According to Londos et al. (2013), 83% percent of the patients suffering from dementia and Parkinson are going to experience at least an event of dysphagia or difficulties to swallow correctly. As a result of the degeneration the disease causes, the patients’ swallowing capacities diminishes, which could cause aspiration pneumonia, leading to death in a large amount of the cases where it occurs. (Robbins et al., 2008). Therefore, given the adverse findings related to long-term artificial feeding methods in patients suffering from Parkinson’s disease call from a manual method that avoid the principal element of mortality among the patients, as a way to improve their well-being and reduce the incidents related to aspiration.
Moreover, this review centers in research related to the topic of swallowing disorders in older patients in acute settings, as well as observational studies on the swallowing functions of patients with Parkinson’s disease. Hence, the literature chosen intends to give a broad perspective related to the subject in hand, as well as provide a guide to observing changes in the patients that might imply that changes in the way their food is administered could improve their well-being. For this reason. The chin-tuck method appeared as the method that could achieve the greater amount of success in patients over 70 years, regardless their level of dementia (Logemann et all, 2008). Nevertheless, Logemann’s investigation indicates a good starting point from which the investigation could part to suggest that the chin-tuck method could hinder the appearance of cases of pneumonia among the patients. Therefore, the research indicates that by changing the consistency of the liquids administered to patients, the cases of aspiration are bound to diminish, but given the fact that thick liquids are not as moist, the decreased oral intake of fluids results in dehydration. Ultimately, by training the patients in the chin-tuck posture and using less thick liquids, aspiration rates will decrease, along with the cases of dehydration.
Comparison of 2 Interventions for Liquid Aspiration on Pneumonia Incidence
Robbins, J., Gensler, G., Hind, J., Logemann, J., Lindblad, A., Brandt, D., . . . Miller Gardner, P. (2008)
The study sustains that given the increased rate of mortality and morbidity related to swallowing disorders, at least 18 million adults are estimated to suffer from dysphagia-related conditions such as malnutrition, dehydration, and pneumonia by 2010 (Robbins et al., 2008). Hence, drawing from the existing clinical evidence and randomized clinical trials, the researchers aimed to find if there is a way to reduce dysphagia-related incidents and pneumonia in patients with dementia or Parkinson disease using two different methods of feeding: Chin-down posture and thickened liquids (nectar and honey thick). The trial included patients from 50 to 95 years diagnosed with dementia or Parkinson disease. The exclusion factors were tobacco, alcohol use, cancer, nasogastric diabetes tube, infectious neurological diseases, and pneumonia. Among the study’s limitations were the lack of a control group, the limited follow-up periods (only three months) and the impossibility to blind the caregivers. Hence, the investigation is not capable of offering conclusive results. Nevertheless, since using a control group in tests that require treatment is not possible due to ethical issues, the study’s limitations are not of medical nature. After the 3-month follow-up, 413 patients had completed the study without signs of pneumonia and 52 developed the condition (of those 52, 21 died). On the other hand, 11 patients did not complete the 3-month follow-up. Therefore, the results claim a decrease of 51% HR in patients with chin-down posture (0.84 HR [CI, 0.49 TO 1.45]). Also, those who received nectar-thick liquids had a lower HR than those who received thicker liquids (HR, 0.50 [CI, 0.23 to 1.09]). (Robbins et al., 2008).
Therefore, although the trial’s results are not conclusive given the mentioned limitations, this study shows promising signs that indicate that the chin tuck posture might lead to a decrease in the aspiration in patients over 70 years old. Moreover, it demonstrates that changes the bolus, along with postural changes can lead to less dysphagia-related illnesses.
Swallowing problems and dementia in acute hospital settings: Practical guidance for the management of dysphagia
Smith, H., Kindell, J., Baldwin, R., Waterman, D., & Makin, A. (2009).
This study sought to guide the decision-making process in acute settings regarding feeding patients suffering from severe dementia in hospital settings. The article challenges the perspective of using artificial feeding methods that are not adequate for a prolonged time in patients suffering from severe dementia. Therefore, using perspective based in the proper care of patients, instead of the perceived as most-efficient, the study aimed to show how problems related to the physicians care and the patients’ mental deterioration can hinder their swallowing capabilities. On the other hand, given the theoretical nature of the study, the only perceived limitations are related to the lack of research and clinical practice of their theoretical findings.
