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ABEA: Assessment Program Reduces Risk For Deadly Swallowing Disorders PALM BEACH, FL -- May 12, 1998 -- Aspiration pneumonia is the leading cause of death for the more than 1.5 million Americans residing in nursing homes and other long term care facilities. This deadly medical disorder is caused by the inhalation of food particles or saliva into the trachea and can lead to hospitalisation and further medical complications. Among nursing home residents, swallowing disorders commonly lead to aspiration or malnutrition. The risk of aspiration or inability to maintain an oral diet can dictate the quality and quantity of meals provided to the nursing home patient. The diet, generally agreed to by the patient's family and the nursing home staff, can affect the patient's care, independence and overall quality of life. Presently, in several long-term care facilities, many nutritional decisions are made without the benefit of a cost-effective, convenient and medically-sound evaluation of a patient's swallowing ability. Now, medical researchers from Philadelphia have developed a patient management program that can evaluate a patient's swallowing at bedside, in a treatment area, or a physician's office. The evaluation procedure is well tolerated by the patient and can be performed on a routine or urgent basis. These findings were presented at a meeting of the American Broncho-Esophagological Association in Palm Beach, FL., co-ordinated by the American Academy of Otolaryngology -- Head and Neck Surgery Foundation. The study was presented by authors Joseph Spiegel, MD and Robert Sataloff, MD, both from the department of otolaryngology-Head and Neck Surgery, The Graduate Hospital, Philadelphia, PA. The program designed is based on a team concept that includes evaluation by a speech-language pathologist, consulting otolaryngologist, and attending nursing home physician. The protocol described in the study utilised video endoscopic swallowing studies (VESS), performed on-site to gain detailed diagnostic information about a patient's swallowing. This study reviewed 144 video endoscopic swallow studies on 122 nursing home residents referred for evaluation of swallowing dysfunction over a 12-month period. Each patient was a resident of one of four skilled nursing facilities in the Philadelphia area. The reasons for referral were aspiration (45 consultations whose average age was 86 years); a request to upgrade the patient's diet (45 consultations, average of 73 years); dysphagia (41 consultations, 83 years old); and decreased oral intake secondary to impairment of swallowing function, a condition noted in 13 patients, with an average age of 92 years. Seventy-two percent of the residents in the study were female, 28 percent were male, the ratio of reported nursing home patients in the United States. VESS is a procedure which the examiner directly visualises the throat during swallowing. VESS consists of two parts. The first stage evaluated the body's swallowing equipment, most notably the tongue, palate, pharynx, larynx and gag reflex. The cough reflex was assessed for strength and efficiency. The second part of VESS is a dynamic assessment of swallowing that evaluates multiple swallowings of the patient, in taking soft foods and liquids. VESS was performed successfully on all patients with no complications. None of the patients studied developed aspiration complications while 11 of 110 patients in a cohort group were hospitalised for that swallowing disorder. The results of the VESS studies provided information to the researchers enabling recommendations for a variety of changes to the patients' diet. In the entire group, 73 percent of the patients started and maintained a new diet over the course (one year) of the study. Of the remaining 27 percent of the group who did not tolerate diet recommendations, one-third experienced a deterioration of their medical status. Among the several conclusions reached in the study is that VESS provides an attractive alternative to videoflueroscopic technology now used to assess swallowing in many long-term care facilities. VESS can avoid the scheduling, expenses and inconvenience incurred by patients and, most importantly, prevent the onset of deadly aspiration and malnutrition. All contents Copyright 1998 P\S\L Consulting Group Inc. All rights reserved -- Judith Richards, London, Ontario, Canada [log in to unmask]