Dysphagia In Elderly Patients Research Articles

Application Effect of Early Rehabilitation Nursing in Elderly Cerebral Infarction Patients with Dysphagia

Objective: To observe the application effect of early rehabilitation nursing in elderly cerebral infarction patients with dysphagia. Methods: 120 cases of elderly cerebral infarction patients with dysphagia were divided into 60 cases in the control group and 60 cases in the observation group by the double-blind method, and conventional nursing and early rehabilitation nursing were implemented respectively. Swallowing function, quality of life, adverse events, and nursing satisfaction were compared before and after nursing care. Results: After nursing, the swallowing function score of the observation group (1.01 ± 0.18 points) was lower than that of the control group, and the quality of life score (160.63 ± 9.95 points) was higher than that of the control group (P < 0.05); the incidence rates of aspiration and aspiration pneumonia in the observation group (5.00% and 3.33%) were lower than that of the control group (P < 0.05); the total nursing satisfaction of the observation group (98.33%) was higher than that of the control group (P < 0.05). Conclusion: Early rehabilitation nursing can reduce the degree of dysphagia in elderly patients with cerebral infarction, reduce the incidents of aspiration and aspiration pneumonia, and improve the quality of life, with high nursing satisfaction.

Summary of the best evidence for the management of dysphagia in elderly patients.

To search for and summarize the best evidence for themanagement of elderly patients with dysphagia. Clinical decisions, recommended practices, evidence summaries, clinical practice guidelines, expert consensus, and systematic reviews on the management of dysphagia among elderly patients were systematically reviewed from domestic and foreign guideline websites, association websites, and Chinese and English databases according to the 6S model of evidence-based resources. The search period was between January 1, 2010 and November 1, 2023. Two researchers evaluated the quality of the included literature respectively and extracted evidence. A total of 14 literatures were identified, including 2 guidelines, 2 clinical decisions, 5 evidence summaries, 3 expert consensus statements, and 2 systematic reviews. Twenty-four pieces of evidence from 7 aspects were summarized, including assessment, treatment and rehabilitation, medication care, nutrition management, oral care, complication management, and psychological care. The best evidence-based recommendations for the management of dysphagia in elderly patients is summarized, it is suggested that the best evidence should be selected according to the actual situation of patients, and a personalized management plan should be formulated to improve the quality of life of patients and achieve high-quality nursing.

Low Nutrition before Injury Is a Risk Factor for Dysphagia in Older Patients with Cervical Spinal Cord Injury: Based on a Multicenter Data of 707 Patients.

For older adults, dysphagia is a serious problem that can occur after spinal cord injury (SCI), but its risk factors are unclear. This study aimed to identify risk factors for dysphagia in elderly patients (≥65 years) with cervical SCI. This multicenter study included 707 patients with cervical SCI (mean age 75.3 years). Univariate and multivariate analyses were conducted for patient characteristics and geriatric nutritional risk index (GNRI). Dysphagia occurred in 69 patients (9.8%). The significant factors were as follows: male sex (odds ratio [OR] 3.43), GNRI <92 (1.83), dementia (2.94), fracture (3.40), complete paralysis (3.61), anterior surgery (3.74), and tracheostomy (17.06). Age was not identified as a risk factor. Low GNRI before injury was one of the independent risk factors for dysphagia after geriatric cervical SCI. GNRI represents the comprehensive nutritional status of the elderly and reflects feeding function and its recovery capacity.

Evaluation of Esophageal Dysphagia in Elderly Patients.

