Subjective dysphagia in older care home residents: A cross-sectional, multi-centre point prevalence measurement

doi:10.1016/j.ijnurstu.2013.10.016

International Journal of Nursing Studies

Volume 51, Issue 6, June 2014, Pages 875-881

https://doi.org/10.1016/j.ijnurstu.2013.10.016 Get rights and content

Abstract

Background

Dysphagia has been found to be strongly associated with aspiration pneumonia in frail older people. Aspiration pneumonia is causing high hospitalization rates, morbidity, and often death. Better insight in the prevalence of (subjective) dysphagia in frail older people may improve its early recognition and treatment.

Objective

First, to assess the prevalence of subjective dysphagia in care home residents in the Netherlands. Second, to assess the associations of subjective dysphagia with potential risk factors of dysphagia.

Design

Retrospective data-analysis of a cross-sectional, multi-centre point prevalence measurement.

Setting

119 care homes in the Netherlands.

Participants

Data of 8119 care home residents aged 65 years or older were included and analyzed.

Methods

Subjective dysphagia was assessed by a resident's response to a dichotomous question with regard to experiencing swallowing problems. If a resident was not able to respond (e.g. residents with dementia or aphasia), the question was answered by the ward care provider, or the resident's file was consulted for registered swallowing complaints and/or dysphagia. Several residents’ data were collected: gender, age, (number of) diseases, the presence of malnutrition, the Care Dependency Scale score, and the body mass index.

Results

Subjective dysphagia was found in 751 (9%) residents. A final model for subjective dysphagia after multivariate backward stepwise regression analysis revealed eight significant variables: age (B −0.022), Care Dependency Scale score (B −0.985), ‘malnutrition’ (OR 1.58; 95% CI 1.31–1.90), ‘comorbidity’ (OR 1.07; 95% CI 1.01–1.14), and the disease clusters ‘dementia’ (OR 0.55; 95% CI 0.45–0.66), ‘nervous system disorder’ (OR 1.55; 95% CI 1.20–1.99), ‘cardiovascular disease’ (OR 0.81; 95% CI 0.67–0.99) and ‘cerebrovascular disease/hemiparesis’ (OR 1.74; 95% CI 1.45–2.10).

Conclusion

It seems justified to conclude that subjective dysphagia is a relevant care problem in older care home residents in the Netherlands. Care Dependency Scale score, ‘malnutrition’, and the disease clusters ‘dementia’, ‘nervous system disorder’, and ‘cerebrovascular disease/hemiparesis’ were associated with the presence of subjective dysphagia in this study. Age, ‘comorbidity’ and ‘cardiovascular disease’ showed very small influence.

Section snippets

Introduction and background

In a systematic review with homogeneity of cohort studies, dysphagia has been found to be strongly associated with aspiration pneumonia in frail older people (van der Maarel-Wierink et al., 2011). Aspiration pneumonia, an inflammatory condition of lung parenchyma usually initiated by the introduction of bacteria into the lung alveoli, is causing high hospitalization rates, morbidity, and often death in frail older people (Welte et al., 2012). Therefore, risk factors of aspiration pneumonia,

Methods

The LPZ survey design was a cross-sectional, multi-centre point prevalence measurement and was carried out on April 13 and November 2, 2010. Ethical approval was received from the medical ethical committee of the University Hospital of Maastricht. For this retrospective data analysis, data of care home residents aged 65 years or older were included. Tube-fed patients were excluded.

Based on literature findings, variables considered as potential risk factors of dysphagia were gender, age,

Results

In 2010, 119 (33%) out of the total number of 360 care homes in The Netherlands participated in the LPZ survey. Data of 8119 residents aged 65 years or older were analyzed. Table 1 shows the personal and health characteristics of the participating residents.

