Prevalence Of Oropharyngeal Dysphagia Research Articles

Prevalence of Oropharyngeal Dysphagia in Patients with Stroke: A Systematic Review and Meta-Analysis

Oropharyngeal dysphagia (OD) is a prevalent and clinically significant challenge among patients with stroke, affecting their quality of life and overall prognosis. This systematic review aims to comprehensively assess and synthesize existing evidence on the prevalence of OD in a patient’s stroke. A comprehensive literature search was performed in major medical databases, including PubMed, Scopus, and Web of Science, from inception to March 2023. Studies revealed the prevalence of OD in adult stroke patients. Two reviewers independently assessed the titles, abstracts, and full texts of potentially eligible studies. The studies were evaluated for bias using the Joanna Briggs Institute’s critical appraisal checklist. Data from the studies were extracted, and a meta-analysis was performed to estimate the pooled prevalence of OD in stroke patients. The initial search yielded 1,272 relevant studies, of which eight met the inclusion criteria for the systematic review. The combined sample size of the studies included was 1,830 patients. The pooled prevalence of OD in stroke patients was estimated to be 31.0% (95% confidence interval [CI]: 11.0-55.0%). Subgroup analysis based on stroke type (ischemic vs. hemorrhagic), stroke location (left hemisphere vs. right hemisphere vs. brainstem), and time since stroke onset was conducted to explore potential sources of heterogeneity. In conclusion, the study highlights the significant burden of OD in patients with stroke, emphasizing the need for early detection, comprehensive assessment, and tailored interventions to improve patient outcomes and identify risk factors.

Prevalence of Oropharyngeal Dysphagia and Its Value as a Prognostic Factor in Community-Acquired Pneumonia: A Prospective Case-Control Study.

Although oropharyngeal dysphagia (OD) is a common finding in patients with community-acquired pneumonia (CAP), specific recommendations are not provided in the current clinical guidelines. To estimate the prevalence of OD and its associated factors among patients hospitalized for CAP and to assess one-year outcomes according to the presence or absence of OD. We studied 226 patients hospitalized for CAP and 226 patients hospitalized for respiratory conditions other than CAP. We screened the risk of OD using the Eating Assessment Tool-10 (EAT-10), followed by the volume-viscosity swallow test (V-VST). A total of 122 (53.9%) patients with CAP had confirmed OD compared with 44 (19.4%) patients without CAP. Patients with CAP and OD were older (p < 0.001; 1.02-1.07) and had less familial/institutional support (p = 0.036; 0.12-0.91) compared to patients with CAP and no OD. OD was more prevalent as the CURB-65 score increased (p < 0.001). Patients with OD spent more time in the hospital (14.5 vs. 11.0 days; p = 0.038) and required more visits to the emergency room (ER). Twenty (16.4%) patients with CAP and OD died after discharge vs. one (0.8%) patient with CAP and no OD (p < 0.001; CI = 2.24-42.60). The prevalence of OD in hospitalized patients with CAP is higher than in patients hospitalized for other respiratory diagnoses. Advanced age, lower familial/institutional support, and increased CAP severity are associated with OD. Patients with CAP and OD are more frequent ER visitors after discharge and have a higher mortality. In patients with CAP and OD, aspiration pneumonia is likely underestimated.

The Prevalence of Oropharyngeal Dysphagia in Adults: A Systematic Review and Meta-analysis.

To determine the global prevalence of oropharyngeal dysphagia (OD) in adults. Six electronic databases (Embase, LILACS, LIVIVO, PubMed/Medline, Scopus, and Web of Science) were searched, in addition to gray literature (ASHA, Google Scholar, ProQuest Dissertation, and Theses). A random-effects model for meta-analysis of proportions was conducted, and heterogeneity was evaluated according to the moderator variable through subgroup analysis and meta-regression. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the certainty of the evidence was assessed using the GRADE tool. Thirty papers were included for qualitative and quantitative synthesis. The combined prevalence estimate was 60% [CI 95% = 50%-70%; I2 = 95%], accounting for different baseline conditions. However, the wide variation that exists between the different baseline conditions (underlying disease or risk factor) tended to overestimate this prevalence when considering the general population. Only one study evaluated healthy individuals, which showed a prevalence of 31% [CI95% = 27%-36%]. The risk of bias was considered low for all studies. None of the variables were considered predictors for the observed variance between the effect sizes of the included studies. For the prevalence of OD, the GRADE rating was considered very low. Despite the high prevalence observed, with over half of the individuals affected, the evidence regarding this outcome remains uncertain due to an overestimation of the generated estimates caused by the baseline condition of the sample.

