Skip to main content

Advertisement

SpringerLink
Log in

The GUSS test as a good indicator to evaluate dysphagia in healthy older people: a multicenter reliability and validity study

  • Research Paper
  • Published:
European Geriatric Medicine Aims and scope Submit manuscript

Key summary points

AbstractSection Aim

We aimed to evaluate whether the Gugging Swallowing Screen (GUSS) test is an effective method for evaluating swallowing difficulty in healthy older people.

AbstractSection Findings

Total GUSS score sensitivity was 95.5% and its specificity was 94.4%.

AbstractSection Message

The GUSS test is a valid and reliable test to identify possible oropharyngeal dysphagia risk in healthy older person who had no secondary dysphagia. It is suitable as a screen test for clinical practice.

Abstract

Purpose

Dysphagia is known to be a disorder of the swallowing function, and is a growing health problem in aging populations. Swallowing screening tests have mostly been studied in comorbidities such as stroke associated with old age. There is no simple, quick and easy screening test to best determine the risk of oropharyngeal dysphagia in geriatric guidelines. We aimed to evaluate whether the Gugging Swallowing Screen (GUSS) test is an effective method for evaluating swallowing difficulty in healthy older people.

Methods

This cross-sectional and multicenter study was conducted at 13 hospitals between September 2017 and February 2019. The study included 1163 participants aged ≥65 years and who had no secondary dysphagia. Reliability was evaluated for data quality, scaling assumptions, acceptability, reliability, and validity as well as cutoff points, specificity and sensitivity.

Results

The age distribution of 773 (66.5%) patients was between 65 and 74 years and 347 (29.8%) of them were male and 767 (66%) patients were female. The average total GUSS score was 18.57 ± 1.41. The Cronbach’s alpha was 0.968. There was a moderate statistically significant negative correlation between the total GUSS and 10-item Eating Assessment Tool scores as well as between the total GUSS score and quality of life. The cutoff point of the total GUSS score was 18.50, sensitivity was 95.5% and specificity was 94.4%.

Conclusions

The GUSS test is a valid and reliable test to identify possible oropharyngeal dysphagia risk in healthy older people who had no secondary dysphagia. It is suitable as a screen test for clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clave P (2010) Prevalence and prognostic implications of dysphagia in older patients with pneumonia. Age Ageing 39(1):39–45

    Article  Google Scholar 

  2. Serra-Prat M, Hinojosa G, Lopez D, Juan M, Fabré E, Voss DS, Calvo M, Marta V, Ribó L, Palomera E, Arreola V, Clavé P (2011) Prevalence of oropharyngeal dysphagia and impaired safety and efficacy of swallow in independently living older persons. J Am Geriatr Soc 59(1):186–187

    Article  Google Scholar 

  3. Yang EJ, Kim MH, Lim JY, Paik NJ (2013) Oropharyngeal dysphagia in a community-based older cohort: the Korean longitudinal study on health and aging. J Korean Med Sci 28(10):1534–1539

    Article  Google Scholar 

  4. Holland G, Jayasekera V, Pendleton N, Horan M, Jones M, Hamdy S (2011) Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an older population: a self-reporting questionnaire survey. Dis Esophagus 24(7):476–480

    Article  CAS  Google Scholar 

  5. Westmark S, Melgaard D, Rethmeier LO, Ehlers LH (2018) The cost of dysphagia in geriatric patients. Clinicoecon Outcomes Res 10:321–326

    Article  Google Scholar 

  6. Wakabayashi H (2014) Presbyphagia and sarcopenic dysphagia: association between aging, sarcopenia, and deglutition disorders. J Frailty Aging 3:97–103

    CAS  PubMed  Google Scholar 

  7. Ebihara S, Sekiya H, Miyagi M, Ebihara T, Okazaki T (2016) Dysphagia, dystussia, and aspiration pneumonia in older people. J Thorac Dis 8(3):632–639

    Article  Google Scholar 

  8. de Lima Alvarenga EH, Dall’Oglio GP, Murano EZ, Abrahão M (2018) Continuum theory: presbyphagia to dysphagia? Functional assessment of swallowing in the older. Eur Arch Otorhinolaryngol 275(2):443–449

    Article  Google Scholar 

  9. Wirth R, Lueg G, Dziewas R (2018) Orophagyngeal dysphagia in older persons—evaluation and therapeutic options. Dtsch Med Wochenschr 143(3):148–151

    Article  Google Scholar 

  10. Roy N, Stemple J, Merrill RM, Thomas L (2007) Dysphagia in the older: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol 116(11):858–865

    Article  Google Scholar 

  11. Kawashima K, Motohashi Y, Fujishima I (2004) Prevalence of dysphagia among community-dwelling older individuals as estimated using a questionnaire for dysphagia screening. Dysphagia 19(4):266–271

