Abstract
BackgroundDysphagia is a common health care problem and poses significant risks including mortality and hospitalization. China has many unsolved long-term care problems, as it is a developing country with the largest ageing population in the world. The present study aimed to identify the prevalence and risk factors of dysphagia among nursing home residents in China to direct caregivers towards preventative and corrective actions.MethodsData were collected from 18 public or private nursing homes in 9 districts of Nanjing, China. A total of 775 older adults (aged 60 ~ 105 years old; 60.6% female) were recruited. Each participant underwent a standardized face-to-face interview by at least 2 investigators. The presence of risk of dysphagia was assessed using the Chinese version of the EAT-10 scale. The Barthel Index (BI) was used to evaluate functional status. Additionally, demographic and health-related characteristics were collected from the participants and their medical files. Univariate analyses were first used to find out candidate risk factors, followed by binary logistic regression analyses to determine reliable impact factors after adjusting for confounders.ResultsOut of 775 older adults, the prevalence of dysphagia risk was calculated to be 31.1%. A total of 85.0% of the older adults reported at least one chronic disease, and diseases with the highest prevalence were hypertension (49.5%), stroke (40.4%), diabetes (25.5%) and dementia (18.2%). Approximately 11.9% of participants received tube feeding. The mean BI score was 56.2 (SD = 38.3). Risk factors for dysphagia were texture of diet (OR = 2.978, p ≤ 0.01), BI level (OR = 1.418, p ≤ 0.01), history of aspiration, pneumonia and heart attack (OR = 22.962, 4.909, 3.804, respectively, p ≤ 0.01), types of oral medication (OR = 1.723, p ≤ 0.05) and Parkinson disease (OR = 2.566, p ≤ 0.05).ConclusionsA serious risk of dysphagia was observed among Chinese nursing home residents. Overall, nursing home residents were moderately dependent, according to the BI level. The risk for dysphagia increased with thinner diet texture, worse functional status, history of aspiration, pneumonia and heart attack, more oral medications and Parkinson disease. The findings of our study may serve to urge nursing home staff to pay more attention to the swallowing function of all residents and to take more actions in advance to prevent or reduce dysphagia.
Highlights
Dysphagia is a common health care problem and poses significant risks including mortality and hospitalization
Dysphagia was reported in 13.4% of the residents from 19 counties in Europe and North America according to the polar question answered by nursing home staff [4]
To identify the risk of dysphagia early and properly prevent it, these findings suggest that nursing home staff should consider the risk factors of dysphagia in those residents who have difficult performing activities of daily living
Summary
Dysphagia is a common health care problem and poses significant risks including mortality and hospitalization. Dysphagia was recognized as a geriatric syndrome by the European Union Geriatric Medicine Society, who defined it as a condition involving perceived or real difficulty in forming or moving a bolus safely from the oral cavity to the oesophagus [1, 2]. In Italy and the Netherlands, studies have reported that 9.0–12.8% of nursing home residents suffered from dysphagia, as assessed by health care professionals, a standardized questionnaire or a resident’s response to a dichotomous question [5,6,7]. Another study with older adults living in intermediate-care facilities in the Taiwan area found a prevalence of self-reported swallowing difficulty of 51.0% [9]
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