Prevalence of oropharyngeal dysphagia and risk of mortality among hospitalized COVID-19 patients: A meta-analysis

Post-extubation and neurologic complications in COVID-19 patients have been shown to cause oropharyngeal dysphagia (OD). We performed the first meta-analysis to explore and estimate the pooled prevalence of OD, risk of mortality, and associated factors among hospitalized COVID-19 patients. We searched Scopus, PubMed, Embase, CINAHL, WHO COVID-19 database, and Web of Science for literature on dysphagia in COVID-19 patients. We used the generalized linear mixed model (GLMM) to determine the prevalence estimates of OD in the R software and the DerSimonian-Lard random-effects model in the Comprehensive Meta-Analysis software to explore the risk of mortality and associated factors of OD, presented as odds ratios (ORs) and corresponding 95% confidence intervals (CIs). We used Cochran's Q, τ2, and the I2 statistic to assess heterogeneity and conducted a moderator analysis to identify moderator variables. We included eighteen studies with a total of 2055 participants from the 910 studies retrieved from electronic databases. The prevalence of OD among hospitalized COVID-19 patients was estimated at 35% (95% CI = 21-52; low certainty of evidence) associated with a high risk of mortality (OR = 6.41; 95% CI = 1.48-27.7; moderate certainty of evidence). Intubation (OR = 16.3; 95% CI = 7.10-37.3; high certainty of evidence), use of tracheostomies (OR = 8.09; 95% CI = 3.05-21.5; high certainty of evidence), and proning (OR = 4.97; 95% CI = 1.34-18.5; high certainty of evidence) among hospitalized COVID-19 patients were highly associated with developing OD. The prevalence of OD was higher among hospitalized COVID-19 patients who were admitted in intensive care units (ICU), intubated, and mechanically ventilated. The prevalence of OD among hospitalized COVID-19 patients is estimated at 35% associated with a high risk of mortality. OD assessment among hospitalized COVID-19 patients who are managed in an ICU, prone position, intubated, and mechanical ventilated deserves more attention. PROSPERO CRD42022337597.

A Comparative Study between the Three Waves of the Pandemic on the Prevalence of Oropharyngeal Dysphagia and Malnutrition among Hospitalized Patients with COVID-19.

Background: The phenotype of patients affected by COVID-19 disease changed between the waves of the pandemic. We assessed the prevalence of oropharyngeal dysphagia (OD), malnutrition (MN), and mortality between the first three waves of COVID-19 patients in a general hospital. Methods: a prospective observational study between April 2020–May 2021. Clinical assessment for OD was made with the volume-viscosity swallowing test; nutritional assessment was performed consistent with GLIM criteria. A multimodal intervention was implemented in the second and third wave, including (a) texturized diets—fork mashable (1900 kcal + 90 g protein) or pureed (1700 kcal + 75 g protein), (b) oral nutritional supplements (500–600 kcal + 25–30 g protein), and (c) fluid thickening (250 mPa·s or 800 mPa·s). Results: We included 205 patients (69.3 ± 17.6 years) in the 1st, 200 (66.4 ± 17.5 years) in the 2nd, and 200 (72.0 ± 16.3 years;) in the 3rd wave (p = 0.004). On admission, prevalence of OD was 51.7%, 31.3% and 35.1%, and MN, 45.9%, 36.8% and 34.7%, respectively; mortality was 10.7%, 13.6% and 19.1%. OD was independently associated with age, delirium, and MN; MN, with age, OD, diarrhea and ICU admission; mortality, with age, OD and MN. (4) Conclusions: Prevalence of OD, MN and mortality was very high among COVID-19 patients. OD was independently associated with MN and mortality. An early and proactive multimodal nutritional intervention improved patients’ nutritional status.

