[Dysphagia] Dehydration and falls 2

[eripley at yahoo.com (Irene Campbell-Taylor)]

I sent a lengthy response - as requested- that may or may not get through. Please note that I did not say that dehydration is the only cause of falls simply that dehydration is the most common cause of orthostatic hypotension that leads to falls. VFSS with food is not best practice since it bears no resemblance to eating a meal. NHs are, to my personsl knowledge, being sued for using thickened liquids.Fear of litigation related to the devlopment of pneumonia is unfounded for many reasons and if you are informed otherwise, get a new lawyer.
  I refer you to:
  Merck Manual of Geriatrics:  Orthostatic Hypotension
  A reduction of >= 20 mm Hg in systolic blood pressure or of >= 10 mm Hg in diastolic blood pressure on standing upright.
  Orthostatic hypotension occurs in 15 to 20% of community-dwelling and in about 50% of institutionalized elderly persons. Orthostatic hypotension is often provoked by common hypotensive stresses such as dehydration, use of hypotensive drugs, or the Valsalva maneuver during voiding. The most common cause of acute orthostatic hypotension is dehydration. Patients with acute orthostatic hypotension due to dehydration should be treated with fluid replacement therapy.
  and
  Design, Procedures, Findings and Issues from the Largest NIH-funded Dysphagia Clinical Trial
  Entitled:Randomized Study of Two Interventions for Liquid Aspiration:
  Short- and Long-term Effects (aka: ?Protocol 201?)
  Commercial Relationships: Novartis Food Service Division?, E-Z-EM, Inc.?
  Supported by Grant #DC03206 to ASHA from DHHS/NIH/NIDCD
  Protocol 201
  Logemann, Robbins et al.
   
  Major Findings  Long term results show that despite differential effect of interventions on immediate elimination of aspiration in videofluoroscopic suite (Part I findings)

the 3-month incidence of pneumonia was similar for chin down posture compared to thickened liquids
   
  Adverse Events  Hospitalization
  Dehydration
   Dehydration
  No difference in measured parameters  Subset: n=16
  Serum osmolality
  Sodium
  BUN (mg/dL)
  Serum creatine (mg/dL)
  Defined by primary physician
  Was more frequent in thickened liquid arms (6% vs. 2%, p<0.05)
  Current Clinical Notion
  ?The thicker the liquid, the safer the swallow?
  *Not true in patients who aspirate thick liquids ? worse health outcomes
   
   


Dr I Campbell-Taylor
Clinical Neuroscientist
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