Subjective dysphagia was found in 751 (9%) residents (Table 2). Statistically significant results indicate that residents with dysphagia, when compared to residents without dysphagia, were younger, had lower Care Dependency Scale scores and

Discussion

In this survey, the prevalence of subjective dysphagia in care homes residents was 9%. The literature shows prevalence estimates of general (objective) dysphagia of 50–75% (Cabre et al., 2010, Marik and Kaplan, 2003). These estimates are based on three cross-sectional surveys, in which the prevalence rates of dysphagia varied from 13.7% to 97.5% (Kayser-Jones and Pengilly, 1999, Lin et al., 2002, Turley and Cohen, 2009). It seems reasonable to presume that objectively assessed dysphagia, as

Conclusion

Within the limitations of this cross-sectional, multi-centre point prevalence measurement, it seems justified to conclude that subjective dysphagia is a relevant care problem in older care home residents in the Netherlands. Care Dependency Scale score, ‘malnutrition’, and the disease clusters ‘dementia’, ‘nervous system disorder’, and ‘cerebrovascular disease/hemiparesis’ were associated with the presence of subjective dysphagia in this study. Age, ‘comorbidity’ and ‘cardiovascular disease’

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Factors related to dysphagia-specific quality of life in aged patients with neurologic disorders: A cross-sectional study
2022, Geriatric Nursing
Citation Excerpt :
With aging, the swallowing function decreases along with the deterioration of body functions.19 Furthermore, the older adults with neurological diseases are more prone to swallowing disturbance than those without.17,20,21 It may also have more dangerous and fatal consequences for the older adults with the disease than without.22
This cross-sectional study aimed to analyze dysphagia-specific quality of life and its influencing factors in aged patients with neurologic disorders, and is reported according to the STROBE checklist for observational research. The study included 120 outpatients, aged ≥65 years, diagnosed with neurologic diseases at a general hospital Neurology Department in Seoul, Korea. Data collected during a one-month (March and April 2021) questionnaire survey were statistically analyzed using SPSS. Factors related to dysphagia-specific quality of life were gender, education level, neurological diagnosis, type of diet, subjective swallowing disturbance, and affectionate support—a subscale of social support. The combined explanatory power of these factors was 42.1%. It is essential to note that the factors related to the emotional, functional, and physical domains–the subscales of dysphagia-specific quality of life–are different. Therefore, each factor should be considered when planning nursing interventions to improve dysphagia-specific quality of life.
Dysphagia screening in residential care settings: A scoping review
2021, International Journal of Nursing Studies
Older adults with dysphagia are at a higher risk of experiencing serious complications where dysphagia is not identified and adequately managed. Nursing personnel are critical for timely identification and management of dysphagia and prevention of these subsequent serious complications in residential care settings.
To identify dysphagia screening tools used in residential care and to establish whether validated and used as per guidelines, their diagnostic accuracy and reliability and to identify the prevalence rate of dysphagia in this setting.
A scoping review based on Arksey & O'Malley (2005) methodological framework.
An electronic search of databases CINAHL, Pubmed and Scopus was conducted. Reference lists were checked in all identified articles for additional studies. Peer-reviewed publications describing the process of identifying dysphagia and using a screening protocol in residential care settings were considered for inclusion.
All identified studies were screened by reading of titles, keywords and abstracts. Those articles that were deemed eligible for inclusion were read in full.
Nineteen quantitative studies and one mixed-methods study out of 1,674 articles were included in the review. Thirteen different instruments for dysphagia screening were identified, with the Modified Water Swallow Test being the most commonly used. Other diagnostic procedures, such as fiberoptic endoscopic evaluation of swallowing, pulse oximetry or cervical auscultation, were implemented along with the administration of a dysphagia screening tool in six studies. The 3-Ounce Water Swallow Test, the Yale Swallow Protocol and the Gugging Swallowing Screen were identified as the instruments with the best clinical accuracy values. The reported prevalence of dysphagia in this setting ranged from 15% to 70%.
Formal dysphagia screening in residential care settings is not common practice. The dysphagia screening tools identified in this review are not validated for use in this setting. The implementation of dysphagia screening protocols specific to this population may facilitate identification of dysphagia and avoid complications.
