Dysphagia from the Perspective of Home Health Care

Abstract

　Patients with dysphagia under home care range from those who have difficulty in swallowing their usual meals to those who are unable to take their food orally and need tube feeding. Patients with dysphagia of varying degrees of severity are seen at local clinics. The purpose of this study was to clarify the characteristics of dysphagia in patients under home care and the features of dysphagia treatment in otorhinolaryngology clinics.

　A total of 361 patients with dysphagia who visited four otorhinolaryngology clinics in Kobe over a 11-year period from June 2008 to September 2019 were included in the study. We examined the interrelationships between the patients' form of meals, alternative nutritional methods, causative diseases, presence/absence of pneumonia, referring physicians, swallowing rehabilitation, and long-term care insurance certification.

　The results of our study revealed that in 137 of 361 cases (38%), the patients were not able to consume their conventional diet (so-called normal diet) orally; of the 137, 51 had a gastrostomy. Nearly half of the patients (166 cases)received referrals from home-related occupations.

　There were many cases of dementia, including those with underlying Parkinson's syndrome and cerebrovascular disorders. There were a number of cases in which the speech therapists visited the home as part of the visiting nursing about the rehabilitation at home.

　In home care, patients receive less nursing and care than during hospitalization. The role of the otolaryngologist is to provide outpatient guidance about the appropriate diet and eating style for each stage/severity of dysphagia. It is also important to provide appropriate rehabilitation and nutritional management at home, if necessary. This requires the cooperation of the patient's primary physician at home and other medical professionals in the community. In addition, collaboration with regional medical-related occupations is necessary, and especially for rehabilitation, it is often necessary to utilize long-term care insurance at home.