Prevalence of Oropharyngeal Dysphagia and Risk of Pneumonia, Malnutrition, and Mortality in Adults Aged 60 Years and Older: A Meta-Analysis

Introduction: Oropharyngeal dysphagia (OD) is a serious health condition associated with poor survival and quality of life in adults aged 60 years and older. Comprehensive assessment and management of OD could lead to better and improved health outcomes for older adults. Therefore, we performed the first meta-analysis to determine the pooled prevalence of OD and risk of pneumonia, malnutrition, and mortality. Methods: Databases including Ovid-MEDLINE, Web of Science, Embase, PubMed, Cochrane, and CINAHL were searched up to January 2021. Data analysis was conducted using logistic-normal for prevalence rate and DerSimonian-Lard random-effects models for outcomes and associated factors of OD, providing odds ratio (OR) and corresponding 95% confidence interval (CI). Results: The pooled prevalence of OD in 39 studies with 31,488 participants was 46% associated with higher pooled OR for risk of pneumonia 2.07 (95% CI, 1.58–2.72), malnutrition 2.21 (95% CI, 1.43–3.41), and mortality 2.73 (95% CI, 1.62–4.60). Geriatric syndromes including fecal incontinence 6.84 (4.955–9.44), immobility syndrome 6.06 (5.28–6.96), pressure ulcers 4.02 (2.46–6.56), sarcopenia 3.10 (1.89–5.09), urinary incontinence 2.75 (1.81–4.19), frailty 2.66 (1.16–6.13), delirium 2.23 (1.73–2.87), and falls 1.47 (1.19–1.81) and comorbidities including dementia 3.69 (2.36–5.78) and stroke 1.92 (1.47–2.52) were associated with OD. Conclusion: Early identification and management of OD should consider geriatric syndromes and neurogenic comorbidities to prevent malnutrition and pneumonia and reduce mortality in adults aged 60 years and older.

Prevalence of oropharyngeal dysphagia in geriatric patients and real-life associations with diseases and drugs

Risk factors for oropharyngeal dysphagia (OD) in elderly patients are mainly central nervous system (CNS) and structural organic diseases or presbyphagia. We analysed the OD prevalence and association of OD with multimorbidity and polypharmacy using real-life data to complete this spectrum, with a focus on further and iatrogenic risk. This was a cross-sectional retrospective study based on a random sample of 200 patients admitted to a geriatric hospital. Data analysis included diagnoses, the detailed list of drugs, and an intense clinical investigation of swallowing according to Stanschus to screen for OD in each patient. The mean patient age was 84 ± 6.5 years. The prevalence of OD was 29.0%, without an effect of age, but a higher rate was found in men and in nursing home residents and an elevated risk of pneumonia. OD risk was slight in diabetes mellitus and COPD, and pronounced in CNS diseases. A relevant OD association was found, even after adjusting for CNS diseases, with antipsychotics, benzodiazepines, anti-Parkinson drugs, antidepressants, and antiepileptics. Further risk of OD was found with beta-blockers, alpha-blockers, opioids, antiemetics, antivertiginosa or antihistamines, metoclopramide, domperidone, anticholinergics, loop diuretics, urologics, and ophthalmics. From real-life data in patients with and without CNS diseases, we identified drug groups associated with a risk of aggravating/inducing OD. Restrictive indications for these drugs may be a preventative contribution, requiring implementation in dysphagia guidelines and an integrative dysphagia risk scale that considers all associated and cumulative medication risks in addition to diseases.

A low phase angle determined by bioelectrical impedance analysis is associated with oropharyngeal dysphagia among institutionalized older adults.

The aim was to evaluate the prevalence of oropharyngeal dysphagia (OD) and its association with body composition by bioelectrical impedance analysis (BIA) and functionality among institutionalized older adults. A cross-sectional study was conducted. The swallowing function and diagnosis of OD were evaluated with a volume-viscosity swallow test. Activities of daily living were evaluated by the Barthel Index. Body composition was evaluated by BIA, and phase angle (PhA) was determined. Eighty institutionalized older adults were evaluated. The mean age of the study population was 82±9.5 years, and 65% were females. The OD prevalence was 30%, dependence was 30%, and sarcopenia was 16%. In the multivariate analysis, a low PhA (<3.5°) was independently associated with the presence of OD adjusted by sex and age (OR: 2.60, 95%CI 2.41-2.90, p=0.01). A higher prevalence of OD was found. Significant and independent associations were found between low PhA, dependence, and sarcopenia with the presence of OD among institutionalized older persons.

