Prevalence Of Oropharyngeal Dysphagia Research Articles

Screening for oropharyngeal dysphagia in older adults: A systematic review of self-reported questionnaires.

Oropharyngeal dysphagia is a swallowing disorder with signs and symptoms which may be present in older adults, but they are rarely noticed as a health concern by older people. The earliest possible identification of this clinical condition is needed by self-reported population-based screening questionnaire, which are valid and reliable for preventing risks to nutritional status, increased morbidity and mortality. The aim of this systematic review was to identify self-reported screening questionnaires for oropharyngeal dysphagia in older adults to evaluate their methodological quality for population-based studies. An extensive search of electronic databases (PubMed (MEDLINE), Ovid MEDLINE(R), Scopus, Cochrane Library, CINAHL, Web of Science (WOS), PsycINFO (APA), Lilacs and Scielo) was conducted in the period from April to May 2017 using previously established search strategies by the two evaluators. The methodological quality and the psychometric properties of the included studies were evaluated by the COSMIN (Consensus based Standards for the selection of health Measurement Instruments) checklist and the quality criteria of Terwee and colleagues, respectively. The analysed information was extracted from three articles which had conducted studies on the prevalence of oropharyngeal dysphagia by self-reported screening questionnaires, showing poor methodological quality and flaws in the methodological description to demonstrate its psychometric properties. This study did not find any self-reported screening questionnaires for oropharyngeal dysphagia with suitable methodological quality and appropriate evidence in its psychometric properties for elders. Therefore, the self-reported questionnaires within the diagnostic proposal require greater details in its process for obtaining valid and reliable evidence.

The Prevalence of Oropharyngeal Dysphagia in Acute Geriatric Patients.

Oropharyngeal dysphagia (OD) is underdiagnosed and undertreated in many geriatric centers. The aim of this study is to explore the prevalence of OD in acute geriatric patients. The outcome was mortality during hospitalization, mortality, and rehospitalization within 0–30 and 31–180 days of discharge. A total of 313 consecutive acute geriatric patients (44.1% male, mean age 83.1 years (SD 7.8)) hospitalized from 1 March to 31 August 2016 in the North Denmark Regional Hospital were included in this study. The volume-viscosity swallow test and the Minimal Eating Observation Form-II were conducted for each patient in order to screen for OD. A total of 50% patients presented with OD. In the group of patients with OD, significantly more lived in nursing homes; had a lower weight, DEMMI score, and handgrip strength; and smaller circumference of arms and legs compared with non-dysphagia patients. Patients with OD presented an increased length of stay in hospital of one day (p = 0.70). Intra-hospital mortality was 5.8% vs. 0.7%, (p < 0.001) compared with patients with no symptoms of OD. OD is prevalent in acute geriatric patients, and the mortality is 34% within six months of hospitalization. Screening for OD should be given more attention and included in geriatric guidelines.

Prevalence, risk factors and complications of oropharyngeal dysphagia in stroke patients: A cohort study.

Oropharyngeal dysphagia (OD) is a prevalent poststroke condition with severe complications and increased mortality. Poststroke OD prevalence varies among studies and there is little evidence of its related risk factors and associated complications. to evaluate the prevalence of OD after stroke and the risk factors and associated complications. We performed a prospective longitudinal study of stroke patients consecutively admitted to a general hospital. OD was diagnosed with the volume-viscosity swallow test (V-VST). Demographic, functional status and topographical and clinical variables of stroke were collected to assess risk factors for OD. We evaluated functional status, mortality, respiratory infections, and readmissions 3 and 12months after stroke. A multivariate regression analysis determined associated risk factors for OD and for each outcome variable. We included 395 stroke patients with a 45.06% prevalence of OD on admission. OD was independently associated with age (OR=1.05; CI=1.02-1.08), previous stroke (OR=2.40; CI=1.00-5.79), severity using the National Institute of Health Stroke Scale (OR=3.52; CI=1.57-7.87) and volume of the lesion (OR=1.02; CI=1.01-1.03). OD after stroke was an independent risk factor for prolonged hospital stay (P=.049; β=0.938) and institutionalization after discharge (OR=0.47; CI=0.24-0.92); OD was an independent risk factor for poorer functional capacity (OR=3.00; CI=1.58-5.68) and increased mortality (HR=6.90; CI=1.57-30.34) 3months after stroke. Poststroke OD is prevalent and associated with poor short and long term prognosis. Stroke severity and patient status before stroke were more relevant to OD than lesion location. Systematic screening programs and early OD management could significantly improve poststroke patient outcome.

