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Abstract
The aim of this pilot study was to develop a Thai-version of a simple swallowing questionnaire, called the T-SSQ, and to evaluate the association between malnutrition risk and swallowing ability, determined objectively by tongue strength and subjectively by the T-SSQ. Sensitivity analysis was also performed to determine which swallowing indices better estimate malnutrition in older adults. This cross-sectional study comprised two phases: Phase I, development and cross-cultural translation of the T-SSQ; and Phase II, application of the T-SSQ in 60 older adults. In Phase I, content and face validity of the T-SSQ was evaluated by 10 experts and 15 older adults. In Phase II, the convergent validity of the T-SSQ was evaluated by determining its association with objective tongue strength. Nutritional status was evaluated using the Thai-version of the Mini-Nutritional Assessment. Covariates included sociodemographic characteristics, and oral and health-related status. Adjusting for covariates, the associations between the two swallowing indices and malnutrition risk were determined using multivariable regression analyses. A cut-off value for low tongue strength was determined using a receiver operating characteristic (ROC) curve, and sensitivity analysis between the swallowing indices and malnutrition risk was performed. The T-SSQ comprised 4-items of common signs and symptoms of a swallowing problem. Its content and face validity were verified. Older adults were considered as having a swallowing problem when at least one item was reported. Convergent validity of the subjective index was shown by significantly different tongue strength values between the participants with and without a swallowing problem (p for independent t-test = 0.014). Based on the highest area under the ROC curve, an 18-kPa cut-off value was chosen to classify low tongue strength. Having a swallowing problem and low tongue strength was significantly associated with malnutrition risk. The positive predictive value of the subjective swallowing index was 1.8-fold higher than objective tongue strength. Self-reported swallowing problems determined by the T-SSQ can be used as a subjective index for evaluating swallowing ability in older adults. Subjective swallowing problems and objective tongue strength were associated with malnutrition risk. However, the T-SSQ estimated malnutrition risk better than the objective index.
Highlights
Oral and general health functionally decline as people age [1]
The aim of this pilot study was to develop a Thai-version of a simple swallowing questionnaire, called the Thai-version of a simplified swallowing questionnaire (T-SSQ), and to evaluate the association between malnutrition risk and swallowing ability, determined objectively by tongue strength and subjectively by the T-SSQ
Convergent validity of the subjective index was shown by significantly different tongue strength values between the participants with and without a swallowing problem (p for independent t-test = 0.014)
Summary
Oral and general health functionally decline as people age [1]. Declined oral function can lead to oral frailty followed by oral hypofunction. They can recover to the healthy stage by early detection and proper dental treatment [2]. Oral health becomes oral frailty when a person has decreased occluding pairs of natural teeth, increased unchewable foods, or slight choking/spillage while eating. Oral hypofunction is diagnosed when 3 out of 7 oral signs or symptoms are present: oral uncleanness and dryness, reduced occlusal force, declined masticatory function, reduced tongue and lip motor function, and reduced tongue pressure and swallowing function [2]. Because eating and swallowing ability plays a major role in oral function, a decline in swallowing ability contributes to malnutrition [3, 4]. Malnutrition increases the risk of morbidity and mortality, and negatively affect the quality of life of older adults [5]
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