Journal of Rehabilitation Medicine 51-4inkOmslag | Page 81

Nutrition intake status of elderly people in disaster settings
DISCUSSION
To our knowledge, this is the first study to assess the
adaptability of emergency foods for the community-
dwelling, care-requiring, elderly population. This study
revealed that approximately one-third of such elderly
residents in Shinjuku city experienced some difficulties
with swallowing. After excluding the non-orally-fed
population, approximately one-fifth of community-
dwelling elderly care recipients would be at risk of
aspiration during the post-disaster period, and more
than half of these would face a risk of aspiration solely
attributable to the intake of common emergency foods.
Using the same questionnaire, Kawashima et al. repor-
ted previously that 13.8% of the community-dwelling
elderly population experienced dysphagia, regardless
of their requirement for care (14).
It is notable that our study population was relatively
similar to that in a study by Chen et al., which targeted
residents of an urban independent-living senior facility.
Although that earlier study involved only 4% of the
population requiring substantial care, a questionnaire-
based survey revealed that 23.4% of the participants
had dysphagia (16). Although these studies cannot be
unconditionally compared, the current results were
consistent with those of Chen et al. Other studies
of healthy community-dwelling populations have
reported dysphagia prevalence rates of 11.4% among
people older than 65 years (17) and 16.2% among those
older than 87 years (18), suggesting that a potentially
much larger number of otherwise healthy community-
dwelling elderly people would be at risk of aspiration in
a disaster setting. This is consistent with our findings,
which were also obtained in a population of mostly
healthy subjects (support levels 1 and 2).
The 19.7% of care recipients classified into classes
C and D in our study would require a specific post-
disaster food supply. Again, it is noteworthy that the
population in class D could be considered as having
normal swallowing function when consuming familiar
foods in ordinary settings. These people accounted
for 8.5%, 11.8% and 49.7% of care recipients in our
simplified Low-, Middle-, and High-grade support/care
level categories, respectively. However, it may not be
practical to store very large amounts of pre-packaged,
texture-modified foods, which tend to be costlier and
have shorter expiration periods. Therefore, a critical
social safeguard would require not only the storage, but
also the supply, or even cooking, of adequate foods for
this vulnerable population during post-disaster periods.
Well-formulated strategies to achieve this safeguard
have been outlined in the principles of “disaster food”
(3, 10). It is also notable that both elderly individuals
and their non-ordinary caregivers (including volunte-
ers) are frequently overlooked when communicating
315
the potential risks of consuming emergency foods (9).
Disaster rehabilitation can play a pivotal role in raising
public awareness about this issue.
Disaster rehabilitation (2) and feeding support teams
(19) worldwide should better organize efforts to address
the large population of elderly survivors with special
food intake needs, including those at risk of aspiration
solely when consuming regularly distributed emergency
foods. Studies have reported the effects of disaster
rehabilitation on improvements in physical function,
post-traumatic stress disorder, quality of life, and re-em-
ployment among disaster victims with various disorders
(20). Although, to our knowledge, no previous study has
evaluated swallowing management during disasters,
disaster evacuees with dysphagia may benefit from
a multidisciplinary rehabilitative approach. Previous
reports have suggested that oral care reduces the rate of
pneumonia in vulnerable elderly populations (21), and
home-based exercise has been shown to significantly
reduce the incidence of aspiration pneumonia (22).
Another report from a feeding support team discusses
successful cases in which signs of aspiration were redu-
ced by contriving a means of cooking emergency foods
after a disaster (3). These aspects should be evaluated
more systematically through structured studies, and
preventive interventions should be enforced accordingly
to reduce harm during future disasters.
This preliminary study had several limitations of note.
First, although most elderly individuals with health is-
sues are certified in the mandatory LTCI system, some
people, such as individuals with dysphagia who consider
themselves healthy, do not utilize this system. Secondly,
nursing home residents were not included in the present
study; therefore, the results do not reflect the entire el-
derly population. However, as nursing homes usually
prepare sufficient stockpiles of appropriate foods for
their residents, it may not be necessary to include this
population from the standpoint of preventive medicine.
However, both of these factors will additionally restrict
the external validity of the findings from this cross-
sectional survey. Thirdly, the survey response rates were
relatively low among the CM offices (28.6%) and target
population (11.8%). Although we do not have data on
attrition at several levels, we speculate that a possible
reason for the low response rate may be the lack of a
sense of crisis. Despite this low response rate, the cur-
rent study included a large number of participants (1,271
care recipients), and the findings are considered to be
reasonably reliable. Future studies will require better
strategies to improve the survey response rate, possibly
including hand delivery and collection of the forms, an
explanation of the specific method used at each office,
detailed subsequent feedback, and an acknowledgement
or monetary reward. Fourthly, because we lack exact
demographic data about the sample, we cannot deter-
mine which groups of elderly people (e.g. females vs
J Rehabil Med 51, 2019