Orophagyngeal Dysphagia in Older Persons - Evaluation and Therapeutic Options

The prevalence of oropharyngeal dysphagia in older persons is high. Because it is frequently undetected, screening tests should be applied in risk groups. If the screening test is positive or typical risk factors are present, an instrumental assessment should be utilized. Objective diagnostic tools such as endoscopic evaluation and videofluoroscopy allow the description of the individual dysphagia pattern, which is the basis for an individualized treatment. The endoscopic evaluation of swallowing is increasingly used because it includes several advantages. Potential therapeutic strategies are multifaceted. The evidence for the effectiveness of adaptive, compensatory and rehabilitative strategies is growing, supporting the evolution of dysphagia therapy to an evidence based treatment.

Prevalence of dysphagia in China: an epidemiology survey of 6102 participants

Objective To determine the prevalence of dysphagia among elderly population and patients with stroke, head and neck cancer or neurodegenerative diseases in China. Methods Patients with stroke, head and neck cancer and neurodegenerative diseases, as well as elderly people older than 65 were selected. They were surveyed using the Sydney or Ohkuma swallowing questionnaire and evaluated using the Kubota's water swallow test and videofluoroscopic swallowing study (VFSS). The incidence of dysphagia among patients with the three diseases and elderly population was recorded, and its relationship with age, gender and economic status was also observed. Results For 7000 people surveyed, 6102 met the inclusion criteria. Of all the included participants, 2363 (38.7%) were identified as having swallowing abnormalities. Dysphagia was found in 46.3% of stroke patients at the acute phase, 56.9% of stroke patients at the chronic phase, 40.8% of Alzheimer′s disease patients, 46.2% of Parkinson′s disease patients, 12.5% of multiple sclerosis patients, 50.0% of amyotrophic lateral sclerosis patients, 36.6% of nasopharyngeal cancer sufferers, 58.4% of laryngeal cancer sufferers. The prevalence of oropharyngeal dysphagia was 26.4% and 13.9% in nursing home- and community-dwelling elderly people. The average prevalence rate of deglutition disorder in the midland (55.0%) was significantly higher than the east coast (38.6%), still significantly higher than the western areas (32.5%) of China (χ2=116.2, P<0.001), representing 3 different economic development status. This study demonstrated that the prevalence of the male (40.0%) was higher than the female (36.3%). Moreover, the prevalence increased with age. Conclusion Dysphagia is of high prevalence among patients with stroke, head and neck cancers or neurodegenerative diseases, as well as the elderly in China. Its prevalence has significant correlations with age, gender and economic status. Key words: Dysphagia; Epidemiology; Chinese economic regions; Hospital; Community; Prevalence

Interrater reliability of the Volume-Viscosity Swallow Test; screening for dysphagia among hospitalized elderly medical patients