While guidelines exist for the evaluation and management of esophageal dysphagia in the general population, dysphagia disproportionately affects the elderly. In this article, we reviewed the literature on evaluating esophageal dysphagia in elderly patients and proposed a diagnostic algorithm based on this evidence. In older patients, dysphagia is often well compensated for by altered eating habits and physiologic changes, underreported by patients, and missed by healthcare providers. Once identified, dysphagia should be differentiated into oropharyngeal and esophageal dysphagia to guide diagnostic workup. For esophageal dysphagia, this review proposes starting with endoscopy with biopsies, given its relative safety even in older patients and potential for interventional therapy. If endoscopy shows a structural or mechanical cause, then further cross-sectional imaging should be considered to assess for extrinsic compression, and same session endoscopic dilation should be considered for strictures. If biopsies and endoscopy are normal, then esophageal dysmotility is more likely, and high-resolution manometry and additional workup should be performed following the updated Chicago Classification. Even after diagnosis of the root cause, complications including malnutrition and aspiration pneumonia should also be assessed and monitored, as they both result from and can further contribute to dysphagia. The successful evaluation of esophageal dysphagia in elderly patients requires a thorough, standardized approach to collecting a history, selection of appropriate diagnostic workup, and assessment of risk of potential complications, including malnutrition and aspiration.

Esophageal motility disorders in symptomatic patients and its relation to age

BackgroundAlthough swallowing disorders can impact individuals of any age, some are unique to the elderly, and others are frequent. Some disorders, such as achalasia, are diagnosed by esophageal manometry studies, which assess lower esophageal sphincter (LES) pressure and relaxation, peristalsis in the esophageal body, and contraction wave characteristics. This research aimed to evaluate esophageal motility dysfunction in symptomatic patients and its relation to age.MethodsConventional esophageal manometry was performed on 385 symptomatic patients who were divided into two groups; Group A (age < 65 years old) and Group B (age ≥ 65 years). The geriatric assessment for Group B included cognitive, functional, and clinical frailty scales (CFS). Additionally, a nutritional assessment was done for all patients.ResultsAbout one-third of the patients (33%) had achalasia, in which manometric results were significantly higher in Group B (43.4%) than in Group A (28.7%) (P = 0.016).The resting lower esophageal sphincter (LES) pressure, as determined by manometry examination, was significantly lower in Group A than in Group B. In contrast, complete LES relaxation percentage and normal esophageal body peristalsis were significantly higher in Group A than in Group B. Patients who exhibited evidence of achalasia in the manometric study had a significantly increased risk of established malnutrition and functional impairment.ConclusionsAchalasia is a prevalent cause of dysphagia in elderly patients, placing them at risk of malnutrition and functional impairment. Thus, a multidisciplinary approach is vital when providing care for this population.

Myofunctional device use in oral care and swallowing: a protocol for a feasibility study in an aged care population

BackgroundPoor oral health is a known predictor of aspiration pneumonia in vulnerable populations such as the elderly and chronically ill and has been linked to systemic disease, morbidity, and mortality. Reduced oral health not only places individuals at a greater risk of aspiration pneumonia but may result in pain or poorer dentition which can impact on mastication and swallowing. Consequences of this may include reduced oral intake, malnutrition, poorer health outcomes, and reduced quality of life. Few evidence-based protocols exist to manage oral care in aged care populations, and maintenance of good oral hygiene is difficult for nursing and care staff to facilitate. However, a recent literature review found that improvements in oral hygiene, oral behaviors, and swallowing, along with breathing and speech have been found to be associated with the use of myofunctional devices due to positive changes in orofacial functions such as lip seal, mastication, swallowing, and nasal breathing patterns. The primary aim of this study is to assess the feasibility of using a myofunctional device to improve oral care and swallowing function in an aged care population.Methods/designThis project is a feasibility study that involves a 5-week intervention for oral hygiene and dysphagia for residents >65 years old in an aged care setting. Feasibility will be determined by the acceptability of the intervention, study recruitment and retention, and adherence to the intervention. Feasibility testing will also include an evaluation of clinical outcome measures, and sensitivity to detect changes in oral health and swallowing in an aged care population.DiscussionThe results of this trial will provide important information regarding the feasibility of utilizing a myofunctional device to improve oral care and dysphagia in elderly patients in an aged care facility. This knowledge will further guide and inform design of a larger trial or future research.Trial registrationThis trial was registered August 10, 2021, with the Australian New Zealand Clinical Trials Registry and allocated the ACTRN: ACTRN12621001359820.

Cognitive Impairment and Mild to Moderate Dysphagia in Elderly Patients: A Retrospective Controlled Study.

