Project Summary
Oropharyngeal dysphagia (OD) is a syndrome that affects up to 84% of hospitalized older adults with
Alzheimer's disease and Related Dementias (ADRD), and is associated with malnutrition, dehydration,
aspiration events, pneumonia, increased mortality, longer hospital stay, and higher costs. In the hospital
setting, where OD is often exacerbated by the acute illness and hospital environment, standard of care entails
withholding all oral intake (nil per os, NPO) and dysphagia diets (texture modified food and thickened liquids).
Yet, there is insufficient evidence for the clinical benefit of these dietary restrictions. Furthermore, dietary
restrictions lead to decreased oral intake and dehydration, which may further exacerbate OD and lead to
delirium, respiratory complications, decreased quality of life, and mortality. Therefore, it is critical for us to
examine the standard of care assumption that dietary restrictions result in improved clinical outcomes. The
overarching aim of this study is to use an existing data set of hospitalized persons with ADRD to evaluate the
relationship between dietary restrictions (standard care) and adverse clinical outcomes in the management of
OD, as compared to a non-restricted diet (alternative to standard care). Our hypothesis is that dietary
restrictions will be associated with increased adverse hospital outcomes (mortality, respiratory complications,
dehydration, length of stay, and readmission) as compared to a non-restricted diet. Our data consists of 35,925
hospitalized persons with ADRD admitted to the medicine service across 11 diverse hospitals between 2017
and 2019. In preliminary work using a subset of this data, we demonstrated high prevalence of dietary
restrictions in patients with ADRD. Our multidisciplinary research team is well-positioned to accomplish the
following 3 Aims: 1) Determine whether NPO is associated with adverse outcomes in hospitalized persons with
ADRD and OD, compared to any oral intake (restricted and non-restricted diet); 2) Determine whether a
dysphagia diet is associated with adverse outcomes in hospitalized persons with ADRD and OD, compared to
a non-restricted diet; and 3) Determine whether dietary restrictions (NPO or dysphagia diet) are associated
with delirium in hospitalized persons with ADRD and OD, compared to a non-restricted diet. We will use
propensity score matching to evaluate associations between dietary restrictions and adverse outcomes. This
line of work is significant, because it will examine the current standard of care of OD in hospitalized patients
with ADRD. This research is innovative, because it will be the first study to associate dietary restrictions with
meaningful clinical outcomes, using a large hospital database of clinically rich variables. The findings from this
proposal will be used to support the application for a large-scale clinical trial to prospectively evaluate the
effects of dietary restrictions for OD in hospitalized patients with ADRD. Our findings will lay the essential
groundwork needed to examine the current standard of care of OD in patients with ADRD and has the potential
to improve important clinical outcomes and quality of life for this vulnerable patient population.