 67 | 57.3 | |||
II | 10 | 8.5 | |||
III | 7 | 6.0 | |||
Independence (PS) | 0 | 2 | 1.7 | ||
1 | 9 | 7.7 | |||
2 | 20 | 17.1 | |||
3 | 37 | 31.6 | |||
4 | 49 | 41.9 | |||
Type of professional performing the oral management | Ward nurses | 63 | 53.8 | ||
Dental professionals | 54 | 46.2 |
At Referral to NST | At Completion of NST | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Mean ± SD | Median | n | % | Mean ± SD | Median | n | % | p-Value | ||
FOIS score | 2.6 ± 2.1 | 1 | 117 | 3.4 ± 2.5 | 2 | 117 | <0.001 * | |||
1 | 65 | 55.6 | 49 | 41.9 | ||||||
2 | 11 | 9.4 | 10 | 8.5 | ||||||
3 | 7 | 6.0 | 5 | 4.3 | ||||||
4 | 5 | 4.3 | 4 | 3.4 | ||||||
5 | 7 | 6.0 | 11 | 9.4 | ||||||
6 | 15 | 12.8 | 19 | 16.2 | ||||||
7 | 7 | 6.0 | 19 | 16.2 | ||||||
DSS score | 3.3 ± 1.9 | 3 | 117 | 3.7 ± 2.0 | 4 | 117 | <0.001 * | |||
1 | 28 | 23.9 | 20 | 17.1 | ||||||
2 | 24 | 20.5 | 26 | 22.2 | ||||||
3 | 13 | 11.1 | 7 | 6.0 | ||||||
4 | 15 | 12.8 | 18 | 15.4 | ||||||
5 | 17 | 14.5 | 17 | 14.5 | ||||||
6 | 17 | 14.5 | 17 | 14.5 | ||||||
7 | 3 | 2.6 | 12 | 10.3 | ||||||
OHAT score | 6.1 ± 3.0 | 6 | 117 | 100 | 3.6 ± 2.7 | 3 | 117 | 100 | <0.001 * | |
Lip | 0.6 ± 0.7 | 1 | 0.3 ± 0.5 | 0 | <0.001 * | |||||
Tongue | 0.9 ± 0.7 | 1 | 0.6 ± 0.5 | 1 | <0.001 * | |||||
Gingiva/mucosa | 0.6 ± 0.7 | 0 | 0.4 ± 0.6 | 0 | <0.001 * | |||||
Saliva | 1.1 ± 0.7 | 1 | 0.6 ± 0.6 | 1 | <0.001 * | |||||
Remaining teeth | 0.5 ± 0.8 | 0 | 0.5 ± 0.8 | 0 | 0.317 | |||||
Dentures | 0.9 ± 1.0 | 0 | 0.7 ± 1.0 | 0 | 0.002 * | |||||
Oral hygiene | 1.0 ± 0.8 | 1 | 0.4 ± 0.6 | 0 | <0.001 * | |||||
Dental pain | 0.4 ± 0.7 | 0 | 0.2 ± 0.5 | 0 | <0.001 * |
Independent Variables | B | SE | 95% Confidence Interval of Estimate | β | p Value | Variance Inflation Factor |
---|---|---|---|---|---|---|
Age | −0.003 | 0.012 | −0.027 to 0.022 | −0.018 | 0.822 | 1.093 |
Sex | 0.361 | 0.312 | −0.257 to 0.978 | 0.091 | 0.250 | 1.123 |
Duration of NST intervention | 0.009 | 0.004 | 0.001 to 0.018 | 0.170 | 0.030 * | 1.074 |
BMI | 0.003 | 0.034 | −0.064 to 0.069 | 0.006 | 0.940 | 1.088 |
CCI | −0.064 | 0.061 | −0.185 to 0.057 | −0.082 | 0.299 | 1.108 |
JCS | −0.322 | 0.219 | −0.756 to 0.112 | −0.128 | 0.144 | 1.353 |
PS | 0.015 | 0.170 | −0.322 to 0.353 | 0.008 | 0.928 | 1.432 |
Change in DSS score after intervention | 0.944 | 0.144 | 0.658 to 1.230 | 0.537 | <0.001 * | 1.213 |
Change in OHAT score after intervention | −0.153 | 0.076 | −0.304 to −0.002 | −0.166 | 0.047 * | 1.227 |
Type of professional performing oral management | −0.380 | 0.321 | −1.016 to 0.256 | −0.097 | 0.239 | 1.202 |
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Suzuki, H.; Furuya, J.; Nakagawa, K.; Hidaka, R.; Nakane, A.; Yoshimi, K.; Shimizu, Y.; Saito, K.; Itsui, Y.; Tohara, H.; et al. Changes in Nutrition-Intake Method and Oral Health through a Multidisciplinary Team Approach in Malnourished Older Patients Admitted to an Acute Care Hospital. Int. J. Environ. Res. Public Health 2022, 19, 9784. https://doi.org/10.3390/ijerph19169784
Suzuki H, Furuya J, Nakagawa K, Hidaka R, Nakane A, Yoshimi K, Shimizu Y, Saito K, Itsui Y, Tohara H, et al. Changes in Nutrition-Intake Method and Oral Health through a Multidisciplinary Team Approach in Malnourished Older Patients Admitted to an Acute Care Hospital. International Journal of Environmental Research and Public Health. 2022; 19(16):9784. https://doi.org/10.3390/ijerph19169784
Chicago/Turabian StyleSuzuki, Hiroyuki, Junichi Furuya, Kazuharu Nakagawa, Rena Hidaka, Ayako Nakane, Kanako Yoshimi, Yukue Shimizu, Keiko Saito, Yasuhiro Itsui, Haruka Tohara, and et al. 2022. "Changes in Nutrition-Intake Method and Oral Health through a Multidisciplinary Team Approach in Malnourished Older Patients Admitted to an Acute Care Hospital" International Journal of Environmental Research and Public Health 19, no. 16: 9784. https://doi.org/10.3390/ijerph19169784
APA StyleSuzuki, H., Furuya, J., Nakagawa, K., Hidaka, R., Nakane, A., Yoshimi, K., Shimizu, Y., Saito, K., Itsui, Y., Tohara, H., Sato, Y., & Minakuchi, S. (2022). Changes in Nutrition-Intake Method and Oral Health through a Multidisciplinary Team Approach in Malnourished Older Patients Admitted to an Acute Care Hospital. International Journal of Environmental Research and Public Health, 19(16), 9784. https://doi.org/10.3390/ijerph19169784