Oropharyngeal Dysphagia in Community-Dwelling Older Patients with Dementia: Prevalence and Relationship with Geriatric Parameters
2018, Journal of the American Medical Directors Association
To define the prevalence of oropharyngeal dysphagia (OD) in community-dwelling older persons with dementia, using V-VST (Volume-Viscosity Swallow Test), the reference clinical screening test for swallowing disorders, to assess the feasibility of the V-VST in an ambulatory care setting, to search for associations between geriatric parameters and OD, and to identify a relationship between severities of cognitive impairment and OD.
Prospective, monocentric study.
Population from a geriatric outpatients clinic.
Patients older than 70 with a diagnosis of dementia (NINCDS-ADRDA criteria), effective cough, and ability of voluntary swallowing for testing.
OD screening was realized using V-VST during consultation. Severity of cognitive impairment was estimated by the MMSE and severity of OD by the Dysphagia Outcome Severity Scale (DOSS). Six geriatric domains were evaluated (comorbidities, functional abilities, cognition, nutrition, mood disorders, frailty).
117 patients participated in the study (77 women, mean age = 84.5 ± 5.1 years). Prevalence of OD was 86.6%. Among the 97 patients with OD, 3 (3.1%) had only safety impairment, 52 (53.6%) had only efficacy impairment and 42 (43.3%) had both. The mean time necessary to realize V-VST was 8.7 ± 2.7 minutes with a rate of success of 96%. Dependency was independently associated with OD [odds ratio (OR) 4.8; 95% confidence interval (CI) 1.5-15.9; P < .05], and age and grip strength were associated with safety impairment (OR 1.1; 95% CI 1.0-1.2 and OR 1.9; 95% CI 1.2-3.2 respectively; both P < .05). No significant relationship was found between severity of OD and severity of cognitive impairment.
OD is very frequent in community-dwelling older persons with dementia and is associated with dependency and frailty. The V-VST is an easy-to-perform and well tolerated screening test in this population and therefore should be systematically included in the geriatric assessment of older persons with dementia. The role of V-VST in therapeutic strategies of OD remains to be evaluated.
Dysphagia in Nursing Homes—Results From the NutritionDay Project
2018, Journal of the American Medical Directors Association
Citation Excerpt :
This is reflected in our study as residents with dysphagia were more often dehydrated and is consistent with a previous report on NH residents where 75% with dysphagia had signs of dehydration.32 In addition to the expected risk factors of dysphagia such as impaired cognitive10–12 and functional status,8,10,11 we found that having digestive diseases and the use of antibiotics were also associated with a higher risk of dysphagia. The higher antibiotic intake in residents with dysphagia might indicate that these residents were treated for infections because of aspiration pneumonia in consequence of their dysphagia.
Dysphagia is a major healthcare problem as it increases the risk of malnutrition, dehydration, aspiration pneumonia, and death. The aims of this analysis of data from nursing homes (NHs) worldwide were to examine prevalence rates of dysphagia, to identify characteristics of residents with dysphagia, and to describe which type of nutrition residents with dysphagia receive.
One-day cross-sectional study, repeated in yearly intervals since 2007.
926 NH units from 19 countries.
NH residents participating in the nutritionDay between 2007 and 2014, aged 65 years or older, from Europe and North America, and with available information on dysphagia.
Data on resident and unit level were collected on nutritionDay by local nursing staff using standardized questionnaires. Residents' nutritional status, nutritional intake, general residents’ characteristics, and unit characteristics were of interest as potential predictors of dysphagia (no vs yes). Univariable generalized estimating equations were performed for all variables, and significant predictors (P < .01) included in a multivariable analysis. Nutritional strategies (type of diet, use of oral nutritional supplements, tube feeding, and parenteral nutrition) are described for residents with and without dysphagia.
Dysphagia was reported in 13.4% of the 23,549 residents included, with great variation in the prevalence rates between participating countries. Twelve variables of 23 remained in the multivariable model [area under the receiver operating curve = 0.898; 95% confidence interval (CI) 0.892–0.904; P < .001]. Residents who were not able to eat lunch orally on nutritionDay were 14.90 [odds ratio (OR); 95% CI 9.61–23.11] times more likely to have dysphagia compared with residents who ate everything. ORs of dysphagia were higher for residents with chewing problems (OR 10.48; 95% CI 8.98–12.23), immobile (OR 5.10, 95% CI 4.25–6.11) and partially mobile residents (OR 1.94; 95% CI 1.64–2.29) compared to mobile residents, and residents with severe cognitive impairment (OR 1.99; 95% CI 1.64–2.42). Poor nutritional status, digestive diseases, neurologic diseases, dehydration, and use of antibiotics were also related to a higher risk of dysphagia. The most common nutritional strategy for residents with dysphagia was providing texture-modified diet (42.5%) followed by normal diet (28.2%). One-quarter of residents with dysphagia received oral nutritional supplements additionally, 7.4% of residents with dysphagia received tube feeding exclusively, and 8.0% in combination with oral nutrition.