    Article  Google Scholar 

  12. Almirall J, Rofes L, Serra-Prat M, Icart R, Palomera E, Arreola V, Clavé P (2013) Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the older. Eur Respir J 41(4):923–928

    Article  Google Scholar 

  13. Nogueira D, Reis E (2013) Swallowing disorders in nursing home residents: how can the problem be explained? Clin Interv Aging 8:221–227

    Article  Google Scholar 

  14. Sarabia-Cobo CM, Pérez V, de Lorena P, Domínguez E, Hermosilla C, Nuñez MJ, Vigueiro M, Rodríguez L (2016) The incidence and prognostic implications of dysphagia in older patients institutionalized: A multicenter study in Spain. Appl Nurs Res 30:e6–e9

    Article  Google Scholar 

  15. Lancaster J (2015) Dysphagia: its nature, assessment and management. Br J Community Nurs 6a:S28–S32

    Article  Google Scholar 

  16. Baijens LW, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M (2016) European Society for Swallowing Disorders —European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 7(11):1403–1428

    Article  Google Scholar 

  17. Khan A, Carmona R, Traube M (2014) Dysphagia in the older. Clin Geriatr Med 30(1):43–53

    Article  Google Scholar 

  18. Jørgensen LW, Søndergaard K, Melgaard D, Warming S (2017) Interrater reliability of the Volume-Viscosity Swallow Test; screening for dysphagia among hospitalized older medical patients. Clin Nutr ESPEN 22:85–91

    Article  Google Scholar 

  19. Rech RS, Hugo FN, Baumgarten A, Dos Santos KW, de Goulart BNG, Hilgert JB (2018) Development of a simplified dysphagia assessment by dentists in older persons. Community Dent Oral Epidemiol 46(3):218–224

    Article  Google Scholar 

  20. Clavé P, Arreola V, Romea M, Medina L, Palomera E, Serra-Prat M (2008) Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr 27(6):806–815

    Article  Google Scholar 

  21. Umay E, Eyigor S, Karahan AY et al (2019) Which swallowing difficulty of food consistency is best predictor for oropharyngeal dysphagia risk in older person. EGM 10(4):609–617

    Google Scholar 

  22. Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A, Brainin M (2007) Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Stroke 38(11):2948–2952

    Article  Google Scholar 

  23. Umay EK, Gurcay E, Bahceci K, Ozturk E, Yilmaz V, Gundogdu I, Ceylan T, Eren Y, Cakcı A (2018) Validity and reliability of Turkish version of the Gugging Swallowing Screen test in the early period of hemispheric stroke. Neurol Sci Neurophysiol 35:6–13

    Google Scholar 

  24. AbdelHamid A, Abo-Hasseba A (2017) Application of the GUSS test on adult Egyptian dysphagic patients. Egypt J Otolaryngol 33:103–110

    Article  Google Scholar 

  25. da Silva Ferreira AM, Pierdevara L, Ventura IM, Gracias AMB, Marques JMF, dos Reis MGM (2018) The Gugging Swallowing Screen: a contribution to the cultural and linguistic validation for the Portuguese context. Rev Enf Ref 4(16):85–92

    Article  Google Scholar 

  26. Lee KM, Kim HJ (2015) Practical assessment of dysphagia in stroke patients. Ann Rehabil Med 39(6):1018–1027

    Article  Google Scholar 

  27. Xiao S, Chang H, Wu J, Shuai D, Ma J, Huang W, Liu J (2013) Chinese version of GUSS swallowing function assessment scale for reliability and validity. Chin J Mod Nurs 19(34):4189–4191

    Google Scholar 

  28. Lee KW, Kim SB, Lee JH, Kim MA, Kim BH, Lee GC (2009) Clinical validity of Gugging Swallowing Screen for acute stroke patients. J Korean Acad Rehabil Med 33(4):458–462

    Google Scholar 

  29. Park YH, Bang HL, Han HR, Chang HK (2015) Dysphagia screening measures for use in nursing homes: a systematic review. J Korean Acad Nurs 45(1):1–13

    Article  Google Scholar 

  30. Jiang JL, Fu SY, Wang WH, Ma YC (2016) Validity and reliability of swallowing screening tools used by nurses for dysphagia: a systematic review. Tzu Chi Med J 28(2):41–48

    Article  Google Scholar 

  31. Dziewas R, Warnecke T, Olenberg S, Teismann I, Zimmermann J, Kramer C, Ritter M, Ringelstein EB, Schabitz WR (2008) Towards a basic endoscopic assessment of swallowing in acute stroke-development and evaluation of a simple dysphagia score. Cerebrovasc Dis 26(1):41–47

