title: Analysis of resources assisting in coping with swallowing difficulties for patients with Parkinson's disease: a cross-sectional study.
abstract: Malnutrition induced by swallowing difficulties (SD) impairs the quality of life and gives rise to SD-related costs in Parkinson's disease (PD) patients. With results of a swallowing difficulty questionnaire and data of resources specifically obtained such as SD-related costs, caregivers, and dietary therapies, this study is to suggest statistically supported ideas for improvements in arrangements for how participants cope with SD and maintain general well-being.
  
  
  
  We interviewed 237 PD patients. The SD-related costs involved those incurred by the provision of dietary modifications, care oriented foods, alternatives, and supplements. Dietary therapies included rice porridge and commercially available care foods. The relationships between BMI (body mass index) and the severity of SD assumed in this paper as indicators for general well-being and as resources for coping with SD for PD patients were statistically analyzed.
  
  
  
  A lower BMI was found in participants eating porridge consistency rice (p = 0.003) and eating porridge rice is significantly related to the severity of SD (p < 0.0001) and PD (p = 0.002). The severity of SD increased with age and PD duration (p = 0.035, p = 0.0005). Outlays for dietary modifications are the lowest reported here (p < 0.004) but the number of participants using dietary modifications is the largest among the SD-related items (n = 58). Eating care foods were reported for 11 older participants (p < 0.0001), most female (10/11). No lower BMI was found in participants eating care foods when compared with participants eating ordinary foods. Dietary modifications were performed by caregivers (OR: 6.8, CI: 3.1-15.2, p < 0.0001) and were related to the presence of children (OR: 3.4, CI: 1.2-11.4. p = 0.024). Older participants commonly live with spouses and children.
  
  
  
  Severe SD is associated with higher costs of coping with SD. A lower BMI is associated with modified foods, mostly eaten to cope with SD. Presence of caregivers and other persons residing with the participants here are related to dietary modifications but not to care food-related costs. Care foods may be effective in preventing malnutrition although the number who are able to cover the added expenses is limited because of the higher prices and shortage of information on the usefulness of care foods.
authors.affiliation: Department of Public Health, Sapporo Medical University, School of Medicine, Nishi 17-chome, Minami 1-jo, Chuo-ku, Sapporo, 060-8556, Japan. aikokirin@sapmed.ac.jp.
authors.forename: Aiko
authors.initials: A
authors.lastname: Matsushima
authors.affiliation: ENT Clinic, Sapporo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Matsushima
authors.affiliation: Department of Neurology, Jyouzankei Hospital, Sapporo, Japan.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Matsumoto
authors.affiliation: Hokuyukai Neurological Hospital, Sapporo, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Moriwaka
authors.affiliation: Hokuyukai Neurological Hospital, Sapporo, Japan.
authors.forename: Sanae
authors.initials: S
authors.lastname: Honma
authors.affiliation: Iwamizawa Neurological Medical Clinic, Iwamizawa, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Itoh
authors.affiliation: Iwamizawa Neurological Medical Clinic, Iwamizawa, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Department of Neurology, Sapporo Medical University, School of Medicine, Sapporo, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Shimohama
authors.affiliation: Department of Public Health, Sapporo Medical University, School of Medicine, Nishi 17-chome, Minami 1-jo, Chuo-ku, Sapporo, 060-8556, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ohnishi
authors.affiliation: Department of Public Health, Sapporo Medical University, School of Medicine, Nishi 17-chome, Minami 1-jo, Chuo-ku, Sapporo, 060-8556, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Mori
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000178:diet therapy* / Q000209:etiology*; D005260:Female; D006295:Health Resources; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*; D036301:Qualitative Research; D011788:Quality of Life; D018454:Spouses; D011795:Surveys and Questionnaires
keywords: BMI; Care foods; Caregivers; Costs; Dietary modification; PD; Swallowing difficulty