This analysis of NHs participating in the nutritionDay provides important insight into the current awareness of dysphagia, associated factors, and nutritional strategies. Residents who were unable to eat orally, malnourished, or dehydrated suffered more often from dysphagia, which substantiates the challenges of providing safe and adequate nutrition for residents with dysphagia. Adequacy and efficiency of different nutritional strategies need to be clarified in future studies.
Nursing home-acquired pneumonia, dysphagia and associated diseases in nursing home residents: A retrospective, cross-sectional study
2017, Geriatric Nursing
Citation Excerpt :
Nonetheless, cognitive decline or impairment, such as dementia, will influence the individual ability of nursing home residents and nurses to interpret the symptoms of swallowing problems.24 Furthermore, residents of Dutch nursing homes did recognize their swallowing problems (subjective dysphagia), but considered their swallowing problems to be a natural symptom of aging or of their diseases.25 Owing to this decreased ability to interpret symptoms and the perception of swallowing problems as a natural symptom of aging, dysphagia might not be recognized in time, which increases the risk of aspiration pneumonia amongst these people.
Nursing home-acquired pneumonia (NHAP) is a common infection among nursing home residents. There is also a high prevalence of dysphagia in nursing home residents and they suffer more often from comorbidity and multimorbidity. This puts nursing home residents at higher risk of (mortality from) NHAP. Therefore it is important to gain more insight into the incidence of NHAP and the associated medical conditions in nursing home residents with dysphagia.
To investigate possible associations between NHAP and dysphagia in nursing home residents and to search for a medical risk profile for NHAP.
A retrospective cross-sectional study.
Three nursing homes in The Netherlands.
416 electronic medical files of nursing home residents aged 65 or older living in 3 nursing homes.
Data about age, gender, diagnosis of dysphagia and/or pneumonia, medical diagnosis and possible cause of death of the nursing home residents were extracted from electronic medical files.
The data of 373 electronic medical files were analyzed. A significant difference in the prevalence of dysphagia was found between the nursing homes (p < 0.001). The incidence of NHAP was 5–12% in the participating nursing homes. Statistically significant higher incidence of NHAP was found in residents with dysphagia (p = 0.046). Residents with dysphagia had statistically significantly more diseases compared to residents without dysphagia (p = 0.001). Logistic regression analyses revealed no statistically significant associations between NHAP and the number of diseases and the ICD-10 diseases.
Dysphagia was found to be a risk factor for NHAP. Awareness of the signs of dysphagia by nurses and other care providers is important for early recognition and management of dysphagia and prevention of NHAP.
Dysphagia and Functional Limitations Among Adults in the United States: Findings from the 2022 National Health Interview Survey
2024, Dysphagia

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Subjective dysphagia in older care home residents: A cross-sectional, multi-centre point prevalence measurement

Abstract

Background

Objective

Design

Setting

Participants

Methods

Results

Conclusion

Section snippets

Introduction and background

Methods

Results

Discussion

Conclusion

J. Stroke Cerebrovasc. Dis.

Parkinsonism Relat. Disord.

Chest

Nutrition

Nutrition

Int. J. Nurs. Stud.

Otolaryngol. Head Neck Surg.

J. Am. Med. Dir. Assoc.

Chest

Dysphagia is a common and serious problem for adults with mental illness: a systematic review

Dysphagia

Modification of the risk of mortality from pneumonia with oral hygiene care

J. Am. Geriatr. Soc.

Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia

Age Ageing

Feeding difficulty in older adults with dementia

J. Clin. Nurs.

Prevalence of perceived dysphagia and quality-of-life impairment in a geriatric population

Dysphagia

A reliability and utility study of the care dependency scale

Scand. J. Caring Sci.

Diagnostic accuracy of the care dependency scale

J. Adv. Nurs.

Identification of the cerebral loci processing human swallowing with H2(15)O PET activation

J. Neurophysiol.

Swallowing in Alzheimer's disease

Alzheimer Dis. Assoc. Disord.