Dysphagia in Hospitalized Persons with Dementia
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Project Summary Oropharyngeal dysphagia (OD) is a syndrome that affects up to 84% of hospitalized older adults with Alzheimer's disease and Related Dementias (ADRD), and is associated with malnutrition, dehydration, aspiration events, pneumonia, increased mortality, longer hospital stay, and higher costs. In the hospital setting, where OD is often exacerbated by the acute illness and hospital environment, standard of care entails withholding all oral intake (nil per os, NPO) and dysphagia diets (texture modified food and thickened liquids). Yet, there is insufficient evidence for the clinical benefit of these dietary restrictions. Furthermore, dietary restrictions lead to decreased oral intake and dehydration, which may further exacerbate OD and lead to delirium, respiratory complications, decreased quality of life, and mortality. Therefore, it is critical for us to examine the standard of care assumption that dietary restrictions result in improved clinical outcomes. The overarching aim of this study is to use an existing data set of hospitalized persons with ADRD to evaluate the relationship between dietary restrictions (standard care) and adverse clinical outcomes in the management of OD, as compared to a non-restricted diet (alternative to standard care). Our hypothesis is that dietary restrictions will be associated with increased adverse hospital outcomes (mortality, respiratory complications, dehydration, length of stay, and readmission) as compared to a non-restricted diet. Our data consists of 35,925 hospitalized persons with ADRD admitted to the medicine service across 11 diverse hospitals between 2017 and 2019. In preliminary work using a subset of this data, we demonstrated high prevalence of dietary restrictions in patients with ADRD. Our multidisciplinary research team is well-positioned to accomplish the following 3 Aims: 1) Determine whether NPO is associated with adverse outcomes in hospitalized persons with ADRD and OD, compared to any oral intake (restricted and non-restricted diet); 2) Determine whether a dysphagia diet is associated with adverse outcomes in hospitalized persons with ADRD and OD, compared to a non-restricted diet; and 3) Determine whether dietary restrictions (NPO or dysphagia diet) are associated with delirium in hospitalized persons with ADRD and OD, compared to a non-restricted diet. We will use propensity score matching to evaluate associations between dietary restrictions and adverse outcomes. This line of work is significant, because it will examine the current standard of care of OD in hospitalized patients with ADRD. This research is innovative, because it will be the first study to associate dietary restrictions with meaningful clinical outcomes, using a large hospital database of clinically rich variables. The findings from this proposal will be used to support the application for a large-scale clinical trial to prospectively evaluate the effects of dietary restrictions for OD in hospitalized patients with ADRD. Our findings will lay the essential groundwork needed to examine the current standard of care of OD in patients with ADRD and has the potential to improve important clinical outcomes and quality of life for this vulnerable patient population.