Assessment of Swallowing Disorders, Nutritional and Hydration Status, and Oral Hygiene in Students with Severe Neurological Disabilities Including Cerebral Palsy.

Background: Special needs schools (SNS) educate children and young people with major neurological disabilities who are at high risk of oropharyngeal dysphagia (OD) and malnutrition (MN). We aimed to assess the prevalence of OD, MN, dehydration (DH), and oral health (OH) in students at an SNS. Methods: A cross-sectional observational study was conducted at SNS L’Arboç, Catalonia, Spain. We assessed (a) demographics, health status, comorbidities, and gross motor function classification system (GMFCS), (b) swallowing function, oral-motor evaluation, masticatory capacity, and EDACS classification for eating and drinking abilities, (c) nutritional and DH status (anthropometry, bioimpedance and dietary records), and (d) OH (Oral Hygiene Index Simplified). Results: A total of 33 students (mean age 13.3 years; 39.4% level V of GMFCS) were included. Main diagnosis was cerebral palsy at 57.6%. All students presented OD, 90.6% had impaired safety, 68.7% were at levels II–III of EDACS, and 31.3% required PEG; furthermore, 89.3% had chronic MN, 21.4% had acute MN, 70% presented intracellular DH, and 83.9% presented impaired OH. Conclusion: MN, DH, OD, and poor OH are highly prevalent conditions in students with cerebral palsy and other neurological disabilities and must be specifically managed through nutritional and educational strategies. The multidisciplinary team at SNS should include healthcare professionals specifically trained in these conditions.

Swallowing Disorders and Cricopharyngeal Dysfunction

A functional swallow involves the neuromuscular coordination of ingestion and digestion of food. Dysphagia is the term for abnormal swallowing, a discoordination of respiration, phonation, and digestion. Swallowing disorders can describe a simple abnormal sensation of swallow or a complex disorder leading to aspiration pneumonia. The most common cause of mortality and morbidity in dysphagia patients is aspiration pneumonia. Additional complications include malnutrition and dehydration. The prevalence of oropharyngeal dysphagia is up to 40% in adults over 65 and increases to 60% in institutionalized elderly. Oropharyngeal dysphagia is common after stroke, Parkinson’s disease, and other neurologic disorders. Patients in high-risk groups and patients with signs and symptoms of dysphagia should be diagnosed appropriately to determine underlying cause and aspiration risk. This chapter will focus on dysphagia due to pharyngeal phase disorders and their diagnosis and treatments. This review contains 6 figures, 4 videos, 5 tables and 49 references. Key Words: dysphagia, swallowing, Zenker diverticulum, modified barium swallow, videofluoroscopic swallowing study, FEES, transnasal esophagoscopy, esophagram

COVID-19 is associated with oropharyngeal dysphagia and malnutrition in hospitalized patients during the spring 2020 wave of the pandemic