Oropharyngeal dysphagia (OD) is prevalent among medical and geriatric patients admitted due to acute illness and it is associated with malnutrition, increased length of stay and increased mortality. A valid and reliable bedside screening test for patients at risk of OD is essential in order to detect patients in need of further assessment. The Volume-Viscosity Swallow Test (V-VST) has been shown to be a valid screening test for OD in mixed outpatient populations. However, as reliability of the test has yet to be investigated in a population of medical and geriatric patients admitted due to acute illness, we aimed to determine the interrater reliability of the V-VST in this clinical setting. Reporting in this study is in accordance with proposed guidelines for the reporting of reliability and agreement studies (GRRAS). In three Danish hospitals (CRD-BFH, CRD-GH, NDR-H) 11 skilled occupational therapists examined an unselected group of 110 patients admitted to geriatric or medical wards. In an overall agreement phase raters reached ≥80% agreement before data collection phase was commenced. The V-VST was applied to patients twice within maximum one hour by raters who administrated the test in an order based on randomization, blinded to each other's results. Agreement, Kappa values, weighed Kappa values and Kappa adjusted for bias and prevalence are reported. The interrater reliability of V-VST as screening test for OD in patients admitted to geriatric or medical wards was substantial with an overall Kappa value of 0.77 (95% CI 0.65-0.89) however interrater reliability varied among hospitals ranging from 0.37 (95% CI-0.01 to 0.41) to 0.85 (95% CI 0.75-1.00). Interrater reliability of the accompanying recommendations of volume and viscosity was moderate with a weighted kappa value of 0.55 (95% CI 0.37-0.73) for viscosity and 0.53 (95% CI 0.36-0.7) for volume. The overall prevalence of OD was 34.5%, ranging from 8% to 53.6% across hospitals. The prevalence and bias adjusted Kappa value (PABAK) was 0.76 (range 0.6-0.85). Mean time to perform the test was 13.1min (SD 6.924). The V-VST seems to be a moderately reliable screening tool for detecting OD among medical and geriatric patients. However, the recommendations of volume and viscosity add limited clinical value to the test.

The Prevalence of Oropharyngeal Dysphagia in Adults Presenting with Temporomandibular Disorders Associated with Rheumatoid Arthritis: A Systematic Review and Meta-analysis.

Temporomandibular disorders (TMDs) are the most frequent non-dental orofacial pain disorders and may be associated with rheumatoid arthritis (RA), resulting in oropharyngeal dysphagia (OD). However, clinicians' understanding of involvement with OD caused by RA-related TMDs is limited and the methodological quality of research in this field has been criticised. Therefore, the aim of this study was to systematically review the prevalence of oral preparatory and oral stage signs and symptoms of OD in adults presenting with TMDs associated with RA. A systematic review of the literature was completed. The following electronic databases were searched from inception to February 2016, with no date/language restriction: EMBASE, PubMed, CINAHL, Web of Science, Elsevier Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses A & I. Grey literature and reference lists of the included studies were also searched. Studies reporting the frequency of OD in adults presenting with TMD and RA were included. Study eligibility and quality were assessed by three independent reviewers. Methodological quality was assessed using the Down's and Black tool. The search yielded 19 eligible studies. Typical difficulties experienced by RA patients included impaired swallowing (24.63%), impaired masticatory ability (30.69%), masticatory pain (35.58%), and masticatory fatigue (21.26%). No eligible studies reported figures relating to the prevalence of weight loss. Eligible studies were deemed on average to be of moderate quality. Study limitations included the small number of studies which met the inclusion criteria and the limited amount of studies utilising objective assessments. Valid and reliable prospective research is urgently required to address the assessment and treatment of swallowing difficulties in RA as TMJ involvement may produce signs and symptoms of OD.

Screening oropharyngeal dysphagia in hospitalized older adults: A prevalent problem associated with mortality

Objective: Oropharyngeal dysphagia (OD) is a common but underdiagnosed syndrome among older adults. The aim of this study was to assess the prevalence of OD in hospitalized older adults by using ten-item Eating Assessment Tool (EAT-10) and the relationship between mortality and OD. Patients and Methods: Patients aged over 65 years admitted to an internal medicine inpatient clinic of a university hospital in Turkey were enrolled in the study. The number of drugs, the number of chronic diseases, routes of feeding (oral, parenteral, or both), length of hospital stay, albumin levels on admission day, and mortality status of the patients were recorded by a physician. The EAT-10 questionnaire was administered to all patients for OD. Results: One hundred and thirty-six patients (54.4% female) were enrolled in the study. Their mean age was 74.6±6.6 years. The prevalence of OD in hospitalized older adults was 23%. The mortality rates were significantly higher in the dysphagic subjects as compared to the non-dysphagic ones (25.8% vs.10.5%; p=0.041). The number of patients with malignancy was significantly higher in the dysphagic group as compared to the non-OD subjects (41.9% vs.20%; p=0.018). Conclusion: OD is a geriatric syndrome and should be screened and treated in all geriatric patients in hospitals. It will improve patient outcomes and quality of life. Keywords: Hospitalization, Older patients, Oropharyngeal dysphagia, Screening, Mortality

