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Innovation in Nutritional Treatment for Dysphagia. Thérèse Dufresne, RD. Prophagia : a network of strategic alliances. Synergy : together, we go faster & further Convergence of mission : quality of nutritional care for the Hospital client and LTC Resident Complementarity of compentencies.
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Innovation in NutritionalTreatment for Dysphagia Thérèse Dufresne, RD
Prophagia : a network of strategic alliances • Synergy : together, we go faster & further • Convergence of mission : quality of nutritional care for the Hospital client and LTC Resident • Complementarity of compentencies 2
Our client Scientific Partner Research Partners Sainte.Anne’s Hospital McGill University Technology Partner 3
Outline Overview of Dysphagia • General Overview • Prevalence • Consequence Epikura : a Novel Treatment for Dysphagia • Background • History • Results Introduction to Food Rheology • Texture Parameters • Application to Nutritional Treatment of Dysphagia
Dysphagia dys = difficulty phagein = eat Oral Phase - Preparatory - Transport Pharyngial Phase Oesophagial Phase from: ME Groher, Dysphagia: Diagnosis and Management 5
Etiology of Dysphagia • Neurogenic Dementia Multiple Sclerosis CVA - Strokes Muscular Dystrophy Parkinson’s Disease Alzheimer’s Disease Huntington’s Disease • Inadequate dentition • Psychiatric Depression • Iatrogenic Conditions Medication Induced Injury Chemotherapy Radiotherapy
Sainte.Anne’s Dysphagic Population per Diagnostic April 2005 – March 2006
from: ME Groher, Dysphagia: Diagnosis and Management Prevalence of Dysphagia • Acute Care Setting: 30 to 35% • Chronic Care: 35 to 75% • In Canada: 400,000 dysphagic persons 98,200 institutionalized dysphagic persons
Traditional Modified Texture Diet • Unappealing • Diluted (↓nutrients, ↓taste) • Unrecognizable • No quantification nor standardization of texture • No demonstrated efficiency to treat dysphagia 11
Consequences of dysphagia • Dysphagia • Slow eating • Choking • Fear to eat or drink • Reduced food intake • Undernutrition, frailness, decreased quality of life, decreased autonomy, increased infections, pneumopathies and cost of care 12
A Revolutionin the Nutritional Treatment of Dysphagia The Joy of Eating back on the menu! • 40 main entrees • Normal looking • Minced & Pureed • Meats, poultry & fish • Pasta 13
Epikura’s Fresh Tasting Veggies • 10 Vegetables • Cooked & Raw • Puréed 14
Epikura’s Sweetness • 9 Cakes • 6 Fruits • Puréed 15
Tasting Break • Awareness of 3 phases of swallowing • Dysphagic swallow • Food Descriptors - Compaction vs aeration • Particle size • Cohesiveness • Adhesivene • Syneresis • Taste profile: intensity of flavours
Randomized Clinical Study 1999 (n=17) A Demonstrated Efficacy (Germain et al, JADA, Oct. 2006) • The BMI of the Treated Subjects increases from 22 to 24 in 12 weeks while the BMI of Control Subjects remains low 17
For the Joy of eating and a taste af life! After : 82 kg Before: 60 kg 18
A Unique Technology which offers: • Something for every taste, every day • Offers the dysphagic clientèle a balanced and varied diet • Competitive prices • Fresh food, pure ingredient • Handy frozen individual portions 19
Implementation Support • Expert Team • Consulting and training 20
Objectives and Indicators • consumption of meals served (or food intake: protein, energy, …) • variety of foods consumed • weights (BMI) and nutritional status of residents • meal appreciation by patients 21
Strategy, steps and calendar • Impact analysis • Identification of operational needs • equipements • procedures, recipes, menus, … • Communications • Operation team • Admin and multi team • Nursing team 22