Dermot Power

The efficacy of pre-thickened fluids on total fluid and nutrient consumption among extended care residents requiring thickened fluids due to risk of aspiration

SIR—Dysphagia is associated with many neurological and neuromuscular conditions including stroke and Parkinson’s disease. Consequently dysphagia is a common condition in our patient population. Treatment of dysphagia necessitates the use of thickened fluids, however there are problems with the use of thickener. Failure to achieve the recommended consistency can increase the risk of aspiration. Dysphagia patients who receive thickened fluids frequently fail to meet their fluid requirements [1] and this can lead to dehydration. Whelan [1] investigated fluid intake in 24 stroke patients with dysphagia to evaluate the effect of the disability, and identify the type of fluid given. The mean thickened fluid intake was 455 ml/day resulting in the use of an extra 742 ml/day of supplementary parenteral fluids. This still did not result in an adequate total intake. However, patients not on a specialist stroke unit who received pre-thickened fluids drank almost 100% more than those on powder-thickened fluids. In a small, unpublished study on 10 patients in St. Mary’s Hospital, fibre, fluid and laxative intake was assessed. In this study, the patients on thickened fluids had a lower total intake and their fluid intake consisted mainly of poor nutritional quality beverages such as tea and lemonade. The use of powder thickener added to fluids relies on the staff achieving the correct consistency through correct instruction and adequate guidelines. Poor hydration can adversely affect a number of physiological processes including the regulation of body temperature, the distribution of nutrients and the excretion and elimination of waste products of metabolism. A study conducted on a non-specialist stroke unit who received pre-thickened drinks consumed almost 100% more than those on powderthickened fluids [1]. We conducted a small study at St. Mary’s Hospital in Dublin on 11 patients to assess whether the use of pre-thickened, standardised consistency fluids resulted in an increase in fluid and nutrient intake, reduced constipation rates and improved hydration status in dysphagic patients.

Polypharmacy Is an Independent Risk Factor for Oropharyngeal Isolation of Gram‐Negative Bacilli in Older Persons

and its clinical implications. Ann Intern Med 2005;142:370–380. 6. Tamminen M, Lassila R, Westerbacka J et al. Obesity is associated with impaired platelet-inhibitory effect of acetylsalicylic acid in nondiabetic subjects. Int J Obes Relat Metab Disord 2003;27:907–911. 7. Szczeklik A, Musial J, Undas A et al. Inhibition of thrombin generation by aspirin is blunted in hypercholesterolemia. Arterioscler Thromb Vasc Bio 1996;16:948–954.

Context aware falls risk assessment: A case study comparison

This paper describes three retrospective case studies to illustrate the potential clinical value of a system capable of capturing objective gait metrics and environment data from older adults with a history of falls while they go about their daily lives. Participants in this study wore an inertial sensor above each ankle and a wearable camera around their neck for seven consecutive days. Selected metrics are presented to illustrate scenarios where the data collected by the system could be of clinical value. Evidence suggests that obtaining objective gait metrics and environment data from older adults may not only allow healthcare professionals to assess gait more accurately, but also to design treatment plans and falls prevention strategies that are more specifically tailored to each individual.

Context focused older adult mobility and gait assessment

This paper presents an initial overview of insights gained into how older adults mobilize in the home and community, based on data from inertial sensors which were worn by study participants over a 7-day period. The addition of a wearable camera provided additional contextual information which can be used to assess mobility and understand the factors that influence it in the free living environment. Seven days of data collected from a group of older adults who had experienced one or more falls in the previous six months was compared to that of a control group with no history of falling. Results showed that both groups spent relatively little time walking in challenging environmental conditions, and that the fallers spent significantly less time walking under regular conditions (no effect on gait) and outdoors. Analysis of gait metrics showed that the fallers were slightly slower in general, and more noticeable differences were observed when the participants were regrouped according to mobility levels determined from baseline assessments using traditional methods.