Prevalence of oropharyngeal dysphagia in patients related with cerebrovascular disease at a neurorehabilitation unit

IntroductionThe oropharyngeal dysphagia is a frequently present side effect amongst cerebrovascular pathology, being quite relevant due to the possible respiratory and/or nutritional side effects. ObjectiveTo know the prevalence of oropharyngeal dysphagia in hospitalized-stroke patients within a neurorehabilitation unit. MethodA cross-sectional study was designed whose target population was patients diagnosed of cerebrovascular pathology hospitalized in the neurorehabilitation unit within a mid/long term stay hospital in Madrid, Spain, from April 1st 2012 until January 31st 2015. Social-demographical and clinical variables have been chosen by checking the clinical records from the patients included. ResultsDuring the period time of the study 124 patients were admitted in the unit, amongst those 88 were male. A big part of the patients with oropharyngeal dysphagia were admitted with a diagnosis of focal-ischaemic stroke, 43.1% (n=58), and 39.7% (n=49) with intracerebral haemorrhagic stroke. It was also verified that 79.3% (n=46) of the patients diagnosed with dysphagia presented a total dependency, 17.3% (n=10) severe helplessness and 3.4% (n=2) moderate dependence in daily activities. ConclusionDysphagia has a high prevalence within our unit and it is related to the degree of patient dependence related to life actions and, being recommended the use of the Volume–Viscosity Swallow Test when dealing with patients with stroke in order to identify early diagnosis.

The Prevalence of Oropharyngeal Dysphagia in Danish Patients Hospitalised with Community-Acquired Pneumonia.

Community-acquired pneumonia (CAP) and oropharyngeal dysphagia (OD) are prevalent conditions in the elderly. The aim of this study was to explore the relationship between CAP, OD, and frailty in patients admitted to a department of respiratory medicine at a regional hospital. The outcome was mortality during hospitalization and within 30 days of discharge and rehospitalization within 30 days of discharge. A total of 154 consecutive patients (54.5% male, mean age 77.4 years (SD 11.51)) hospitalized because of CAP from September 1, 2013 to March 31, 2014 at North Denmark Regional Hospital were included in this study. The volume-viscosity swallow test was conducted for each patient. A total of 34.42% patients presented with OD. Patients with OD and CAP presented significant differences in age, CURB-65, and dementia compared with those of patients with CAP alone. The majority lived in nursing homes, had a lower body mass index, Barthel 20 score, and handgrip strength, and had poor oral health compared with patients with CAP only. Patients with OD presented an increased length of stay in hospital (P<0.001), intra-hospital mortality (P<0.001), and 30-day mortality rate (P<0.001) compared with those of patients with CAP only. Their rate of rehospitalization 0-30 days after discharge was also increased (P<0.001) compared with that of patients with CAP only. Thus, OD is related to frailty and poor outcome.

MON-P126: Prevalence of Oropharyngeal Dysphagia in an Internal Medicine Unit and Assessment of the Utility of the Eat (Eating Assessment Tool) 10 Test in the Routine Evaluation

MON-P126: Prevalence of Oropharyngeal Dysphagia in an Internal Medicine Unit and Assessment of the Utility of the Eat (Eating Assessment Tool) 10 Test in the Routine Evaluation

Prevalencia de disfagia orofaríngea en pacientes con patología cerebrovascular en una unidad de neurorrehabilitación

