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    An International Commentary on Dysphagia and Dysphonia During the COVID-19 Pandemic
    (Springer Nature, 2022-12) Miles A; McRae J; Clunie G; Gillivan-Murphy P; Inamoto Y; Kalf H; Pillay M; Pownall S; Ratcliffe P; Richard T; Robinson U; Wallace S; Brodsky MB
    COVID-19 has had an impact globally with millions infected, high mortality, significant economic ramifications, travel restrictions, national lockdowns, overloaded healthcare systems, effects on healthcare workers’ health and well-being, and large amounts of funding diverted into rapid vaccine development and implementation. Patients with COVID-19, especially those who become severely ill, have frequently developed dysphagia and dysphonia. Health professionals working in the field have needed to learn about this new disease while managing these patients with enhanced personal protective equipment. Emerging research suggests differences in the clinical symptoms and journey to recovery for patients with COVID-19 in comparison to other intensive care populations. New insights from outpatient clinics also suggest distinct presentations of dysphagia and dysphonia in people after COVID-19 who were not hospitalized or severely ill. This international expert panel provides commentary on the impact of the pandemic on speech pathologists and our current understanding of dysphagia and dysphonia in patients with COVID-19, from acute illness to long-term recovery. This narrative review provides a unique, comprehensive critical appraisal of published peer-reviewed primary data as well as emerging previously unpublished, original primary data from across the globe, including clinical symptoms, trajectory, and prognosis. We conclude with our international expert opinion on what we have learnt and where we need to go next as this pandemic continues across the globe.
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    Investigation of nutrition risk in community living adults aged 75 years and older : prevalence and associated physical health factors : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand
    (Massey University, 2016) Williams, Vicki Jean
    Background: New Zealand’s population is ageing. Given prevalence of functional disability and chronic disease increases with age, and older adults account for one third of health loss in New Zealand, supporting older adults to maintain independence is paramount to reducing future health care costs. A compromised nutritional status, and declining muscle mass, strength and function threatens independence. This study aims to investigate the prevalence of nutrition risk, and identify associated socio-demographic and physical health factors among community-living older adults aged 75 years and older. Methods: A total of 200 participants were recruited from eligible patients enrolled at the Henderson Medical Centre. Baseline sociodemographic, and health information was collected using an interview style questionnaire. Body composition, including muscle mass was estimated using Bioimpedance Analysis (BIA). Muscle strength was assessed using a hand held dynamometer to measure grip strength, and a Five Times Sit To Stand (5TSTS) test. Lower extremity function performance was assessed using 2.4 meter gait speed. Validated screening tools identified nutrition status (Mini Nutritional Assessment Short Form MNA-SF), swallowing status (10 item Eating Assessment Tool EAT-10), and cognitive status (Montreal Cognitive Assessment MoCA). Pearson’s Coefficient Correlations were used to identify associations between nutrition risk and physical health nutrition risk factors. Results: The study sample (n= 200) included 89 (44.5%) men, and 111 (55.5%) women with a mean age of 80.5 years. The MNA-SF identified 2 (1%) malnourished participants, and 24 (12%) participants at risk of malnutrition. MNA-SF scores were positively correlated with a lower BMI (r=0.257, p=<0.001), lower muscle mass, lower calf circumference (r=0.333, p=<0.001), lower percentage of body fat (r=0.287, p=<0.001), and weaker grip strength (r=0.143, p=0.047). MNA-SF scores had an inverse correlation with EAT-10 scores indicating dysphagia risk (r=0.182, p=<0.010). Conclusion: A low prevalence of malnutrition was found in this study population. Those at risk of malnutrition or malnourished were more likely to use support services, be at risk of dysphagia, have a low BMI, low muscle mass, a lower calf circumference, lower percentage of body fat, and poor muscle strength. Routine nutrition risk screening is recommended to identify at risk individuals early to prevent escalation to malnutrition and poor health. Key words: Malnutrition, MNA-SF, Older Adults, Community, Dysphagia, Muscle Mass
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    An Investigation of Nutrition Risk among Hospitalised Older Adults Admitted to the Assessment, Treatment and Rehabilitation Wards of Waitemata District Health Board Hospitals : A Thesis Presented in Partial Fulfilment of the Requirements for the Degree of Master of Science in Nutrition and Dietetics Massey University, Albany New Zealand
    (Massey University, 2016) Patel, Darshan Arvind