Background & aimsPrevalence and complications of oropharyngeal dysphagia (OD) and malnutrition (MN) in COVID-19 patients is unknown. Our aim was to assess the prevalence, risk factors and clinical outcomes of OD and MN in a general hospital during the first wave of the COVID-19 pandemic.MethodsThis was a prospective, observational study involving clinical assessment of OD (Volume-Viscosity Swallowing Test), and nutritional screening (NRS2002) and assessment (GLIM criteria) in COVID-19 patients hospitalized in general wards at the Consorci Sanitari del Maresme, Catalonia, Spain. The clinical characteristics and outcomes of patients were assessed at pre-admission, admission and discharge, and after 3 and 6-months follow-up.ResultsWe included 205 consecutive patients (69.28 ± 17.52 years, Charlson 3.74 ± 2.62, mean hospital stay 16.8 ± 13.0 days). At admission, Barthel Index was 81.3 ± 30.3; BMI 28.5 ± 5.4 kg/m2; OD prevalence 51.7% (44.1% impaired safety of swallow); and 45.5% developed MN with a mean weight loss of 10.1 ± 5.0 kg during hospitalization. OD was an independent risk factor for MN during hospitalization (OR 3.96 [1.45–10.75]), and hospitalization was prolonged in patients with MN compared with those without (21.9 ± 14.8 vs 11.9 ± 8.9 days, respectively; p < 0.0001). OD was independently associated with comorbidities, neurological symptoms, and low functionality. At 6-month follow-up, prevalence of OD was still 23.3% and that of MN only 7.1%. Patients with OD at discharge showed reduced 6-month survival than those without OD at discharge (71.6% vs 92.9%, p < 0.001); in contrast, those with MN at discharge did not show 6-month survival differences compared to those without (85.4% vs 83.8%, p = 0.8).ConclusionsPrevalence and burden of OD and MN in patients hospitalized in COVID-19 wards is very high. Our results suggest that optimizing the management of MN might shorten the hospitalization period but optimizing the management of OD will likely impact the nutritional status of COVID-19 patients and improve their clinical outcomes and survival after hospital discharge. ClinicalTrials.gov Identifier: NCT04346212.

Oropharyngeal dysphagia and malnutrition in patients with Covid-19 at the Consorci Sanitari Del Maresme, Catalonia, Spain: Prevalence and needs of compensatory treatment

Rationale: COVID-19 may manifest with a wide range of symptoms and its degree of severity may be from mild to severe. Our aim was to assess the prevalence and pathophysiology of oropharyngeal dysphagia (OD), malnutrition (MN), nutritional risk, and the needs of compensatory treatments in patients admitted due to COVID-19 at the Consorci Sanitari del Marseme (CSdM), Catalonia, Spain. Methods: Prospective observational study with clinical assessment of OD (clinical symptoms, clinical observation and Volume-Viscotisy Swallowing Test) and nutritional screening with NRS2002 and GLIM criteria in consecutive COVID-19 patients admitted at the Hospital de Mataró (CSdM) during 2020 Covid-19 pandemics. Patient’s clinical characteristics and their needs of compensatory treatments for OD and MN were assessed at baseline and will be followed up at 3 and 6 months. Here we present the baseline data. Results: We included 268 hospitalized patients, 52.2% men, with a mean age of 70.2±17.0 yr, severity of disease was moderate-severe in 34%. At hospital admission prevalence of OD was 52.4% (49.4% had impaired efficacy and 44.9% impaired safety of swallow). Pathophysiology of OD includes ICU and post-extubating factors (16%), neurological factors (32%), respiratory insufficiency (42%) and interstitial pneumonia (74%). Up to 43.7% of patients needed thickeners to be safely hydrated (38.7% with 250mPa·s and 5.2% with 800mPa·s of Xanthan Gum thickeners) and 54.5% had mastication impairments needing texture-modified diets (27.7% easy mastication and 28.8% puree). 74.2% of patients presented a NRS2002>3 and were at risk of MN, 46% had MN and 73.8% of patients received ONS. Conclusion: Prevalence of OD, nutritional risk and MN in patients with COVID-19 at admission in a General Hospital is very high. Pathophysiology is multifactorial and not limited to ICU factors. Early treatment includes fluid thickening, texture modified foods and nutritional support.

Buccofacial Apraxia, Oropharyngeal Dysphagia, and Dementia Severity in Community-Dwelling Elderly Patients.

Apraxia occurs frequently in patients with dementia. Buccofacial apraxia (BFA) characteristics have been less investigated than limb or speech apraxia. An association between BFA and oropharyngeal dysphagia (OD) in old patients with dementia has not yet been explored. We aimed to assess the prevalence of BFA in patients with dementia and evaluate the relationship between BFA, OD, and dementia. We have prospectively included 117 outpatients with dementia referred to a geriatric consultation. Oropharyngeal dysphagia was diagnosed using the volume viscosity swallowing test (V-VST). Buccofacial apraxia was evaluated by miming 7 meaningless gestures. A complementary geriatric assessment of 6-domains completed the evaluation. Buccofacial apraxia was present in 54 (48.6%) patients. Proxies reported OD more frequently in the group of patients with BFA compared to the group without (P = .04). Prevalence of OD assessed with the V-VST was similar between patients with and without apraxia (P = .9). Patients with BFA had a significant lower Mini-Mental State Examination suggesting a more severe cognitive decline (18.1 ± 4.5 vs 15.8 ± 5, P = .01), a lower activities of daily living relative to disabilities (5 ± 0.8 vs 4.3 ± 1.3, P = .001), and had a lower gait speed that indicated frailty (P = .03).In conclusion, our results indicate a relationship between BFA and severity of dementia, disability, and frailty with no significant association between BFA and OD.

