2007 Volume 11 Issue 1 Pages 60-66
The objective of this study was to investigate the measures to improve the quality of care for the frail elderly. We conducted a mail survey of people with ingestion and swallowing disorders and the situation of the care within geriatric health-care facilities in Nagano prefecture (response rate 57.5%, 46 facilities). The subjects included both resident patients and those admitted for a short-term stay within the facilities. Regarding people with ingestion and swallowing disorders, we investigated the type of nutritional management and the application of assistance for oral feeding. Regarding the situation of the care, we investigated how to decide the method of care, whether the facility offered a care program, whether reimbursement was requested under the Long-term Care lnsurance (LTCI) scheme, and the incidence of aspiration accidents. From the 46 facilities, a total of 3699 users were evaluated per day. The users were categorized into four classes as follows：Support Required and Care Level 1, 11.7% (432 persons)；Care Levels 2 and 3, 38.8% (1437 persons) ； Care Levels 4 and 5, 48.8% (1805 persons)；Others, 0.7% (25 persons). People aged 85 and over accounted for 56.0% (2071 persons) of users. Those requiring assistance/supervision for oral feeding accounted for 38.4% (1422 persons), and those with cognitive disorders necessitating this type of support accounted for 28.0% (1037 persons). People using tube-feeding accounted for 6.4% (238 persons). At 30 facilities (65.3%) the staff assessed the method of feeding care with a formal evaluation tool. Thirty-five facilities (76.1%) held a conference about the feeding problems of each case； 12 (26.1%) performed speech therapy for dysphagia； and regular dentistry was done at 8 facilities (17.4%). Screening for nutritional disorders was performed by recording the BMI in 42 facilities (91.3%).Thirty-eight facilities (82.6%) requested the benefits of nutritional management from LTCI. There were aspiration accidents at 20 facilities (43.5%) during a three-month period. To improve the quality of the care, we need to (1) improve the evidence to support the feeding activities of the elderly with dementia；(2) increase the number of the facilities where the staff assesses the method of feeding care with a formal evaluation tool and where conferences are conducted about feeding problems, dentistry, and professional swallowing training.