    Article  Google Scholar 

  32. Nunnally JC, Bernstein IH (2010) Psychometric theory. Tata McGraw-Hill Education, New York

    Google Scholar 

  33. Bowling A (2009) Research methods in health: Investigating health and health services. Open University Press, Buckingham

    Google Scholar 

  34. Molina L, Santos-Ruiz S, Clave P, lez-de Paz LG, Cabrera E (2017) Nursing interventions in adult patients with oropharyngeal dysphagia: a systematic review. Eur Geriatr Med 9(1):5–21

    Article  Google Scholar 

  35. Rofes L, Arreola V, Mukherjee R, Clave P (2014) Sensitivity and specificity of the eating assessment tool and the volume-viscosity swallow test for clinical evaluation of oropharyngeal dysphagia. Neurogastr Motil 26(9):1256–1265

    Article  CAS  Google Scholar 

  36. Uhm KE, Kim M, Lee YM, Kim BM, Kim YS, Choi J, Han SH, Kim HJ, Yoo KH, Lee J (2019) The Easy Dysphagia Symptom Questionnaire (EDSQ): a new dysphagia screening questionnaire for the older adults. Eur Geriatr Med 10(1):47–52

    Article  Google Scholar 

  37. Poorjavad M, Jalaie S (2014) Systemic review on highly qualified screening tests for swallowing disorders following stroke: validity and reliability issues. J Res Med Sci 19(8):776–785

    PubMed  PubMed Central  Google Scholar 

  38. Orlandoni P, Peladic NJ (2016) Health-related quality of life and functional health status questionnaires in oropharyngeal dysphagia. J Aging Res Clin Pract 5(1):31–37

    Google Scholar 

Download references

Funding

There is no funding source in this study.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Altindag, Ankara, Turkey

    Ebru Umay & Ibrahim Gundogdu

  2. Department of Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey

    Sibel Eyigor

  3. Department of Physical Medicine and Rehabilitation, Usak University, Usak, Turkey

    Ali Yavuz Karahan

  4. Department of Physical Medicine and Rehabilitation, Selcuk University, Konya, Turkey

    Ilknur Albayrak Gezer & Ayse Kurkcu

  5. Department of Physical Medicine and Rehabilitation, Kırıkkale University, Kirikkale, Turkey

    Dilek Keskin & Gulten Karaca

  6. Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey

    Zeliha Unlu & Canan Tıkız

  7. Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

    Meltem Vural & Banu Aydeniz

  8. Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey

    Ebru Alemdaroglu & Emine Esra Bilir

  9. Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey

    Ayse Yalıman & Ekin Ilke Sen

  10. Department of Physical Medicine and Rehabilitation, Gaziantep University, Gaziantep, Turkey

    Mazlum Serdar Akaltun & Ozlem Altındag

  11. Department of Physical Medicine and Rehabilitation, Istanbul Training and Research Hospital, Istanbul, Turkey

    Betul Yavuz Keles

  12. Department of Physical Medicine and Rehabilitation, Antalya Training and Research Hospital, Antalya, Turkey

    Meral Bilgilisoy

  13. Department of Physical Medicine and Rehabilitation, Izmir Tepecik Training and Research Hospital, Izmir, Turkey

    Zeynep Alev Ozcete & Aylin Demirhan

  14. Department of Physical Medicine and Rehabilitation, Kocaeli University, Kocaeli, Turkey

    Murat Inanir

  15. Department of Physical Medicine and Rehabilitation, Bolu Izzet Baysal Training and Research Hospital, Bolu, Turkey

    Yalkin Calik

Authors
  1. Ebru Umay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sibel Eyigor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ali Yavuz Karahan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ilknur Albayrak Gezer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ayse Kurkcu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dilek Keskin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gulten Karaca
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zeliha Unlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Canan Tıkız
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Meltem Vural
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Banu Aydeniz
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ebru Alemdaroglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Emine Esra Bilir
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Ayse Yalıman
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Ekin Ilke Sen
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Mazlum Serdar Akaltun
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Ozlem Altındag
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Betul Yavuz Keles
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Meral Bilgilisoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Zeynep Alev Ozcete
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Aylin Demirhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Ibrahim Gundogdu
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Murat Inanir
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Yalkin Calik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ebru Umay.

Ethics declarations

Conflict of interest

There is no conflict of interest among the authors.

Ethical approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee ((Ethics committee of University of Health Sciences, Ankara Diskapi Training and Research Hospital) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

All participants or the relatives of illiterate participants were informed about the study and their written informed consents were obtained at the beginning of the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Umay, E., Eyigor, S., Karahan, A.Y. et al. The GUSS test as a good indicator to evaluate dysphagia in healthy older people: a multicenter reliability and validity study. Eur Geriatr Med 10, 879–887 (2019). https://doi.org/10.1007/s41999-019-00249-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41999-019-00249-2

Keywords

Search

Navigation