    Background: The proportion of older adults in New Zealand is increasing. Studies shows compromised nutrition status is prevalent in older adults, and can exacerbate poor health. It is therefore important to identify those who are malnourished, or those who are at nutrition risk for early nutrition intervention. Nutrition screening tools allow for the identification of nutrition risk status and initiation of nutritional care to result in improved health outcomes. Current data on the prevalence of nutrition risk in hospitalised older adults in New Zealand is limited. Design: Cross-sectional, observational study as part of a multicentre prospective study. Aim: To investigate the prevalence of nutrition risk among older adults (65-84 years) in the Assessment, Treatment and Rehabilitation (AT&R) wards of North Shore and Waitakere Hospitals. Potential nutrition risk factors including dysphagia risk, muscle mass and hand grip strength will also be investigated, as well as other relevant physiological and socio-demographic risk factors. Methods: Participants were recruited within five days of admission to the AT&R wards. Face-to-face interviews and assessments were conducted on the wards. A questionnaire incorporating participant characteristics, health and support data and validated screening and assessment tools were used. Nutrition risk status was assessed by the Mini Nutrition Assessment-Short Form, dysphagia risk status was assessed by the Eating Assessment Tool, cognitive status was assessed by the Montreal Cognitive Assessment and muscle mass was assessed by bioelectrical impedance analysis. Hand grip strength was measured using a hydraulic dynamometer. Results: A total of 89 participants took part in the study. Nutrition risk and malnutrition was evident in 43.8 and 27.0 percent of the study participants respectively. Indicated by the Mini-Nutrition Assessment-Short Form, participants with poor nutritional status were more likely to report reduced food intake, unintentional weight loss, requiring aid with activities of daily living, having previous dietetic input and being at risk of dysphagia compared to participants with ‘normal’ nutritional status. Conclusion: A high percentage of hospitalised older adults recently admitted to the AT&R wards had compromised nutritional status. Routine screening is highly advised to identify nutritional risk and instigate nutritional care.
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    Screening for nutrition risk and dysphagia among older adults newly admitted to age related residential care facilities in the Waitemata DHB region : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Auckland, New Zealand
    (Massey University, 2014) Watkin, Rebecca Stephanie
    Background: New Zealand has an ageing population, reflected by an older average population age and reduced mortality. Good nutrition is essential for successful ageing. Many factors are known to influence nutrition risk, and a high prevalence has been observed overseas in people living in age related residential care (ARRC) facilities. In New Zealand, there is limited data on both the prevalence of nutrition risk in ARRC facilities and the health factors that contribute to risk. The changing demographics of the population means that a greater understanding in this area will be important to develop strategies which support the maintenance of good nutrition status for longer, thus potentially reducing health burden. This study aims to determine nutrition risk and the risk of dysphagia (swallowing difficulties) in older adults recently admitted to an ARRC facility in the Waitemata District Health Board (DHB) region. Methods: Fifty-six individuals aged ≥65 years (or ≥55 years for Māori and Pacific) who were admitted for the first time to an ARRC facility within the Waitemata DHB region were invited to participate in the study. Potential contributors to nutrition risk were explored using a questionnaire that asked about nutritional and non-nutritional risk factors. The Mini Nutritional Assessment®-SF (MNA®-SF) was used to determine level of nutrition risk. Risk of dysphagia was identified using the Eating Assessment Tool (EAT-10). The Montreal Cognitive Assessment (MoCA) was carried out at the end of the interview and was used as a measure of cognitive function. Results: A total of 53 participants with a mean age of 88 years were included. Overall, 91% of the participants were either malnourished (47%) or at risk of malnutrition (43%). Normal nutritional status was only prevalent in 9% of participants. Fifty-seven percent of participants were widowed, of which, 52% were malnourished. When malnourished participants were compared to those with normal nutritional status, malnourished participants were more likely to be underweight, in hospital level care, have a recent severe decrease in food intake, recent weight loss of greater than 3kg, have poorer mobility, experienced psychological stress or acute disease and have severe dementia or depression. Malnourished participants were more likely to report weight loss of greater than 3 kg than those at risk of malnutrition (56% vs. 13% respectively, p = 0.03; Fisher’s exact test). Those who were malnourished had poorer mobility (χ2 = 8.592 p = 0.003) and were more likely to be at risk of dysphagia (χ2 = 6.273 p = 0.01) compared to those at risk of malnutrition. Participants in hospital level of care were also more likely to be at risk of dysphagia compared to those in rest home level of care (χ2 = 4.627 p = 0.03). ii Conclusions: These findings suggest there may be a high prevalence of nutrition risk among older adults newly admitted to ARRC facilities within New Zealand and that existing poor nutrition may have contributed to the need to move into ARRC. The predisposing factors that affect nutrition status warrant further investigation so initiatives can be undertaken to avoid a change in living situation. The results highlight the need for nutrition screening and early intervention by a dietitian.