Effect of a Minimal-Massive Intervention in Hospitalized Older Patients with Oropharyngeal Dysphagia: A Proof of Concept Study

Oropharyngeal dysphagia (OD) is a newly defined geriatric syndrome that causes nutritional and respiratory complications in older hospitalized patients. Following hospital discharge, OD also causes hospital readmission and mortality in this population. Our aim was to assess the effect of a minimal-massive intervention (MMI) in reducing nutritional and respiratory complications in older hospitalized patients with OD. An open label trial was performed on 186 hospitalized older patients (> 70y) with OD; 62 of these patients with OD were treated with the MMI and paired by sex, age, functionality, comorbidities and body mass index with two controls. The MMI consisted of: a) fluid thickening and texture-modified foods, b) caloric and protein supplementation; and c) oral health and hygiene recommendations during hospitalization and following discharge. The control group followed the standard clinical practice without MMI. Main study outcomes were hospital readmissions, respiratory infections, nutritional status and survival after 6 months follow up. Both groups had similar advanced age (84.87 +/- 6.02MMI and 84.42 +/- 5.31 years), poor functionality (Barthel 59.51 +/- 26.76 MMI and 58.84 +/- 26.87), and high comorbidities (Charlson 3.00 +/- 1.60 MMI and 3.06 +/- 1.45). Main results showed that MMI improved nutritional status (MNA 9.84 +/- 2.05 pre-MMI vs. 11.31 +/- 2.21 post-MMI; p=0.0038) and functionality (Barthel 62.34 +/- 25.43 pre-MMI vs. 73.44 +/- 25.19 post-MMI; p=0.007). In addition MMI decreased hospital readmissions (68.8 readmissions/100 persons-year (28.1-109.38) MMI vs. 190.8 (156.0-225.7); p=0.001), respiratory infections (12.50 readmissions/100 persons-year (0-29.82) MMI vs. 74.68 (52.86-96.50); p=0.002), and increased 6-month survival (84.13% MMI vs. 70.96%; p=0.044). Our results suggest that a MMI in hospitalized older patients with OD improves nutritional status and functionality and reduces hospital readmissions, respiratory infections and mortality. MMI might become a new simple and cost-effective strategy to avoid OD complications in the geriatric population admitted with an acute disease to a general hospital.