Consequently, along with its implications for the improvement of the patient’s well-being, the article explores changes in the dietary textures and in the patients’ posture to improve the feeding process. Hence, it is quite crucial to the investigation having a practical guide from which prospective practitioners could draw information to apply the correct feeding methods in the long-term feeding of patients suffering from dementia. Also, given the importance of the ethical issues related to feeding patients with severe dementia. Furthermore, the study highlights the necessity of training on suitable feeding techniques as well as the care needed to ensure the patients’ hygiene to avoid the spread of bacteria inside the lungs. Besides, the study’s findings are related to those of Robbins et al., when they mentioned the necessity of training in the feeding methods as a limitation to its use in patients versus changes in thickness of the food, serving as a show that chin-tuck method could improve patients’ well-being.
Dysphagia in Lewy body dementia – an observational clinical study of swallowing function by video fluoroscopic examination
Londos, E., Hanxsson, O., Hirsch, I., Janneskog, A., Bülow, M., & Palmqvist, S. (2013).
Given Lewy Body dementia’s etiology and its and its relation between motor impairment and cognitive symptoms as well as the swallowing difficulties related to both diseases, this research aims to observe the swallowing function by video fluoroscopic examination. Therefore, this study focuses on the chewing function, along with the changes in the textures of solids and liquids during the phases of swallowing. As a result of these dysfunctions, dementia patients are most likely to suffer from aspiration pneumonia and other swallowing problems (Londos et al., 2013).To adequately assess the swallowing difficulties, the researchers took samples of all the patients diagnosed of Parkinson and Lewy Body in the University Hospital in Malmo, Sweden. Therefore, to test the swallowing capabilities of the test subjects the researchers fed them solid test material to describe and analyze the characteristics of the swallowing sequence.
Therefore, according to the researchers, 32% of the patients reported dysphagia or coughing. Of that initial 32%, 92% of these had their dysfunction reported in the VFSE. Conversely, 88% suffered from pharyngeal dysfunction.
Ultimately, the Videofluoroscopic analysis revealed that aspiration pneumonia is the number one cause of death among patients with pharyngeal dysfunction and dementia. Therefore, basing on previous literature, the researchers found that 83% of the patients suffering from aspiration, developed pneumonia within two years compared to the 4% who did not suffer from aspiration (Yamamoto et al., 2003). Moreover, this study is of capital importance regarding the investigation since it highlights the perils of aspiration while using inadequate feeding techniques. Hence, the VFSE technique serves as a way to accurately assess the swallowing process to aspiration issues in patients suffering from dementia.
Swallowing in moderate and severe phases of Alzheimer’s disease
De Medeiros, S., Morillo, L., Filho, W., & Mansur, L. (2010)
This study discusses the mechanics of swallowing in patients suffering from moderate and severe Alzheimer. Likewise, it aims to study the relation between Parkinson disease and the lack of neurophysiological support for swallowing. The study discusses the modifications in swallowing techniques that discriminate the different food types and their consistency. On the other hand, besides Parkinson disease, the study discusses the importance of the aging process, along with the neurological disease in the swallowing impairment and dysphagia. Also, it tries to establish a link between the difficulties of oral feeding and the cognitive and functional conditions of the patient.
To separate both trials, the 50 subjects were separated according to their diagnosis, from moderate (18 patients) to severe (32 patients). The research group gave the caregivers a questionnaire and observed that dysphagia is only present in the severe phase, as well as problems regarding the patients’ correct positioning and swallowing reflex, interfering in the feeding process (De Medeiros et al., 2010). This is of capital importance to our prospective investigation since it explores the possibility of dysphagia only in patients with severe Parkinson, which leads to the belief that patients with severe Parkinson require further supervision to avoid the potential aspiration problems that London’ (2013) investigation described. On the other hand, De Medeiros’ research found a negative correlation between mental state and behavior, along with a relation between the patients’ mental state and the severity of their dysphagia. Hence, the study discovered that the subjects’ levels of awareness reflect in their swallowing capabilities, what could favor or hinder aspiration when feeding them. Moreover, Parkinson patients present stasis in the oral cavity, a situation known to produce aspiration. Ultimately, the study indicates that given the patients’ impossibility to feed themselves, the caretakers have an important role in their prognosis as with improper feeding methods and velocity they can harm the patients. These findings strengthen the investigation since they indicate a healthy evidence that without proper feeding techniques, Parkinson patients’ morbidity rates due to aspiration could increase.
