Aims: Soybean is one of the best sources of vegetable protein and especially black soybean contains polyphenol in anthocyanin group, which is appreciated for antioxidative effects. It is difficult for the dysphagic persons to masticate and swallow even well- stewed soybeans, owing to the remains of soybean skin. In this study we prepared the soybean protein added with black soybean broth, using soybean protein isolate with over 85% protein. We investigated textural properties and sensory evaluation and further, underwent the video-fluorographic examination of swallowing (VF). We discussed whether these gels had the advantages to a modified diet for the dysphagic persons.
Methods: For the preparation of the black soybean broth added-soybean protein gels (BS-SP gels), soybean protein isolate was added with black soybean broth to be concentrated into 14, 15, 16 and 17%, respectively, which were processed by heating and pressure. For the heating process, the samples were heated for 30 min at 85℃ (heated gels), while the other samples were pressurized at 400 MPa for 20 min with a food pressurized testing machine for the pressure process (pressurized gels). Textural values in physical properties of both samples were measured by a creepmeter. Sensory evaluation was done by healthy young females. All the factors affecting overall acceptance were analyzed by the analysis of covariance. A VF was undertaken for the dysphagic patients. The number of mastication and swallowing and the transit time of the bolus were determined based on the VF lateral view using a video editing software program.
Results and Discussion: Textural values of BS-SP gels were conformed to the dietary criteria of Food for Special Dietary Uses for Dysphagic patients. For the sensory test the pressurized gels were evaluated easier to swallow and less residues remained than the heated gels. From the behavior of swallowing by VF, the pressurized gels were suggested easy to swallow, owing to making a bolus easily and the short transit time of the bolus in the regions of valleculae and hypopharynx. Compared the evaluation of each gel with the results in the table of Japanese Dysphagia Diet 2013 by the JSDR dysphagia diet committee (JDD2013), 14 to 16% heated and pressurized gels and 17% ones were consistent with the code 1j and 3 of the modified diet for dysphagic persons, respectively. From these results it is suggested BS-SP gels, rich nutritional and high functional foods, were identified as a modified diet for the dysphagic persons.
Aims: This research aimed to acquire basic information about the practice of the types of easy-to-eat meals served at special schools, daycare facilities and residential facilities for children and adults with disability in the developmental period in order to make a Japanese standard classification of swallowing-ameliorating food for persons getting dysphagia in the developmental period.
Subjects and Method: We constructed a questionnaire about the types of easy-to-eat meals served at lunchtime, and then sent it to all daycare facilities and residential facilities for persons with severe motor and intellectual disabilities (SMID) and all special schools for disabilities in Tokyo and Shizuoka prefectures. The number of facilities targeted by the survey was 502. We evaluated the responses and compared them between special schools and facilities for persons with SMID.
Results and Discussion: Three hundred twelve facilities or schools answered the survey (response rate: 63.3%). The number of types was many, but each type was rearranged by caregivers or teachers to adapt to the swallowing ability of each client or student. The types had various names, and some names indicated multiple types. The number of names of each type was bigger among the facilities than among the schools.
Conclusion: It was found to be important to make a Japanese standard classification of swallowing-ameliorating food for persons getting dysphagia in the developmental period. We will propose a classification using the results.
The number of dependent older people who require oral care and eating assistance are increasing. It is important for trainee dentists to have the chance to provide oral care and eating instructions to older people in nursing homes. However, there are few institutions that provide this opportunity. In the postgraduate clinical training at Niigata University, trainee dentists have this experience at nursing homes once a week. To enable the best training program to be developed for the future, a questionnaire survey was performed.
The subjects participating in this survey were 144 trainee dentists from Niigata University, who were involved in post-graduate training from 2009–2013. The questionnaire included questions testing their knowledge, as well as their experience of providing oral care or eating instructions to older people in nursing homes, and how they rate the value of these practices.
As a result, although 80.4% had adequate knowledge of oral care, only 56.6% and 18.2% of trainee dentists had provided oral care or eating instructions, respectively. Most of the trainee dentists had answered that oral care and the provision of eating instructions were worthwhile. Eighty percent of the trainee dentists thought that intervention by dental staff for oral care and eating instruction was important.
As the number of dependent older people increases, the role of dentists in oral care and the provision of eating instructions become more important. Introducing these practices in nursing homes as part of trainee dentists’ post-graduate clinical training would be very helpful in providing dentists with the experience to give instructions for eating assistance to patients’ families and co-medical staff.
Membranous substances, which are not observed in healthy individuals, are sometimes observed in the mouths of elderly persons requiring nursing care. These are often reported to be in the form of a crust or sputum, but there are reports suggesting that they are actually a peeling epithelial membrane. This latter description is based on the fact that epithelial components exhibiting a layered structure with a stratum corneum have been seen in pathological observation of these membranes. One of the risk factors for developing membranous substances was reported to be dryness of oral membrane. An effective method for suppressing the formation of membranes is not clear. The intervention of oral care (tooth-brushing and application of gel-type moisturizer) by a dentist and spraying of moisturizer by nurses was examined to determine the effectiveness on suppressing membrane formation.
The subjects were 27 elderly patients requiring nursing care in hospital A in Nagano prefecture and hospital B in Yamanashi prefecture. All study subjects were bedridden and assisted tooth-brushing was carried out twice a day. The intervention of oral care (tooth-brushing and application of gel-type moisturizer twice a week) by a dentist was carried out, and spray moisturizer (liquid type) was applied by the nurses more than five times a day.
The liquid-type moisturizer was sprayed by the nurses an average of 6.9±5.3 times a day. The presence of membranous substances was observed at the baseline (pre-intervention): in the buccal mucosa in one person, on the tooth surface in 2, on the tongue in 5, and on the palate in 7. Of the 10 patients who had membranous substances formed at the baseline, the membranous substances were suppressed by intervention after one week in 5 patients (50%). Thus, formation of membranous substances was significantly reduced by the intervention.
In order to suppress the formation of membranous substances, it is clear that the use of moisturizer in addition to assisted tooth-brushing is effective.