Evde bakım hizmeti alan geriatrik hastalarda disfaji prevalansı ve ilişkili risk faktörleri

Amaç: Çalışmamızda evde bakım hizmeti alan 65 yaş ve üstü hastalarda disfaji prevalansının belirlenmesi ve disfaji ile ilişkili faktörlerin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Araştırmamız kesitsel tanımlayıcı bir çalışma olup 1 Aralık 2021 ile 1 Mart 2022 tarihleri arasında Samsun Eğitim ve Araştırma Hastanesi Evde Sağlık Hizmetlerine kayıtlı hastalar ile gerçekleştirildi. Katılımcıların demografik özellikleri, yatağa bağımlılık durumu, beslenme yöntemleri, enteral beslenme ürün kullanımı, beden kitle indeksi (BKİ) verileri ile eşlik eden kronik hastalıklarının belirlenmesi amacı ile Charlson Komorbidite İndeksi (CCI), disfaji belirtileri açısından Yeme Değerlendirme Aracı (EAT-10), beslenme durumunun değerlendirilmesi için Nütrisyonel Risk Tarama-2002 (NRS) yüz yüze uygulanarak veriler kaydedildi. Bulgular: Çalışmaya %62,5'i (n=258) kadın olmak üzere toplam 413 hasta dahil edildi. %44,6’sında (n=184) disfaji semptomları mevcuttu. Erkeklerde (p=0,025), 85 yaş ve üzeri kişilerde (p=0,001), CCI puanı yüksek olanlarda (p<0,001), serebrovasküler hastalık (p<0,001), demans (p<0,001), hemipleji tanısı olanlarda (p=0,001), yatağa tam bağımlı kişilerde (p<0,001) disfaji oranı yüksekti. Benzer şekilde beslenme riski mevcut bireylerde ve enteral beslenme ürünü kullananlarda disfaji oranı anlamlı derecede yüksek saptandı (p<0,001). Multivaryat lojistik regresyonda demansın ve artmış beslenme riskinin disfaji semptomlarının varlığında bağımsız risk faktörleri olduğu tespit edildi (p<0,001). Sonuç: Çalışmamız evde bakım hizmeti alan geriatrik hasta popülasyonunda yüksek disfaji prevalansını göstermiştir. İleri yaş, artmış beslenme riski, demans, serebrovasküler hastalık ve çoklu komorbiditesi olan hastalarda disfaji oranının arttığı belirlenmiştir.

Anahtar Kelimeler:

Evde bakım hizmetleri, yutma bozuklukları, yaşlı, komorbidite

Dysphagia prevalence and associated risk factors in geriatric patients receiving home care

Objective: In our study, it was aimed to determine dysphagia prevalence in patients 65 years of age and older who were received home care and to assess factors associated with dysphagia. Methods: This cross-sectional, descriptive study was conducted in patients who were registered to Home Care Services of Samsun Training and Research Hospital between December 1, 2021, and March 1, 2022. In all patients, demographic data, level of dependence, nutrition methods, use of enteral nutrition supplement, body mass index (BMI), and comorbidity were assessed by Charlson Comorbidity Index (CCI) while dysphagia symptoms were assessed by Eating Assessment Tool (EAT-10) and nutritional status was assessed by Nutritional Risk Screening-2002 (NRS) using face-to-face interview method. Results: A total of 413 patients were included in our study, of which 62.5% (n=258) were female. Dysphagia symptoms were present in 44.6% (n=184). The dysphagia prevalence was significantly high in male patients (p=0.025), in patients aged ≥85 years (p=0.001), in those with high CCI score (p<0.001), in those with cerebrovascular disease (p<0.001), dementia (p<0.001), and hemiplegia (p=0.001), and in bedridden patients (p<0.001). Similarly, dysphagia prevalence was higher in patient with nutritional risk and those using enteral nutrition supplement (p<0.001). In multivariate logistic regression analysis, it was found that dementia and increased nutritional risk were independent risk factors for presence of dysphagia symptoms (p<0.001). Conclusion: Our study showed a high prevalence of dysphagia in the geriatric patient population receiving home care. It has been determined that the rate of dysphagia is increased in patients with older age, nutritional risk, dementia, cerebrovascular disease, and multiple comorbidities.

