34 Dysphagia at the front door: profiling dysphagia in a frail population presenting to the emergency department

Abstract

Abstract Background The prevalence of both frailty and dysphagia advances with age. Worsening dysphagia increases the degree of frailty and reduces quality of life. The aim of this study was to describe the characteristics and mortality risk of a population of patients identified for Speech and language therapy (SLT) review in a Frailty at the Front Door (FFD) team. Methods A FFD team performs comprehensive geriatric assessment (CGA) for older frail patients presenting to the emergency department. To assist service planning, all patients were screened for the possible presence of dysphagia using the 4QT and those with a response to 1 or more screening questions underwent SLT review. Data were collected from consecutive SLT patient records and a hospital based patient database of CGAs over a 3-month period. Age, gender, 4AT, MST malnutrition risk screen, clinical frailty score (CFS), nursing home (NH) residence, dysphagia outcome severity scale, need for acute hospital admission and mortality rate at 1000 days was collected. Data were entered onto Excel and analysed using descriptive statistics. Results 69 swallow assessments were carried out. The mean age was 83 (+/−9) years. 71% (n = 49) were female. The 4AT was ≥4 in 36% (n = 25). 42% (n = 29) were at risk of malnutrition. The CFS was ≥6 in 62% (n = 43). 23% (n = 16) resided in a nursing home, 72% (n = 50) had dysphagia, 92% (n = 63) required hospital admission and 36% (n = 25) were experiencing their ‘last 1,000 days’ at follow-up. Conclusion Older patients presenting to the ED with a coexisting dysphagia are at high risk of malnutrition and delirium, moderately frail, present with moderate dysphagia, and are more likely to require acute hospital admission. This cohort need early screening, identification, assessment and intervention, in order to reduce dysphagia related risks and improve patient outcomes, particularly given the high proportion that are in their last 1,000 days.