Evaluation of supplemental and oral deglutition foods in bedridden elderly patients receiving parenteral nutrition

Background and Aim: We examined oral dyskinesia (OD), wearing artificial tooth, food test findings and conducted a video - fluoroscopic swallowing study (VFSS) in bedridden elderly patients before they were received parenteral nutrition once daily. However, the validity and properties of these deglutition foods have not been evaluated. Therefore, in this study, we clarified four deglutition foods as four aspects.Method: Forty-five patients (23 males, mean age: 82.5 years) receiving deglutition foods were evaluated. The OD and food tests were performed at the bedside. The VFSS (dynamics of swallowing, oropharyngeal transit time, distance of hyoid bone displacement and difference in the oropharyngeal transit time) was conducted via X-rayunder administration of contrast medium mixed with food. Additionally, the physical properties of the deglutition foods were evaluated in accordance with thestandard methods for patients with dysphagia by the Ministry of Health, and Labour, Welfare and Consumer Affairs Agency.Results: The mean duration receiving deglutition foods was 8 months. Although OD and wearing artificial tooth were observed in 42% of the patients, the rate of OD was significantly higher in patients receiving thick than in patients receiving jelly. The deglutition foods were classified into four types based on their physical properties (thick 1, n=18; thick 2, n=10; jelly 1, n=10; and jelly 2, n=7). The food test scores markedly differ among the four types of deglutition food. The mean score for swallowing dynamics was significantly different among the four types. Although the oropharyngeal transit time was similar for each type, the thick 1 group was divided into fast and slow transitors. The distance of hyoid bone displacement was significantly different among the four types. The oropharyngeal transit time was significantly correlated with the number of teaspoons ingested at a time. In the physical properties test, all four deglutition foods showed appropriate results; thick 1 and 2 were within the standardII category, while jelly 1 and 2 were within the standardIII category.Conclusion: The results of swallowing tests suggest that these four deglutition foods may be safe and reasonable for administration to bedridden elderly patients receiving parenteral nutrition.