Study protocol for the SOFIA project: Swallowing function, Oral health, and Food Intake in old Age: a descriptive study with a cluster randomized trial

Patricia Hägglund, Lena Olai, Katri Ståhlnacke, Mona Persenius, Mary Hägg, Maria Andersson, Susanne Koistinen, Eva Carlsson, Patricia Hägglund, Lena Olai, Katri Ståhlnacke, Mona Persenius, Mary Hägg, Maria Andersson, Susanne Koistinen, Eva Carlsson

Abstract

Background: Extensive studies have shown that older people are negatively impacted by impaired eating and nutrition. The abilities to eat, enjoy food, and participate in social activities associated with meals are important aspects of health-related quality of life (HRQoL) and recovery after illness. This project aims to (i) describe and analyze relationships between oral health and oral HRQoL, swallowing ability, eating ability, and nutritional risk among older individuals admitted to short-term care; (ii) compare the perceptions that older individuals and staff report on care quality related to oral hygiene and eating; and (iii) study the feasibility and effects of a training program for people with impaired swallowing (i.e., dysphagia).

Methods/design: This project consists of two parts, which will be performed in five Swedish counties. It will include approximately 400 older individuals and 200 healthcare professionals. Part 1 is a cross-sectional, descriptive study of older people admitted to short-term care. Subjects will be assessed by trained professionals regarding oral health status, oral HRQoL, eating and nutritional risk, and swallowing ability. Swallowing ability will be measured with a teaspoon test and a swallowing capacity test (SCT). Furthermore, subjects and staff will complete a questionnaire regarding their perceptions of care quality. Part 2 is a cluster randomized intervention trial with controls. Older participants with dysphagia (i.e., SCT <10 ml/s, measured in part 1) will be recruited consecutively to either the intervention or control group, depending on where they were admitted for short-term care. At baseline, all subjects will be assessed for oral health status, oral HRQoL, eating and nutritional risk, swallowing ability, and swallowing-related QoL. Then, the intervention group will receive 5 weeks of training with an oral screen for neuromuscular training focused on orofacial and pharyngeal muscles. After completing the intervention, and at six months post-intervention, all assessments will be repeated in both study groups.

Discussion: The results will make important contributions to rehabilitation knowledge, including approaches for improving swallowing function, oral health, and food intake and for improving the quality of oral care for older people.

Trial registration: This trial was retrospectively registered at ClinicalTrials.gov, on July 4, 2016, identifier: NCT02825927 .

Keywords: Aged; Deglutition; Eating; Oral health; Oral screen; Quality of health care; Quality of life; Short-term care; Swallowing disorders.

Figures

Fig. 1
Fig. 1
Oral screen training. (Left) The oral screen is inserted predentally, behind closed lips. (Right) The patient must press the lips firmly together, then strongly pull the handle straight forward, away from the mouth, and maintain pressure for 5–10 s. Illustrations: Mary Hägg©
Fig. 2
Fig. 2
Flow-chart of the subject inclusion and data collection processes. a See Table 1

