Abstract
Identification of elderly patients in risk of dysphagia as early as possible upon hospital admission seems warranted due to the risk of aspiration pneumonia, dehydration, length of stay, and increased mortality. This study aimed to evaluate the feasibility and outcome of dysphagia screening of elderly persons admitted to the emergency department (ED). Inclusion criteria were age ≥ 60 years. A nurse applied the Simple Water Swallow test within one hour of admission. Subsequent assessment was performed by an occupational therapist (OT) using Volume Viscosity Swallow Test and Minimal Eating Observation Form. Of 113 eligible participants (median age 78 years), 75 (66%) were screened in the ED by the nurse, and among those, 12 (16%) were detected with dysphagia. Twenty of the patients not screened in the ED due to critical illness were tested by the OT in the ward after clinical stabilization and 15 patients (75%) were identified with dysphagia. This study demonstrated that it is feasible to perform dysphagia screening of elderly persons by a nurse in the ED, but there are severe limitations according to screening patients with critical illness and patients fasting before surgery in the ED. These patients have a high prevalence of dysphagia and should be screened as early as possible after hospitalization, as it will rarely be possible in the ED.
Highlights
Dysphagia is common in geriatric patients as well as in patients with neurological diseases, chronic obstructive pulmonary disease (COPD), and cancer [1,2,3]
The results of the screening presumed a prevalence of dysphagia in the selected study population of 16% (n = 12 patient)
The positive screening results from the Water swallow test (WST) were confirmed with Volume Viscosity Swallow Test (V-VST)
Summary
Dysphagia is common in geriatric patients as well as in patients with neurological diseases, chronic obstructive pulmonary disease (COPD), and cancer [1,2,3]. It is well documented that dysphagia is associated with aspiration pneumonia, malnutrition, weight loss, frequent hospital admission with prolonged length of stay (LOS), increased mortality, and decreased quality of life [4,5]. Dysphagia adds an extra burden in the management of the vulnerable patient groups with increased economic cost to the health care sector [6]. When patients are screened for dysphagia at admission, the result allows for administrative consistency regarding food, liquids, and medicine to avoid aspiration pneumonia and to recommend rehabilitative interventions such as bolus modification and postural adjustment of the patient. The positive effect of screening for dysphagia in patients with acute stroke is well known; a recent study indicates an effect of screening for dysphagia in an internal medicine unit, but there is no Geriatrics 2020, 5, 75; doi:10.3390/geriatrics5040075 www.mdpi.com/journal/geriatrics
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