الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Dysphagia is defined as the subjective sensation of difficult swallowing. It is considered a serious problem affecting geriatric patients because of the increased risk of aspiration. Dysphagia and risk for aspiration is a geriatric syndrome and should be early screened and treated in all hospital admitted geriatric patients in order to reduce morbidity and length of hospital stay. The gerontological nurse plays an important role in early assessment; identification; management and prevention of complications related to dysphagia. She also identifies factors associated with aspiration risk among geriatric patients with dysphagia.
This study aimed to identify the factors associated with aspiration risk among geriatric patients with dysphagia.
Materials and Method:
Design: This study followed a descriptive research design.
Settings: The study was carried out in the Medical Units of the Alexandria Main University Hospital namely; cardiovascular diseases, geriatric medicine, gastrointestinal diseases, liver, gallbladder and pancreatic diseases, rheumatoid, autoimmune diseases and hematology diseases.
Subjects: The study included 100 geriatric patients with dysphagia; aged 60 years and more, with no contraindication for oral feeding, able to maintain sitting position, able to communicate and available at the time of data collection.
Tools of the study:
Four tools were used for data collection;
Tool I: Gugging Swallowing Screen (GUSS):
This tool was used to identify alterations of the swallowing process and aspiration risk. It consists of two parts, indirect and direct swallowing test items. Indirect swallowing test items include vigilance, cough and saliva swallow. While direct swallowing test items include deglutition, involuntary cough, drooling and voice change. The total score is 20, where (0-9) denotes severe dysphagia with high risk for aspiration, (10-14) moderate dysphagia with a risk of aspiration, (15-19) slight dysphagia with a low risk of aspiration and (20) no dysphagia and minimal risk of aspiration.
Tool II: Sociodemographic and clinical data of geriatric patients with dysphagia structured interview schedule:
This tool was developed by the researcher to assess the socio demographic characteristics of the study geriatric patients such as age, sex, level of education, marital status, occupation before retirement, monthly income and living arrangement. The clinical data included date and reason of hospital admission, medical diagnosis, treatment regimen, side effects of medications.
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Tool III: Factors associated with aspiration risk among geriatric patients with dysphagia structured interview schedule:
This tool was developed by the researcher to identify factors associated with aspiration risk such as (previous episodes of aspiration) Patient oral condition, eating pattern, distraction and fatigued while eating or drinking.
Tool IV: Barthel Index:
This tool was used to measure level of dependency in performing activities of daily living (ADLs). The scale consists of the following items feeding, bathing, grooming, dressing, controlling bowel and bladder, getting on and off toilet, moving from chair to bed, walking, ascending and descending stairs. The total score of the scale is 20 and is classified as follows; 0-7 dependent, 8-12 need assistance and13-20: independent.
Method:
Permission was obtained from the responsible authorities to carry out the study.
Survey of all hospital statistical records of the medical units affiliated to the Alexandria Main University Hospital 2016 was carried out by the researcher in order to identify those units with high rate of admission of geriatric patients.
The study tools were tested for content validity by 7 experts in the related fields of the study.
Tool I and Tool III were tested for reliability by using Cronbach’s coefficient alpha test, the reliability value=0.77and 0.774 respectively.
Pilot study was done on 10 geriatric patients with dysphagia. These were not included in the study subjects.
The researcher used to visit the selected medical units all days of the week except Friday. It took from 30-40 minutes to collect the necessary data from the selected subjects.
Data collection started from mid-October 2017 till mid-January 2018.
For statistical analysis, the Chi square test was used and the level of significance was set as ≤0.05 level.
The main results obtained were as follows:
The age of the studied geriatric patients ranged from 60-86 years with a mean age of 69.1 ± 7.1 years, females constituted 54.0% and males 46.0% of them, 55.0% were married. Illiteracy was prevailing among 41.0% and 74.0% were living with family members.
Regarding to the level of dependency 57.0% of the studied geriatric patients need assistance in performing activities of daily living, 24.0% were independent and 19.0% totally dependent.
Concerning the history of previous hospitalization during the last year, 61.0% of the studied geriatric patients were admitted to hospital. The main reasons reported were general weakness 50.8%, dyspnea 41.0%, dysphagia 36.1% and chemotherapy 27.9%. While the main reasons reported of the current hospitalization were, anorexia 75.0%, general weakness 68.0%, dysphagia 50.0% and sever tachycardia 41.0%.
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Cardiovascular, hematology, liver, gallbladder and pancreatic diseases were the most common current medical diagnosis (80.0%.66.0% and 64.0%) respectively. Analgesics, antibiotics, antihypertensive, corticosteroids and potassium were the most common prescribed medications (82.0%, 79.0%, 77.0% and74.0%) respectively.
The main causes of dysphagia, either before or after hospitalization were poor oral condition 74.0%, anorexia 72.0%, sore throat 71.0% and side effects of medication 64.0%.
Severe dysphagia with a high risk of aspiration was observed in 37.0% of the study geriatric patients, moderate dysphagia with a risk of aspiration in 27.0% and had slight dysphagia with a low risk of aspiration 36.0%.
A statistically significant difference was observed between the severity of dysphagia and aspiration risk and living arrangement (χ2=7.312, p=0.026), level of dependency(χ2=23.745, p=<0.001), chemotherapy treatment (χ2=6.705, P=0.035), mouth dryness and weak tongue movement as a side effects of medication (χ2=6.062, P =0.048 and χ2=6.651, P =0.036) respectively, semi-solid food (χ2=6.820, P=0.033), mouth full with food (χ2=13.596, P =0.001), Feeling tired and fatigue while eating or drinking (χ2=13.596, P =0.001).
Based on the results of the current study, it can be concluded that:
The severity of dysphagia and aspiration risk is affected significantly by living arrangement, the level of dependency, receiving chemotherapy treatment and mouth dryness and weak tongue movement as a side effects of medication. Also some risk behaviors as filing mouth with foods and feeling tired and fatigued during eating.
Based on this study finding, the following recommendations are suggested:
Comprehensive assessment of geriatric patients for dysphagia and aspiration risk should be a routine and basic procedure of the gerontological nurse in order to identify early those at risk and implement appropriate nursing interventions to prevent complications.
Arabic educational posters and brochures should be developed and used as a teaching aid for the geriatric patients with dysphagia and aspiration risk and their family contain all information about dysphagia, its signs and symptoms, risk factors for dysphagia and aspiration risk and how to manage it to prevent its complications.
Recommendations for further researches:
Effect of an educational program for nurses on their performance in dealing with geriatric patients with dysphagia and aspiration risk.