A Randomized Study of Three Interventions for Aspiration of Thin Liquids in Patients With Dementia or Parkinson’s Disease
Logemann, J., Gensler, G., Robbins, J., Lindblad, A., Brandt, D., Hind, J., Gardner, P. (2008).
Given its similar nature to Robbins study in 2008, Logemann’s study could serve as a follow-up or complementary study to the issue of which treatment for aspiration (chin-down posture, nectar-thickened and honey-thickened) could work better in patients from 50 to 95 years old, suffering from Parkinson and dementia. Secondly, given the lack of appropriate interventions regarding swallowing issues, this study aims to find the ultimate method to treat aspiration in the mentioned group of patients, given the failures of past trials with methods that exhibit an immediate effect that does not improve the patients’ condition but treats an immediate impact.
For those reasons, the involvement of Logemann in the effect of postural changes is crucial to examine changes and improvements in changes of posture versus changes in the food’s consistency. Thus, the study shows the physiological benefits related to the chin tuck position, finding that said position reduced the distance between the base of the tongue and the posterior pharyngeal wall, along with the base of the epiglottis and the arytenoid (Logemann et al., 2008). Also, the study mentions that the feeding technique has been found helpful in patients aspirating thin liquids with a previous diagnosis of stroke, head injuries, and head cancer. Therefore, it seems likely that the technique could work in older patients suffering from Parkinson given their impossibility to swallow adequately. On the other hand, it shows an interesting side related to the possibility of tremors in Parkinson patients, which makes feeding with thickened foods more difficult, hindering the utilization of postural changes and potentially increasing the risks of aspiration. Finally, the study found promising findings related to the immediate elimination of aspiration when using honey-thickened liquids, followed closely by nectar-thickened and chin-down posture. Nevertheless, feeding by honey-thickened requires more muscular tone and training when compared to the rest of the methods. Also, the preference of older patients for the chin-down method could indicate chin tuck as a better method for patients in severe stages of Parkinson disease that enriches the prospective investigation.
De Medeiros, S., Morillo, L., Filho, W., & Mansur, L. (2010). Swallowing in moderate andsevere phases of Alzheimer’s disease. Arq. Neuro-Psiquiatr. Arquivos De Neuro-Psiquiatria, 855-861.
Logemann, J., Gensler, G., Robbins, J., Lindblad, A., Brandt, D., Hind, J., . Gardner, P.(2008). A Randomized Study of Three Interventions for Aspiration of Thin Liquids in Patients With Dementia or Parkinson’s Disease. Journal of Speech, Language, and Hearing Research 173-183.
Londos, E., Hanxsson, O., Hirsch, I., Janneskog, A., Bülow, M., & Palmqvist, S. (2013). Dysphagia in Lewy body dementia – an observational clinical study of swallowingfunction by video fluoroscopic examination. BMC Neurology BMC Neurol, 140-140.
Robbins, J., Gensler, G., Hind, J., Logemannn, J., Lindblad, A., Brandt, D., . . . Miller Gardner, P. (2008). Comparison of 2 Interventions for Liquid Aspiration on Pneumonia Incidence. Annals of Internal Medicine,148, 715-715.
Smith, H., Kindell, J., Baldwin, R., Waterman, D., & Makin, A. (2009). Swallowing problems and dementia in acute hospital settings: Practical guidance for the management of dysphagia. Clinical Medicine, 9(6), 544-548.
Yamamoto, T., Kobayashi, Y., & Murata, M. (2010). The risk of pneumonia onset and discontinuation of oral intake following video fluorograph in patients with Lewy bodydisease. Parkinsonism & Related Disorders,16(8), 503-506.