A Case of Early Nutritional Assessment and Swallowing Rehabilitation for Home-care Elderly People Discharged from Hospital after Gastrostomy

Abstract

　In the early stages after hospital discharge, understanding the patientʼs food style and nutritional status, and evaluating that information to adjust nutritional levels and perform swallowing rehabilitation, are important for continuing home care. We report a case of early nutritional assessment and swallowing rehabilitation for home-care elderly people who have been discharged from hospital after gastrostomy.

　The patient was an 80-year-old man suffering from corticobasal degeneration. Due to his impaired cognitive function, his ability to eat and swallow properly was diminished, leading to aspiration pneumonia. Gastrostomy was performed to ameliorate these issues and he was discharged after the operation. The patient remained bedridden, with communication difficulties, so we carried out home-visit dental treatment. Anthropometric data and blood tests showed slight nutritional disorder, so the patient was instructed to be fed with a high-density liquid diet through the gastric fistula. The patient did not ingest orally at home, so it was decided from the results of a videoendoscopic evaluation of swallowing to improve oral intake as an objective. The patient suffered from wakefulness and found it difficult to sit upright. Due to these factors, the caretaker was given instructions on dysphagia rehabilitation, starting with indirect methods and then gradually integrated direct methods. Through the use of the gastric fistula, the patientʼs nutritional status improved, but his swallowing disorder could not be ameliorated. However, after a nutritional assessment done during home dental care, we surmised that as a result of the indirect and direct swallowing training, the instruction of the caregiver, and the videoendoscopic evaluation, the patientʼs will to eat had improved and there was also a desire to work with the caregiver in continuing the swallowing rehabilitation.