Background: To investigate whether cognitive impairment in elderly patients could correlate with the severity of swallowing disorders detectable through the endoscopic fiber optic evaluation. Methods: Elderly patients (≥65years) performing a swallowing evaluation were included and divided according to the Dysphagia outcome and severity scale (DOSS). Neurological evaluation and Mini-Mental test examination (MMET) were administered to detect cognitive impairment. Results: Significantly worse swallowing function was reported in the cognitive impairment group than the control one (40% vs 19%; P = .001). A different significant distribution of swallowing performance was detected according to the patient's MMET score (P < .001; P < .001; P = .01). At the ANOVA test among dependent variables assessed, only age>65 and MMET<10 were significantly correlated with swallowing function (F = 3.862, P = .028; F = 17.49, P = .000). Conclusions: The elderly patient has an increased risk for unrecognized swallowing disorders, with a prevalence of mild to moderate forms. Assessment of cognitive performance could facilitate the identification of swallowing disorders by providing a higher level of suspicion for silent aspiration in subjects with poor MMET scores.

Comorbid Dysphagia and Malnutrition in Elderly Hospitalized Patients.

Elderly individuals account for one-third of all hospitalizations. The goal of this study was to evaluate the prevalence of dysphagia in elderly patients admitted to a tertiary care center. It also sought to investigate how dysphagia is identified, how it covaries with malnutrition and other conditions, and how it impacts hospital stay. Case Series. A retrospective chart review was performed. All patients >65 years admitted to a tertiary care center in January and February 2016 were included. Patients with primary psychiatric diagnoses and patients with upper aerodigestive tract malignancy or surgery were excluded. A total of 655 patients were identified. Mean age was 76.6 years. Twenty-four percent (155 patients) had dysphagia while 43% (282 patients) had malnutrition. Thirteen percent (84 patients) had both dysphagia and malnutrition. Fifty percent of patients who had malnutrition were seen by speech language pathology (SLP). One hundred percent of malnourished patients that saw SLP were identified as having dysphagia. Three hundred and eighty-two patients (58%) were seen by the dietician but not by SLP. Multiple logistic regression indicated that the presence of dysphagia was positively associated with age, presence of malnutrition, admission to either cardiology or neurology service as compared to medicine service, and history of stroke. One-quarter of elderly patients admitted to our tertiary care center had dysphagia. Dysphagia, especially when linked with malnutrition, has poorer outcomes and increased healthcare costs. Our data suggests a possible disconnect between malnutrition diagnosis and dysphagia identification. This is an important area of intervention that has the potential to improve the treatment and outcomes of these patients. 4 Laryngoscope, 131:2441-2447, 2021.

Study on Factors Influencing Dysphagia in Elderly Patients with Chronic Obstructive Pulmonary Disease Based on Structural Equation Modeling

Dysphagia can occur in elderly patients with chronic obstructive pulmonary disease due to poor coordination between breathing and swallowing. Dysphagia can not only lead to aspiration pneumonia and acute exacerbation of chronic obstructive pulmonary disease, but also increase the risk of death. Previous studies only analyzed the influencing factors, but did not explore the interaction and size of the influencing factors, and there is still a lack of epidemiological investigation of dysphagia in chronic obstructive pulmonary disease patients in China. This study investigated the current situation of dysphagia in patients with chronic obstructive pulmonary disease in elderly chronic obstructive pulmonary disease patients in China, and used structural equation model to explore the direct and indirect effects of influencing factors. From April 2019 to April 2020, 1020 elderly chronic obstructive pulmonary disease patients who met the inclusion and exclusion criteria in the department of respiratory Medicine in 9 tertiary hospitals in Ningxia were selected as study subjects. The data were collected through questionnaires, including general information, chronic obstructive pulmonary disease Assessment Test, Activities of Daily Living, Geriatric Depression Scale, The Mini Nutritional Assessment-Short Form, FRAIL assessment scale, and Water Swallowing Test. On the basis of exploratory factor analysis, Amos was used to construct the initial model in combination with literature and professional knowledge, and the overall fitting evaluation and modification of the model were carried out to construct the final model. The incidence of Dysphagia in patients with chronic obstructive pulmonary disease in elderly chronic obstructive pulmonary disease patients was 19.71 %. The modified structural equation model fitted well, and the comprehensive condition of the elderly, smoking condition and comorbidities directly affects the dysphagia (the effect values respectively were 0.372, 0.112 and 0.095).The disease condition not only directly affects dysphagia, but also influences it through the comprehensive condition of the elderly (direct effect 0.109, indirect effect 0.109, total effect 0.218); age factors not only directly affects dysphagia, but also influences it through The disease condition and comprehensive condition of the elderly (direct effect 0.113, indirect effect 0.183 and total effect 0.296). eating condition not only directly affects dysphagia, but also influences it through comprehensive condition of the elderly (direct effect 0.127, indirect effect 0.074, total effect 0.201). The comprehensive condition of the elderly, smoking status and comorbidities directly affects the swallowing function, and the effect value of comprehensive condition of the elderly on swallowing function is 0.372. The disease status, age factors and eating status not only directly affect swallowing function, but also indirectly affect it through other factors.

Stenting of the esophagus in the course of the malignant dysphagia in elderly patients

Esophageal cancer is a disease with difficult clinical management, and palliative therapy is the only predominant treatment. This retrospective study analyses the results of clinical management of elderly patients (&gt;75 years of age) who were treated with esophageal stenting for malignant dysphagia due to primary esophageal cancer, including squamous cell carcinoma (SCC), esophageal adenocarcinoma (EAC), as well as secondary esophageal malignant strictures due to non-small cell lung cancer (NSCLC). Patients with esophago-respiratory fistula (ERF) were also included in the study. This study included 166 patients aged 75–88 (mean age, 78) years. Nine (5.4%) patients had upper malignant esophageal stenosis, 48 (28.1%) had the middle, 43 (25.9%) in the lower part of the esophagus, 49 (29.5%) patients had EAC-related stenosis, and 17 (10.2%) patients reported lung cancer-related esophageal stenosis. Dysphagia was rated at 2.8 (range, 2–3) before stenting and at 1.2 (range, 1–2) after the stenting procedure. Seven (4%) patients experienced stenting migration, 12 (7.2%) had granulation tissue overgrowth and prosthesis obstruction, two (1.2%) developed respiratory failure, and one (0.6%) patient died. Twelve (7.2%) patients were treated for ERF with double-stenting, and three (1.8%) patients developed a secondary fistula after the stent implantation. The mean survival of patients with esophageal cancer and ERF was 101.8 days and 62.5 days, respectively. Esophageal stenting has proven a safe procedure in patients over 75 years of age. It has a low rate of stenting obstruction and migration. Patients with ERF are a particularly difficult group to treat, show very poor outcomes and short survival rates.

Swallowing disorders in elderly patients with neurological deficits

Aim: The study aimed to identify possible dysphagia in elderly patients with neurological deficits. Design: A cross-sectional study. Methods: A cross-sectional study was carried out using a standardized tool, the Brief Bedside Dysphagia Screening Test-Revised (BBDST-R). The study comprised 141 patients. Data were statistically processed; the sensitivity and specificity of the screening tool were calculated. The level of significance was set at 5%. Results: In the sample, the majority of screening results were positive (67.4%), that is, most patients had possible swallowing disorders. There was a statistically significant difference in the presence of possible dysphagia depending on cognitive functioning. As many as 77% of individuals with cognitive impairment had possible dysphagia. Analysis of the data suggested an increase in the proportion of individuals with possible dysphagia with increasing age. The sensitivity of the screening test with regard to speech pathology assessment was 100% (CI = 89.7–100.0%.). The mean time needed to complete the BBDST-R in one person was 1.3 minutes. Conclusion: For its high sensitivity and short completion time, the BBDST-R is suitable for use in clinical practice to detect possible swallowing disorders in elderly patients with neurological deficits.

Oropharyngeal dysphagia in elderly population suffering from mild cognitive impairment and mild dementia: Understanding the link.

To evaluate the prevalence of oropharyngeal dysphagia in elderly patients suffering from minimal or mild cognitive decline. We retrospectively collected the data of patients suffering from mild cognitive impairment or mild dementia and were undergoing management for suspected oropharyngeal dysphagia, in our department. All our patients were subjected to Mini Mental State Examination test, MD Anderson dysphagia inventory and caregiver mealtime and dysphagia questionnaire. We performed a mealtime observation study and endoscopic evaluation of swallowing in all our patients. Following evaluation, we then analysed the data statistically. Out of 708 patients who visited us for cognitive decline and suspected oropharyngeal dysphagia in the last two years, 52 patients were confirming to the inclusion criteria of this study. Classification of oropharyngeal dysphagia patients according to ASHA-NOMS scale showed that 32.7% of patients presented with grade 4 of dysphagia followed by another 32.7% with grade 5 and 30.8% presented with grade 6. Only 3.8% of our patients were considered normal (grade 7 of ASHA-NOMS scale). MD Anderson dysphagia inventory could collected swallowing alterations in only 23.1% of the cases. The caregiver mealtime and dysphagia questionnaire showed acceptable caregivers patient management in 53.8% of patients. Our study underscores the fact that oropharyngeal dysphagia is present in many cases of mild cognitive decline. While patients understate their swallowing problems, the caregivers are not competent enough to manage this situation in a great percentage of cases. Only a mealtime observation by a speech-language pathologist along with FEES is able to identify the true prevalence of the condition.

Drug-induced dysphagia in elderly patients

Drug-induced dysphagia in elderly patients

The prevalence, risk factors and prognostic implications of dysphagia in elderly patients undergoing hip fracture surgery in Korea

BackgroundDysphagia is prevalent in geriatric patients, such as elderly hip fracture patients, and is associated with a poor prognosis. This study investigated (1) the prevalence of dysphagia based on clinical screening and a video-fluoroscopic swallowing study (VFSS), (2) the risk factors of dysphagia, and (3) the prognostic implications of dysphagia in elderly patients (≥ 65 years) undergoing hip fracture surgery.MethodsIn this retrospective study, data from 393 female and 153 male patients ≥65 years of age who underwent surgery for a hip fracture between 2015 and 2018 were analysed. Patients who were considered at high risk of dysphagia after screening underwent a VFSS. To identify risk factors of dysphagia, demographic factors, the American Society of Anesthesiologists classification, past medical history, known risk factors of dysphagia, and factors associated with surgery were analysed using a binary logistic regression model. Odds ratios (ORs) of dysphagia for having poor prognosis including postoperative pneumonia, intensive care unit (ICU) admission, and death within 6 months after surgery were obtained by logistic regression. The association of postoperative pneumonia with poor prognosis was also analysed.ResultsDysphagia was seen in 5.3% of hip fracture patients. In multivariate regression analysis, a serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia (OR [95%CI] = 3.13 [1.40, 7.01]). Dysphagia was identified as a risk factor for postoperative pneumonia in regression analysis after adjustment (OR [95%CI] = 3.12 [1.05, 9.27]). Postoperative pneumonia was significantly associated with ICU admission (OR [95% CI] = 4.56 [1.85, 11.28]) and death within 6 months after surgery (OR [95% CI] = 2.56 [1.03, 6.33]).ConclusionsDysphagia in elderly hip fracture surgery patients was associated with postoperative pneumonia, a risk factor for poor outcomes including ICU admission and death within 6 months after surgery. A serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia. Therefore, diagnostic testing should be performed to detect dysphagia, especially in patients with a low serum albumin level. Finally, particular care should be taken to prevent postoperative complications in patients with dysphagia.

Nutritional status change and activities of daily living in elderly pneumonia patients admitted to acute care hospital: A retrospective cohort study from the Japan Rehabilitation Nutrition Database

The aim of this study was to examine the effect of improved nutritional status on activities of daily living (ADLs) and dysphagia in elderly patients with pneumonia who were admitted to acute care hospitals. A retrospective cohort study was conducted using registry data from the Japan Rehabilitation Nutrition Database of patients with pneumonia who were admitted to acute care hospitals. Patients were divided into two groups based on the Mini Nutritional Assessment Short-Form (MNA-SF) status at discharge: Patients with no status change or with decreased status were allocated to the unimproved nutritional status (UN) group and those with increased status were assigned to the improved nutritional status (IN) group. The primary outcome was ADLs as assessed by Barthel Index (BI) score at hospital discharge. Secondary outcomes included dysphagia as assessed by the Food Intake Level Scale (FILS) at discharge. The study included 143 patients with a mean age of 84.7 ± 7.8 y. Based on the MNA-SF categories at discharge, 127 (88.8%) patients were assigned to the UN group and 16 (11.2%) to the IN group. Patients in the IN group had significantly higher BI and FILS scores than those in the UN group. Multiple regression analysis indicated that improvement in nutritional status was independently associated with BI gain (B = 9.916; β = 0.153; 95% confidence interval [CI], 1.929-11.761; P = 0.017) and FILS gain (B = 1.259; β = 0.167; 95% CI, 1.224-2.814; P = 0.044). Nutritional improvement is associated with improvements in ADL and dysphagia in patients with pneumonia and malnutrition.

Prevalence and influencing factors of dysphagia in elderly patients

Prevalence and influencing factors of dysphagia in elderly patients

Dysphagia Due to Diffuse Idiopathic Skeletal Hyperostosis

Diffuse Idiopathic Skeletal Hyperostosis (DISH) affects up to 20% of the elderly population, with a greater prevalence in men. It is characterized by the non-inflammatory ossification of spinal ligaments and soft tissues. Most patients are asymptomatic, but the developing osteophytes may cause esophageal compression and DISH should be considered in evaluation of dysphagia. Our case illustrates the importance of maintaining a high index of suspicion, and the difficulty in resolving dysphagia secondary to DISH. A 68-year-old man referred for persistent dysphagia reported solid dysphagia up to 85% of the time with occasional regurgitation. He complained of no odynophagia, dyspepsia, or heartburn. Physical exam was grossly normal. The patient had a history of hepatic steatosis, well controlled gastroesophageal reflux disease, diabetes mellitus, hyperlipidemia, and hypertension. An esophagram revealed large anterior bridging osteophytes from C3-C7, which were effacing portions of the hypopharynx and upper esophagus. The osseous findings were consistent with a diagnosis of DISH. Of note, a CT scan from five years ago had identified osteophytes in the thoracic and lumbar spine. Esophagogastroduodenoscopy (EGD) was remarkable for severe extrinsic stenosis of the upper third of the esophagus. Dilation was performed without subsequent symptom improvement. The patient was counseled regarding possible surgical options but declined further intervention. Over the next eight months the patient continued to report dysphagia prompting two more upper endoscopies with dilation, each failing to provide symptom resolution. A repeat esophagram revealed 40-50% narrowing of the cervical esophagus of about 10 cm in length. Aspiration of barium contrast was also noted. Chest computed tomography with contrast revealed only a small hiatal hernia and hypertrophic spondylosis of the dorsal spine. This patient with DISH experienced dysphagia secondary to osseous esophageal compression. Esophageal dilation is not an effective treatment for dysphagia secondary to DISH. Surgical resection of the osteophytes may be considered, although sufficient studies are lacking regarding outcomes of surgical management. In conclusion, DISH is surprisingly common and should be considered more often in the evaluation of dysphagia in elderly patients. This disorder will be encountered with increasing frequency as the geriatric population expands.2973_A Figure 1. CT showing anterior osteophyte formation (arrows) with narrowing of the oropharynx (Image from similar case)2973_B Figure 2. Barium swallow radiogram showing obstruction opposite C5 (arrow) and DISH bridging C4-C6 (Image from similar case)

Swallowing Muscle Dysfunction and Residual Factor of Dysphagia with Community- Acquired Pneumonia in the Elderly

