Signs of dysphagia and associated outcomes regarding mortality, length of hospital stay and readmissions in acute geriatric patients: Observational prospective study.

Simon Hosbond Poulsen,Henrik Højgaard Rasmussen,Robert Mariusz Modlinski,Pernille Mølgaard Rosenvinge,Mette Holst,Maria Dissing Olesen

doi:10.1016/j.clnesp.2021.07.009

Simon Hosbond Poulsen, Henrik Højgaard Rasmussen + Show 4 more

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https://doi.org/10.1016/j.clnesp.2021.07.009

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Abstract

Dysphagia is a prevalent disorder in acute geriatric patients. This observational prospective study aimed at investigating adverse clinical outcomes linked to signs of dysphagia, including mortality, length of hospital stay (LOS), readmissions, among patients aged≥65 years at a Danish acute medical unit (AMU). Signs of dysphagia were assessed using bedside screening tools including the Eating Assessment Tool (EAT-10), a 30mL Water Swallowing Test (WST) and the Gugging Swallowing Screen tool (GUSS), as described in the preceding cross-sectional study. Data for the follow-up was twice retrieved from electronic medical charts 30 days and 90 days after the patients' primary admission to the hospital. Statistical analysis included non-parametric tests of independence and proportional hazards modelling. 444 patients were recruited, 334 of whom completed the dysphagia screening with 144 (43.1%) showing signs of dysphagia. Patients with signs of dysphagia, compared to those without, experienced higher mortality after 30 days (12.5% vs. 1.6%, p<0.001) and 90 days (21.5% vs. 5.8%, p<0.001), longer LOS (median [Q1; Q3]: 4 [2; 8] vs. 3 [1; 6] days, p=0.004), more total hospital days (THD) during both the 30-day and 90-day follow-up (for 90d: median [Q1; Q3]: 6 [2.25; 12] vs. 4 [2; 9] days, p=0.007), but no significant difference in frequency of readmissions. Multivariate proportional hazards modelling revealed signs of dysphagia, low performance status and high comorbidity to be independent risk factors for mortality. High comorbidity and low hemoglobin, but not signs of dysphagia, were revealed as independent risk factors for readmission. Dysphagia is a notable risk factor linked to increased mortality and length of hospital stay (LOS) for acute geriatric patients in general, not just those suffering from stroke, head and neck cancer or neurodegenerative diseases. Further research is needed to investigate the effectiveness and feasibility of systematic dysphagia screening within this population.

Highlights

Dysphagia is a clinical symptom defined as difficult or disordered swallowing [1]
When contemplating the feasibility of implementing systematic screening for any disease, decision makers will likely be interested in these four factors: prevalence, severity of outcomes, treatability, and health care economics.The aim of this study is to investigate clinical outcomes associated with signs of dysphagia among acute geriatric patients admitted to a general acute medical unit (AMU)
This prospective cohort study is based on the study population of a previous cross-sectional study, consisting of geriatric patients admitted to the acute medical unit (AMU) at Aalborg University Hospital (AAUH) in february 2020 [2]

Summary

Introduction

Dysphagia is a clinical symptom defined as difficult or disordered swallowing [1]. A recent study of geriatric patients (age ! 65 years) admitted to a Danish acute medical unit (AMU) revealed a prevalence of signs of dysphagia of 43.1 % (n: 144 of 334) [2].Previous studies of similar populations set the prevalence of dysphagia at between 26.2 % and 56.7 % [3e10].Dysphagia has been described as a geriatric syndrome associated with multiple diseases such as dehydration [11], pneumonia [12], and malnutrition [3] as well as increased mortality [3,5,10,13], length of hospital stay (LOS) (Attrill 2018, Patel 2018), readmissions with pneumonia and aspiration [10], and increased health care costs [14e16].dysphagia screening reduces incidence of stroke-associated pneumonia [17,18], mortality [18] and LOS [18]. 65 years) admitted to a Danish acute medical unit (AMU) revealed a prevalence of signs of dysphagia of 43.1 % (n: 144 of 334) [2]. Dysphagia is a prevalent disorder in acute geriatric patients This observational prospective study aimed at investigating adverse clinical outcomes linked to signs of dysphagia, including mortality, length of hospital stay (LOS), readmissions, among patients aged ! Multivariate proportional hazards modelling revealed signs of dysphagia, low performance status and high comorbidity to be independent risk factors for mortality. Conclusion: Dysphagia is a notable risk factor linked to increased mortality and length of hospital stay (LOS) for acute geriatric patients in general, not just those suffering from stroke, head and neck cancer or neurodegenerative diseases.

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