IntroductionThe oropharyngeal dysphagia is a frequently present side effect amongst cerebrovascular pathology, being quite relevant due to the possible respiratory and/or nutritional side effects. ObjectiveTo know the prevalence of oropharyngeal dysphagia in hospitalized-stroke patients within a neurorehabilitation unit. MethodA cross-sectional study was designed whose target population was patients diagnosed of cerebrovascular pathology hospitalized in the neurorehabilitation unit within a mid/long term stay hospital in Madrid, Spain, from April 1st 2012 until January 31st 2015. Social-demographical and clinical variables have been chosen by checking the clinical records from the patients included. ResultsDuring the period time of the study 124 patients were admitted in the unit, amongst those 88 were male. A big part of the patients with oropharyngeal dysphagia were admitted with a diagnosis of focal-ischemic stroke, 43.1% (n=58), and 39.7% (n=49) with intracerebral hemorrhagic stroke. It was also verified that 79.3% (n=46) of the patients diagnosed with dysphagia presented a total dependency, 17.3% (n=10) severe helplessness and 3.4% (n=2) moderate dependence in daily activities. ConclusionDysphagia has a high prevalence within our unit and it is related to the degree of patient dependence related to life actions and, being recommended the use of the Volume-Viscosity Swallow Test when dealing with patients with stroke in order to identify early diagnosis.

Dysphagia in the elderly: focus on rehabilitation strategies.

Prevalence of oropharyngeal dysphagia among the elderly is high, but underestimated and underdiagnosed. It may give raise to relevant complications impacting on morbidity, hospital length of stay and health care costs. Dysphagia evaluation and management is a multidisciplinary task; it includes a detailed history taking, clinical and instrumental exams, and identification of the risk of aspiration. Long-standing individual abilities and impairments determine the goals of an ad hoc rehabilitation program. Currently there are no standard algorithmic approaches for the management of dysphagia in the elderly. Education of health professionals on early diagnosis and improvement of therapeutic strategies are mainstays to allow maximal recovery potential in this population. This narrative review summarizes the current rehabilitation approaches for dysphagia in the elderly. The aim is to inform the treating health care professionals, whether caring physician, physical medicine doctor, speech/swallowing therapist or nurse, on the state-of-the-art and stimulate discussion in the scientific community.

Sensitivity and specificity of the Eating Assessment Tool and the Volume-Viscosity Swallow Test for clinical evaluation of oropharyngeal dysphagia.

BackgroundOropharyngeal dysphagia (OD) is an underdiagnosed digestive disorder that causes severe nutritional and respiratory complications. Our aim was to determine the accuracy of the Eating Assessment Tool (EAT-10) and the Volume-Viscosity Swallow Test (V-VST) for clinical evaluation of OD.MethodsWe studied 120 patients with swallowing difficulties and 14 healthy subjects. OD was evaluated by the 10-item screening questionnaire EAT-10 and the bedside method V-VST, videofluoroscopy (VFS) being the reference standard. The V-VST is an effort test that uses boluses of different volumes and viscosities to identify clinical signs of impaired efficacy (impaired labial seal, piecemeal deglutition, and residue) and impaired safety of swallow (cough, voice changes, and oxygen desaturation ≥3%). Discriminating ability was assessed by the AUC of the ROC curve and sensitivity and specificity values.Key ResultsAccording to VFS, prevalence of OD was 87%, 75.6% with impaired efficacy and 80.9% with impaired safety of swallow including 17.6% aspirations. The EAT-10 showed a ROC AUC of 0.89 for OD with an optimal cut-off at 2 (0.89 sensitivity and 0.82 specificity). The V-VST showed 0.94 sensitivity and 0.88 specificity for OD, 0.79 sensitivity and 0.75 specificity for impaired efficacy, 0.87 sensitivity and 0.81 specificity for impaired safety, and 0.91 sensitivity and 0.28 specificity for aspirations.Conclusions & InferencesClinical methods for screening (EAT-10) and assessment (V-VST) of OD offer excellent psychometric proprieties that allow adequate management of OD. Their universal application among at-risk populations will improve the identification of patients with OD at risk for malnutrition and aspiration pneumonia.

Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly

The aim of this study was to explore whether oropharyngeal dysphagia is a risk factor for community-acquired pneumonia (CAP) in the elderly and to assess the physiology of deglutition of patients with pneumonia. In the case-control study, 36 elderly patients (aged ≥ 70 years) hospitalised with pneumonia were matched by age and sex with two independently living controls. All subjects were given the volume-viscosity swallow test to identify signs of oropharyngeal dysphagia. In the pathophysiological study, all cases and 10 healthy elderly subjects were examined using videofluoroscopy. Prevalence of oropharyngeal dysphagia in the case-control study was 91.7% in cases and 40.3% in controls (p<0.001). Adjusting for functionality and comorbidities, dysphagia showed an independent effect on pneumonia (OR 11.9, 95% CI 3.03-46.9). Among cases in the pathophysiological study, 16.7% showed safe swallow, 30.6% high penetrations, 36.1% severe penetrations and 16.7% silent aspirations during videofluoroscopy, while in the healthy elderly subjects these percentages were 80%, 20%, 0% and 0%, respectively (p<0.001). A delay in closure of the laryngeal vestibule (0.414 ± 0.029 s versus 0.200 ± 0.059 s, p<0.01) was the main mechanism of impaired airway protection. In elderly subjects, oropharyngeal dysphagia is strongly associated with CAP, independently of functionality and comorbidities. Elderly patients with pneumonia presented a severe impairment of swallow and airway protection mechanisms. We recommend universal screening of dysphagia in older persons with pneumonia.

Dysphagia in a 73 year old African American Female Due to an Aberrant Course of Internal Carotid Artery: A Case Report

Purpose: The prevalence of oropharyngeal dysphagia amongst individuals older than 50 years of age is 15- 22%, which predisposes them to multiple complications like aspiration, malnutrition and even death. Unlike esophageal dysphagia, oropharyngeal dysphagia is more commonly attributed to functional causes rather than mucosal and structural aberration. We are reporting a rare case of oropharyngeal dysphagia in a 73 year old African American Female (AAF) caused by aberrant right internal carotid artery. Methods: Our patient was a 73 y/o AAF who presented to the ED for evaluation of difficulty in swallowing solids and liquids for one week duration. This was a new onset that was gradually progressive with an intermittent and painless difficulty in swallowing of solids more than liquids with a subsequent sensation of choking and shortness of breath. She stated that despite a good appetite her oral intake has been poor over the past week. No loss of weight and appetite, no chest pain, fever, abdominal or other neurological complaints. Patient had history of hypertension, dyslipidemia and asthma. She had allergy to penicillin and shellfish. She was an ex smoker and did not abuse alcohol or illicit drugs. Her initial vital was stable. Results: Multiple specialties were involved in the care of the patient due to the unclear etiology of dysphagia. A CT scan of the soft tissue of the neck showed a protuberance in the region of the right piriform sinus. Later, an MRA of the neck showed deviation of the proximal right internal carotid artery medially. The proximal portion of the right internal carotid artery deviating medially which resulted in moderate bulging in the mucosa at the level of right pyriform sinus and aryepiglottic folds.The cause of dysphagia was further investigated by modified barium swallow which showed no abnormality in any phases of deglutition. The direct laryngoscopy performed by the ENT specialist showed no anatomical abnormality or foreign body of pharynx or larynx.Gastroenterology team performed an esophagogastroduodenoscopy which showed hiatal hernia and gastritis but no mechanical obstruction of the esophagus. Conclusion: There have been several reports on variation of extracranial portion of Internal Carotid Artery (ICA) that can be of surgical significance but only a few symptomatic cases have been reported. Investigators described the restricted classification for cervical ICAs anomalies which may help radiologist to differentiate actual cervical ICA aberrancy from variations in shape and trajectory. According to their classification our patient had Grade B 1 aberrancy of internal carotid artery which was possibly the cause of dysphagia.