Keywords:

Home care services deglutition disorders, aged, comorbidity, Evde bakım hizmetleri,

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1. Olesen MD, Modlinski RM, Poulsen SH, Rosenvinge PM, Rasmussen HH, Holst M. Prevalence of signs of dysphagia and associated risk factors in geriatric patients admitted to an acute medical unit. Clin Nutr ESPEN. 2021;41:208-16.
2. Mateos-Nozal J, Montero-Errasquin B, Sanchez Garcia E, Romero Rodriguez E, Cruz-Jentoft AJ. High Prevalence of Oropharyngeal Dysphagia in Acutely Hospitalized Patients Aged 80 Years and Older. J Am Med Dir Assoc. 2020;21(12):2008-11.
3. Carrión S, Cabré M, Monteis R, Roca M, Palomera E, Serra-Prat M, et al. 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(3):436-42.
4. Cabré M, Serra-Prat M, Force L, Almirall J, Palomera E, Clavé P. Oropharyngeal dysphagia is a risk factor for readmission for pneumonia in the very elderly persons: observational prospective study. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences. 2014;69(3):330-7.
5. Serra-Prat M, Palomera M, Gomez C, Sar-Shalom D, Saiz A, Montoya JG, et al. Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: a population-based prospective study. Age and ageing. 2012;41(3):376-81.
6. Attrill S, White S, Murray J, Hammond S, Doeltgen S. Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review. BMC Health Serv Res. 2018;18(1):594.
7. Takizawa C, Gemmell E, Kenworthy J, Speyer R. A Systematic Review of the Prevalence of Oropharyngeal Dysphagia in Stroke, Parkinson's Disease, Alzheimer's Disease, Head Injury, and Pneumonia. Dysphagia. 2016;31(3):434-41.
8. Crowder SL, Douglas KG, Yanina Pepino M, Sarma KP, Arthur AE. Nutrition impact symptoms and associated outcomes in post-chemoradiotherapy head and neck cancer survivors: a systematic review. J Cancer Surviv. 2018;12(4):479-94.
9. Baijens LWJ, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, et al. European Society for Swallowing Disorders–European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clinical interventions in aging. 2016;11:1403.
10. Payne MA, Morley JE. Dysphagia: A New Geriatric Syndrome. J Am Med Dir Assoc. 2017;18(7):555-7.
11. Cho SY, Choung RS, Saito YA, Schleck CD, Zinsmeister AR, Locke GR, 3rd, et al. Prevalence and risk factors for dysphagia: a USA community study. Neurogastroenterol Motil. 2015;27(2):212-9.
12. Melgaard D, Rodrigo-Domingo M, Morch MM. The Prevalence of Oropharyngeal Dysphagia in Acute Geriatric Patients. Geriatrics (Basel). 2018;3(2):15.
13. Penalva-Arigita A, Prats R, Lecha M, Sansano A, Vila L. Prevalence of dysphagia in a regional hospital setting: Acute care hospital and a geriatric sociosanitary care hospital: A cross-sectional study. Clin Nutr ESPEN. 2019;33:86-90.
14. Watanabe K, Umegaki H, Huang C, Arakawa Martins B, Asai A, Kanda S, et al. Association between dysphagia risk and unplanned hospitalization in older patients receiving home medical care. Geriatrics & Gerontology International. 2019;19(10):977-81.
15. Güzel EÇ. Home-Care Services In Turkey. J Clin Med Fam Med. 2018;10(5):15-9.
16. Wirth R, Dziewas R, Beck AM, Clavé P, Hamdy S, Heppner HJ, et al. Oropharyngeal dysphagia in older persons–from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clinical interventions in aging. 2016;11:189.
17. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc EHG. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321-36.
18. Bolayir B, Arik G, Yesil Y, Kuyumcu ME, Varan HD, Kara O, et al. Validation of Nutritional Risk Screening-2002 in a Hospitalized Adult Population. Nutr Clin Pract. 2019;34(2):297-303.
19. Rofes L, Arreola V, Mukherjee R, Clave P. Sensitivity and specificity of the Eating Assessment Tool and the Volume-Viscosity Swallow Test for clinical evaluation of oropharyngeal dysphagia. Neurogastroenterol Motil. 2014;26(9):1256-65.
20. Demir N, Serel Arslan S, Inal O, Karaduman AA. Reliability and Validity of the Turkish Eating Assessment Tool (T-EAT-10). Dysphagia. 2016;31(5):644-9.
21. Lin LC, Wu SC, Chen HS, Wang TG, Chen MY. Prevalence of impaired swallowing in institutionalized older people in taiwan. J Am Geriatr Soc. 2002;50(6):1118-23.
22. Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287-98.
23. Güçmen N, Güçmen B, Koca TT. The Importance of Malnutrition and Dysphage in Patient With Stroke. KSU Med J. 2022;17(2):182-90.
24. Gonzalez-Fernandez M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after Stroke: an Overview. Curr Phys Med Rehabil Rep. 2013;1(3):187-96.
25. Ortega O, Cabré M, Clavé P. Oropharyngeal dysphagia: aetiology and effects of ageing. J Gastroenterology Hepatology Res. 2014;3(5).
26. Saito T, Hayashi K, Nakazawa H, Yagihashi F, Oikawa LO, Ota T. A Significant Association of Malnutrition with Dysphagia in Acute Patients. Dysphagia. 2018;33(2):258-65.
27. Wakabayashi H, Matsushima M, Uwano R, Watanabe N, Oritsu H, Shimizu Y. Skeletal muscle mass is associated with severe dysphagia in cancer patients. J Cachexia Sarcopenia Muscle. 2015;6(4):351-7.

ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez