Authors: (including presenting author): :
CHAN TS(1), LUI BKP(1), LAM CY(1), WONG KP(2), CHING KM(3), LAM SS(1), LEE KN(1), CHAN LY(1), TONG PY(1), CHAN LW(1), MOK SM(2), IP SF(2), NG YT(2), YU SP(1), PANG HSI(1), WAN MC(1)
Affiliation: :
(1) Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals, (2) Speech Therapy Department, Ruttonjee and Tang Shiu Kin Hospitals, (3) Dietetic Department, Ruttonjee and Tang Shiu Kin Hospitals.
Keyword 2: :
Tongue Pressure Assessment
Keyword 3: :
Enhancement Program
Keyword 4: :
Geriatric Day Hospital
Introduction: :
Oral Frailty is increasingly recognized as a new geriatric syndrome, due to its strong association with frailty, sarcopenia, institutionalization and premature mortality among geriatric patients (Tanaka et al., 2021; Kawamura et al., 2024). Increasing evidence suggests that sarcopenia plays a significant role in oral frailty and dysphagia due to loss of oral muscle mass and strength. This study tries to find out the relationship between swallowing function, tongue function and sarcopenia, aiming at possible early identification and treatment of subclinical deterioration of tongue function before noticing clinical signs of dysphagia.
Objectives: :
• To enhance the care and service quality of sarcopenia patients • To evaluate the feasibility and effectiveness of a pilot enhancement program on referral system for sarcopenia patients • To increase patient, relatives or caregiver engagement in disease management
Methodology: :
The program was conducted from October to November 2024. Diagnosis of sarcopenia was based on the Asian Working Group for Sarcopenia 2019. Selection criteria for severe sarcopenia patients and bundle care plan were established after discussion with doctor in-charge. Individualized patient and carer education with oromotor exercises or tongue strengthening exercises were implemented. - Comprehensive geriatric assessments including Oral Frailty Index-8 (OFI-8) questionnaire were conducted for selected patients to identify the risk level. - Referral workflow to speech therapists (ST) was established for oral motor examination, measuring maximum anterior tongue pressure, tongue strength endurance and dry swallow tongue pressure using Iowa Oral Performance Instrument (IOPI) and swallowing assessment. The progress was monitored through periodic measurement using IOPI in some patients. - Dietitian was referred for nutrition support and diet education.
Result & Outcome: :
A total of sixty-five patients were assessed for sarcopenia by Geriatric Day Hospital nurses. The prevalence of severe sarcopenia was 38.5% (10 male patients and 15 female patients respectively). Forty-two out of sixty-five patients (64.6%) had scored 3 or above in OFI-8. Thirty-three (14 males and 19 females) out of forty-two patients diagnosed with possible sarcopenia or sarcopenia were recruited with referral to ST. Mean age of patients was 84.7 years old. Eighteen patients (54.5%) were diagnosed by ST with oromotor dysfunction and nine patients (27.3%) with dysphagia. Patients were prescribed with tongue bulb for tongue pressure practice and tongue exercises at home if reduced tongue function and arranged ST follow-up appointment. The mean maximum anterior tongue pressure of those patients was 32.7 +/- 11.7 kPa; 17 patients (51.5%) maximum anterior tongue pressure were below cut-off value 33kPa (with mean age 36.1 +/- 14.9 years) with benchmarking study from Taiwan (Wu et al., 2020). Mean 50% endurance of those patient was 3.5 +/- 2.35 sec which ranged from 1 sec to 8 sec. Spearman’s rho correlation was run to determine the relationships between assessment tools. There were moderate, negative correlation between OFI-8 score and Bioelectrical Impedance Analysis (BIA) (r=-0.466, n=25, p=0.019); OFI-8 score and Body Weight (r=-0.501, n=29, p=0.006), which are statistically significant. These findings indicate moderate association in oral frailty and sarcopenia. The results provide insight to the management of sarcopenic dysphagia using oral frailty screening to identify high-risk group patient. The obvious practical implication of this program is that it proposes sarcopenia and oral frailty screening tools to detect the risk of sarcopenia-related dysphagia in older. Early integration of speech therapy for tongue muscle assessment and training is recommended in multidisciplinary care for severe sarcopenia patients to reduce dysphagia-related complications.