References

    1. Raynaud-Simon A. Virtual clinical nutrition university: malnutrition in the elderly, epidemiology and consequences. E Spen Eur E J Clin Nutr Metab. 2009;4(2):e86–9. doi: 10.1016/j.eclnm.2008.11.002.
    1. Edfors E, Westergren A. Home-living elderly People’s views on food and meals. J Aging Res. 2012;2012:761291. doi: 10.1155/2012/761291.
    1. Nyberg M, Olsson V, Pajalic Z, Örtman G, Andersson HS, Blücher A, Wendin K, Westergren A. Eating difficulties, nutrition, meal preferences and experiences among elderly: a literature overview from a Scandinavian context. J Food Res. 2015;4(1):22. doi: 10.5539/jfr.v4n1p22.
    1. Gustafsson K, Andersson I, Andersson J, Fjellström C, Sidenvall B. Older Women’s perceptions of independence versus dependence in food‐related work. Public Health Nurs. 2003;20(3):237–47. doi: 10.1046/j.0737-1209.2003.20311.x.
    1. Carlsson E, Ehrenberg A, Ehnfors M. Stroke and eating difficulties: long‐term experiences. J Clin Nurs. 2004;13(7):825–34. doi: 10.1111/j.1365-2702.2004.01023.x.
    1. Smithard DG. Dysphagia: A Geriatric Giant?. Med Clin Rev. 2016;2(1):1–7.
    1. Chen P-H, Golub JS, Hapner ER, Johns MM., III Prevalence of perceived dysphagia and quality-of-life impairment in a geriatric population. Dysphagia. 2009;24(1):1–6. doi: 10.1007/s00455-008-9156-1.
    1. Hägg M, Anniko M. Influence of lip force on swallowing capacity in stroke patients and in healthy subjects. Acta Otolaryngol. 2010;130(11):1204–8. doi: 10.3109/00016481003745550.
    1. Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287–98.
    1. Hägg M, Anniko M. Lip muscle training in stroke patients with dysphagia. Acta Otolaryngol. 2008;128(9):1027–33. doi: 10.1080/00016480701813814.
    1. Budtz-Jørgensen E, Chung J-P, Rapin C-H. Nutrition and oral health. Best Pract Res Clin Gastroenterol. 2001;15(6):885–96. doi: 10.1053/bega.2001.0247.
    1. Waldman HB, Perlman SP. Ensuring oral health for older individuals with intellectual and developmental disabilities. J Clin Nurs. 2012;21(7–8):909–13. doi: 10.1111/j.1365-2702.2011.03969.x.
    1. Martin GP, Peet SM, Hewitt GJ, Parker H. Diversity in intermediate care. Health Soc Care Community. 2004;12(2):150–4. doi: 10.1111/j.0966-0410.2004.00481.x.
    1. Meinow B, Wånell SE. Korttidsplats - vårdform som söker sitt innehåll (Short-term care after inpatient care, a randomized controlled trial on effects and review of prevalence and contents) In., vol. 2011:6. Stockholm: Stockholm Gerontology Research Center; 2011.
    1. National Board of Health and Welfare. Åtgärdsförslag för att utveckla vården och omsorgen om de mest sjuka äldre. Primärvård och korttidsboende – vad behöver förändras? (Proposed measures to develop health and social care for the most frail elderly. Primary care and short-term care - what needs to be changed?). In.: National Board of Health and Welfare in Sweden; 2015.
    1. Carpenter I, Gladman JR, Parker SG, Potter J. Clinical and research challenges of intermediate care. Age Ageing. 2002;31(2):97–100. doi: 10.1093/ageing/31.2.97.
    1. World Medical Association World medical association declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4. doi: 10.1001/jama.2013.281053.
    1. Nathadwarawala KM, Nicklin J, Wiles CM. A timed test of swallowing capacity for neurological patients. J Neurol Neurosurg Psychiatry. 1992;55(9):822–5. doi: 10.1136/jnnp.55.9.822.
    1. Wilde B, Starrin B, Larsson G, Larsson M. Quality of care from a patient perspective--a grounded theory study. Scand J Caring Sci. 1993;7(2):113–20. doi: 10.1111/j.1471-6712.1993.tb00180.x.
    1. Wilde Larsson B, Larsson G. Development of a short form of the Quality from the Patient’s Perspective (QPP) questionnaire. J Clin Nurs. 2002;11(5):681–7. doi: 10.1046/j.1365-2702.2002.00640.x.
    1. Hägg M, Tibbling L. Effect of oral IQoro R and palatal plate training in post-stroke, four-quadrant facial dysfunction and dysphagia: a comparison study. Acta Otolaryngol. 2015;135(9):962–8. doi: 10.3109/00016489.2015.1042043.
    1. Hägg M, Tibbling L, Franzén T. Esophageal dysphagia and reflux symptoms before and after oral IQoroR training. World J Gastroenterol. 2015;21(24):7558. doi: 10.3748/wjg.v21.i24.7558.
    1. Westergren A, Lindholm C, Mattsson A, Ulander K. Minimal eating observation form: reliability and validity. J Nutr Health Aging. 2009;13(1):6–12. doi: 10.1007/s12603-009-0002-4.
    1. Vallen C, Hagell P, Westergren A. Validity and user-friendliness of the minimal eating observation and nutrition form - version II (MEONF - II) for undernutrition risk screening. Food Nutr Res. 2011;55:5801.
    1. Eilers J, Berger AM, Petersen M. Development, testing, and application of the oral assessment guide. Oncol Nurs Forum. 1988;15:325–330.
    1. Andersson P, Hallberg IR, Renvert S. Inter-rater reliability of an oral assessment guide for elderly patients residing in a rehabilitation ward. Spec Care Dentist. 2002;22(5):181–6. doi: 10.1111/j.1754-4505.2002.tb00268.x.
    1. Edvinsson J, Rahm M, Trinks A, Höglund PJ. Senior Alert: a quality registry to support a standardized, structured, and systematic preventive care process for older adults. Qual Manag Healthcare. 2015;24(2):96–101. doi: 10.1097/QMH.0000000000000058.
    1. Slade G. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol. 1997;25:284–90. doi: 10.1111/j.1600-0528.1997.tb00941.x.
    1. Larsson P, List T, Lundstrom I, Marcusson A, Ohrbach R. Reliability and validity of a Swedish version of the Oral Health Impact Profile (OHIP-S) Acta Odontol Scand. 2004;62(3):147–52. doi: 10.1080/00016350410001496.
    1. McHorney AC, Bricker ED, Kramer EA, Rosenbek CJ, Robbins J, Chignell AK, Logemann AJ, Clarke C. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. conceptual foundation and item development. Dysphagia. 2000;15(3):115–21. doi: 10.1007/s004550010012.
    1. Finizia C, Rudberg I, Bergqvist H, Ryden A. A cross-sectional validation study of the Swedish version of SWAL-QOL. Dysphagia. 2012;27(3):325–35. doi: 10.1007/s00455-011-9369-6.
    1. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of Adl: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914–9. doi: 10.1001/jama.1963.03060120024016.
    1. Brorsson B, Asberg KH. Katz index of independence in ADL. Reliability and validity in short-term care. Scand J Rehabil Med. 1983;16(3):125–32.

Source: PubMed

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