The relationship between problems specific to elderly with chronic CVA and rehabilitation outcome

Abstract

【Purpose】We often experience elderly patients who have only mild dysphagia but are NPO. The purpose of this study was to investigate the relationship between problems that are specific to elderly patients with chronic CVA and the outcome of dysphagia rehabilitation for these elderly patients.

【Methods】Thirty tube- or IV-fed patients who were： 1) ＞65 years old (aged 66–96, 23 males), 2) chronic CVA (＞30 days from onset), 3） NPO, and 4) exhibiting mild dysphagia, were studied and treated by speech therapists. Two groups of patients were identified based on their responses to swallowing therapy: “good outcome” if all nutrition was oral； and “poor outcome” if nutrition was provided via tube or IV. General medical, activity, mental and motivational status during the first examination, and the number of times of fever and the development of amount intake per day during the therapeutic processes were determined and compared between the good outcome group and the poor outcome group.

【Results】Twenty patients, had good outcomes, while ten had poor outcomes. There were no significant differences between the two groups in general status, activity status or mental function at the first examination. Duration from the onset was significantly longer in good outcome patients. Most were bedridden and demented. Motivation was significantly lower in the poor outcome group. A half of patients with severe dementia and severe apathy could regain oral intake. Seventy-five percent of the good outcome patients increased their oral food intake by more than 50% within 10 days, while none in the poor outcome group showed an increase of more than 50%. There was no significant difference between the number of times of fever in the two groups.

【Discussion】In our study of elderly patients who had only mild dysphagia but who were NPO and bedridden and demented, 67% of the patients were tube-free by the end of treatment. So, dysphagia rehabilitation is important for these patients. As it is important but difficult to determine a feasible method of providing adequate nutrition and direction for dysphagia rehabilitation, clinicians should consider a trial of direct therapy for about 10 days for chronic disabled elderly patients.