The Follow-up Study of Dysphagia caused by Stroke after leaving hospital

Abstract

The purpose of this study is to investigate how the dietary status of dysphagic stroke patients in an acute care hospital predicted their dietary conditions after leaving hospital．

Methods： 149 dysphagic stroke patients (average age 70.2)，who received swallowing training from April 1，2001 to March 31，2003 were the subjects of this study． Data on their dietary status (nutrition type and food modification) on hospital discharge was collected from their medical records． A follow-up survey after they had left hospital was conducted by telephone inquiries on where they lived and their dietary status． The average number of days from the onset of illness to the survey was 429，and that from hospital discharge to the survey was 338．

Results： On hospital discharge，33 patients were on full tube feeding，10 were on the combination of tube and oral feedings，and 94 were on full oral feeding．12 were dead．Of 137 patients who were alive on hospital discharge，133 patients responded to the survey (97％)．76 respondents resided at home and 90％ of them were on full oral feeding．70％ of the patients who needed tube feeding were being hospitalized． The distribution of the dietary status in the follow-up survey was as follows; 19 (13％) were on full tube feeding，7 (5％) were on the combination of tube and oral feedings，89 (60％) were on full oral feeding．29 patients (19％) were dead and the whereabouts of 4 (3％) were unknown．42％ of the respondents returned to normal diet． The coefficient of correlation between the nutrition type on hospital discharge and that at the time of the follow-up survey presented 0.768．

Discussion：Swallowing abnormalities were observed in more than half of the patients one year or more post onset．Patients who presented symptomatic improvement by the time of discharge from an acute care hospital were likely to reside at their homes，not medical or other institutions．The dietary status on hospital discharge may predict dietary status afterwards．It should be noted，however，that some presented conspicuous improvement while some presented deterioration after hospital discharge． The results imply that a long-term care is required for dysphagic patients caused by stroke． A regular follow-up system should be in place taking into consideration the prevention of complications，continuous assessment of swallowing functions，QOL，and burden of nursing care on the patients' families．