Functional Dysphagia Therapy and PEG Treatment in a Clinical Geriatric Setting

Functional dysphagia therapy (FDT) is a noninvasive procedure that can accompany percutaneous endoscopic gastrostomy (PEG) treatment and supports transitioning from tube to oral feeding. In this retrospective study, we investigated the outcome of FDT with or without PEG feeding. Patients with dysphagia were divided into two groups: those with PEG feeding (N = 117) and those with exclusively oral feeding (N = 105). Both groups received functional training (oral motor skills/sensation, compensatory swallowing techniques) from speech-language therapists. Functional oral intake, weight, Barthel index, and speech and language abilities were evaluated pre- and post-training. The non-PEG group showed a significant post-treatment improvement in functional oral intake, with diet improvement from pasty consistency to firm meals in most cases. However, even severely disordered patients (with PEG feeding) showed a significant increase in functional oral intake, still requiring PEG feeding post-treatment but able to take some food orally. The sooner a PEG was placed, the more functional oral intake improved. Significantly more complications and higher mortality occurred in the PEG group compared to the group with exclusively oral feeding. Dysphagia treatment in the elderly requires a multiprofessional setting, differentiated assessment, and functional training of oral motor skills and sensation and swallowing techniques.     

Fracture strength of zirconia implants after artificial aging

Background: Zirconia (ZrO₂) might be an alternative material to titanium (Ti) for dental implant fabrication. However, no data are available on the fracture strength of one‐piece ZrO₂ oral implants. Purpose: The objective of this study was to evaluate the fracture strength of ZrO₂ implants after exposure to the artificial mouth. Materials and Methods: One hundred twenty ZrO₂ and Ti implants were used. The Ti implants were divided into two control groups (A and B). ZrO₂ implants manufactured from yttria‐stabilized tetragonal ZrO₂ polycrystal (Y‐TZP) in group C, from Y‐TZP dotted with alumina (Y‐TZP‐A) in group D, and from Y‐TZP‐A with a modified surface in groups E and F were used. In group F, the implant heads were prepared, and in group G, the implants were restored with ZrO₂ crowns. Each group included 16 samples with the exception of group D, which included 24 samples. A subgroup of each implant type (eight implants) was subjected to thermomechanical cycling in a chewing simulator prior to fracture testing. Test specimens were then loaded until a fracture occurred. Results: Seven of the 120 samples failed in the chewing simulator. ZrO₂ implant fracture occurred at 725 to 850 N when the implants were not prepared, and at 539 to 607 N when prepared. The samples in group A fractured at the level of the abutment screw. All ZrO₂ implants fractured at the level of the Technovit® resin (Heraeus Kulzer GmbH & Co., Wehrheim, Germany). No fracture of the ZrO₂ crowns in group G was observed. Conclusion: Mean fracture strength values obtained were all within the limits of clinical acceptance. However, implant preparation had a statistically significant negative influence on the implant fracture strength. Long‐term clinical data are necessary before one‐piece ZrO₂ implants can be recommended for daily practice.     

Nutrition status and pressure ulcer: what we need for nutrition screening

BACKGROUND: Pressure ulcers (PU) and malnutrition exist in elderly hospitalized patients as a significant and costly problem. The aim of the study was to compare different screening tools to assess nutrition status and to verify them for usage in clinical routine. METHODS: Nutrition status (body mass index [BMI], Mini Nutritional Assessment [MNA], weight loss) was determined in 484 (326 female/158 male) multimorbid elderly patients with mean age of 79.6 +/- 7.6 (80.9 +/- 7.4 female/76.9 +/- 7.4 male) years. Bioelectrical impedance analysis (BIA; Nutrigard 2,000-M) was used for evaluation of body composition. Activities of daily living (ADL) were measured with the Barthel Index. PUs were divided into stages I-IV (European Pressure Ulcer Advisory Panel [EPUAP]) and were assessed by the Norton scale. RESULTS: The prevalence of PU was 16.7%, with a median Norton scale of 20 (range, 17-24). According to MNA, 39.5% of the PU patients were malnourished, and 2.5% were well nourished. By contrast, 16.6% of the non-PU patients were malnourished, and 23.6% were well nourished. BMI decreased significantly in PU patients (p < .008). BIA resulted in no significant resistance and reactance but in a significant reduction of phase angle in PU. According to a significantly reduced body cell mass and lean body mass in PU patients, the ADL decreased in these patients, too. Furthermore, we analyzed a significant effect of age, ADL, MNA, BMI, phase angle, and body cell mass on the Norton scale. CONCLUSIONS: The MNA as a screening and assessment tool is easy to use to determine the nutrition status in multimorbid geriatric patients with PU. Further studies are needed to show an improved outcome of PU healing if evaluation of nutrition status is part of routine clinical practice in multimorbid elderly risk patients within the first day after admission.