Objectives: This study aimed to elucidate the characteristics of swallowing function, including swallowing muscle activity, and the residual factors of dysphagia in elderly patients with community-acquired pneumonia (CAP). Study design: A total of 163 subjects were included in the study. The subjects were classified into an oral intake independent group (severe aspiration), which comprises subjects who have a total fiberoptic endoscopic evaluation of swallowing (FEES) score of seven or more, and an oral intake restriction group (no aspiration or mild aspiration), which comprises subjects who have a total FEES score of less than seven. These two groups were compared, and the residual factors of dysphagia were analyzed. Results: Significant differences between the two groups were found in the repetitive saliva swallowing test, geriatric nutritional risk index, pneumonia severity, swallowing muscle activity, and respiratory rate fasting period. Multivariate logistic regression analysis revealed that the duration of swallowing muscle activity (OR 15.7, 95% CI 1.29 to 19.66; P=0.031) and respiratory rate (OR 1.22, 95% CI 1.03 to 1.58; P=0.026) were the residual factors of dysphagia in elderly people with CAP. Conclusions: This study highlighted the importance of an early approach that focuses on swallowing function and respiratory rate in the rehabilitation of elderly people with dysphagia and CAP. The results for the residual factors of dysphagia provide new evidence in the field of rehabilitation and will help reduce hospitalization and readmission for pneumonia.

Cervical Fractures: Does Injury Level Impact the Incidence of Dysphagia in Elderly Patients?

Dysphagia is common in the elderly with significant consequences such as aspiration and malnutrition. This study seeks to investigate oropharyngeal dysphagia in elderly patients with cervical fractures and determine whether the level of cervical fracture impacts the incidence of swallowing dysfunction. Records of trauma patients ≥65 admitted with cervical fractures over a 76-month period to a level 1 trauma center were reviewed. History of dysphagia, stroke, tracheostomy or spinal cord injury were excluded criteria, leaving 161 patients for analysis. Evaluation of swallowing function was performed to identify dysphagia and variables were analyzed. A total of 161 patients met inclusion criteria and 42 (26.1%) had dysphagia. Patients with dysphagia were older (84.1 ± 8.93 vs. 79.9 ± 8.48, p = 0.006), had higher hospital length of stay (9.0 ± 4.48 vs. 4.6 ± 3.30, p = <0.0001), and were more likely to have intensive care unit days (52.4% vs. 21.8%, p = 0.0002). Non-operatively-managed patients with C1 fractures were more likely to have dysphagia than patients without C1 fractures (29.2% vs. 7.1%, p = 0.0008). After regression analysis, C1 fracture increased the likelihood of dysphagia by four times (OR = 4.0; 95% CI 1.2–13.0). Oropharyngeal dysphagia is common in elderly patients with cervical fracture. Non-operatively-managed patients with C1 fractures are at increased risk and may benefit from more vigorous surveillance.

Analysis of patients ≥65 with predominant cervical spine fractures: Issues of disposition and dysphagia.

Background:Cervical spine fractures occur in 2.6% to 4.7% of trauma patients aged 65 years or older. Mortality rates in this population ranges from 19% to 24%. A few studies have specifically looked at dysphagia in elderly patients with cervical spine injury.Aims:The aim of this study is to evaluate dysphagia, disposition, and mortality in elderly patients with cervical spine injury.Settings and Design:Retrospective review at an the American College of Surgeons-verified level 1 trauma center.Methods:Patients 65 years or older with cervical spine fracture, either isolated or in association with other minor injuries were included in the study. Data included demographics, injury details, neurologic deficits, dysphagia evaluation and treatment, hospitalization details, and outcomes.Statistical Analysis:Categorical and continuous data were analyzed using Chi-square analysis and one-way analysis of variance, respectively.Results:Of 136 patients in this study, 2 (1.5%) had a sensory deficit alone, 4 (2.9%) had a motor deficit alone, and 4 (2.9%) had a combined sensory and motor deficit. Nearly one-third of patients (n = 43, 31.6%) underwent formal swallow evaluation, and 4 (2.9%) had a nasogastric tube or Dobhoff tube placed for enteral nutrition, whereas eight others (5.9%) had a gastrostomy tube or percutaneous endoscopic gastrostomy tube placed. Most patients were discharged to a skilled nursing unit (n = 50, 36.8%), or to home or home with home health (n = 48, 35.3%). Seven patients (5.1%) died in the hospital, and eight more (5.9%) were transferred to hospice.Conclusion:Cervical spine injury in the elderly patient can lead to significant consequences, including dysphagia and need for skilled nursing care at discharge.