Original Study
Managing Xerostomia in Nursing Homes: Pilot Testing of the Sorbet Increases Salivation Intervention

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Objective

The purpose of this article was to describe the pilot testing of the Sorbet Increases Salivation (SIS) intervention and describe its impact on salivation and subsequent resident food intake.

Methods

Using a repeated treatment design with each elder serving as his or her own control, 12 elders were served 2 ounces of sugar-free lemon-lime sorbet just before the lunch meal for two 3-week periods separated by a 6-week observation (no treatment) period. A plate waste protocol was used to determine actual food intake. Before the initiation of the intervention, salivation was measured (using a Modified Schirmer Test [MST] strip) at baseline and then at 1, 2, and 3 minutes of consuming 2 oz of sugar-free lemon-lime sorbet or 2 oz of water. Summary statistics (means, standard deviations, proportions) were used to describe the study sample. Bivariate statistics determined whether there were significant differences between MST measures or food intake within subjects.

Results

Salivation significantly increased after consuming sorbet or water. Most importantly, residents who consumed sorbet salivated more on average in comparison with residents who consumed water. During pilot testing, most residents consumed more food on average during treatment weeks in comparison with observation weeks.

Conclusion

The intervention has the potential to increase salivation, decrease complaints of xerostomia, and increase food intake in institutionalized elders with drug-induced xerostomia. The new knowledge gained from this study will lead to further research and testing of the intervention with the long-term goal of transforming the “care-as-usual” approach to meal service in nursing homes.

Section snippets

Hyposalivation

Saliva is an important lubricant that promotes mastication and swallowing. Compromised salivary flow (hyposalivation) and absence of lubrication would lead to complaints of dry mouth (xerostomia) affecting swallowing and causing an overall deterioration in nutritional status (from inadequate food intake).6, 7, 8 Whole saliva flow rates decrease from 1.6 mL/min (stimulated, no medications) to approximately 1 mL/min if 4 or more medications are taken by older adults.9Hyposalivation → Dry mouth

Methods

Using a repeated treatment design with each elder serving as his or her own control, elders were served 2 ounces of sugar-free lemon-lime sorbet just before the lunch meal for two 3-week periods separated by a 6-week observation (no treatment) period. The participating nursing home had a 6-week menu cycle (eg, the menu for weeks 1 to 3 corresponds to the menu for weeks 7 to 9, weeks 4 to 6 corresponds with weeks 10 to 12). Thus, over the 12-week study period, the intervention was in effect once

Results

Twelve of 20 randomly selected nursing home residents agreed to participate in the study. Of these, 8 were female and 4 were male. All were older than 65 years. Mini-Mental State Examination Scores averaged 24.08 (range 16–30).

Discussion

This study found that salivation significantly increased after consuming sorbet or water. Most important, residents who consumed sorbet salivated more on average in comparison with residents who consumed water.

We hypothesized that if the complaints of xerostomia (because of a lack of saliva) could be alleviated in nursing home residents, even temporarily, food intake might improve. During the pilot testing of SIS, most residents consumed more food on average during treatment weeks in comparison

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Cited by (0)

Funding for this study was provided by the American Academy of Nurse Practitioners Foundation.

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