Prevalence, Risk Factors, and Complications of Oropharyngeal Dysphagia in Older Patients with Dementia.

The prevalence of older patients with dementia and oropharyngeal dysphagia (OD) is rising and management is poor. Our aim was to assess the prevalence, risk factors, and long-term nutritional and respiratory complications during follow-up of OD in older demented patients. We designed a prospective longitudinal quasi-experimental study with 255 patients with dementia. OD was assessed with the Volume-Viscosity Swallowing Test and a geriatric evaluation was performed. OD patients received compensatory treatments based on fluid viscosity and texture modified foods and oral hygiene, and were followed up for 18 months after discharge. Mean age was 83.5 ± 8.0 years and Alzheimer’s disease was the main cause of dementia (52.9%). The prevalence of OD was 85.9%. Up to 82.7% patients with OD required fluid thickening and 93.6% texture modification, with poor compliance. OD patients were older (p < 0.007), had worse functionality (p < 0.0001), poorer nutritional status (p = 0.014), and higher severity of dementia (p < 0.001) than those without OD and showed higher rates of respiratory infections (p = 0.011) and mortality (p = 0.0002) after 18 months follow-up. These results show that OD is very prevalent among patients with dementia and is associated with impaired functionality, malnutrition, respiratory infections, and increased mortality. New nutritional strategies should be developed to increase the compliance and therapeutic effects for this growing population of dysphagic patients.

Oropharyngeal dysphagia in stroke: diagnostic and therapeutic aspects

The prevalence of oropharyngeal dysphagia is high after a stroke. Clinically, it manifests as alterations affecting swallowing efficiency and safety, with the consequent morbidity and mortality associated with nutritional and respiratory alterations. To carry out an updated review of the diagnostic and therapeutic aspects of oropharyngeal dysphagia after a stroke that can be applied in daily clinical practice, and of the non-invasive neurostimulation techniques. The process of diagnosis and treatment of oropharyngeal dysphagia aims to screen, identify and diagnose patients at risk of dysphagia, and establish the dietary and therapeutic measures that ensure proper nutrition and hydration of patients under safe conditions. The diagnosis is based on the clinical examination of swallowing and on instrumental examinations such as videofluoroscopy and fibro-endoscopy. Therapeutic measures include compensatory and rehabilitative strategies (active manoeuvres, motor control exercises, neuromuscular electrostimulation and botulinum toxin treatment). Neurostimulation techniques include non-invasive central stimulation and intrapharyngeal electrical stimulation. The prevalence of oropharyngeal dysphagia is high after a stroke. Diagnosis should include a clinical evaluation and an instrumental examination, and thus objectively indicate the treatment, which will include compensatory and restorative measures with which to reduce the associated morbidity and mortality.

Validation of the Dutch EAT-10 for screening of oropharyngeal dysphagia in the elderly population

The prevalence of oropharyngeal dysphagia (OD) in the elderly population >76y is estimated at 26%. OD can lead to malnutrition, depression, diminished quality of life and increased mortality in the elderly. Despite these important complications, OD is still underdiagnosed due to a lack of a reliable and easily applicable screening tool. The Eating Assessment Tool-10 (EAT-10) questionnaire consists of ten statements about symptoms and signs of OD. In the current literature, a cut-off value of ≥3 points is preferred to be considered as in risk for OD. The EAT-10 questionnaire shows good internal consistency and reliability and is validated in different languages with comparable results. The purpose of this study is to validate the EAT-10 questionnaire in Dutch. The results show a strong test-retest reliability (Spearman's rho 0.841) and an internal consistency of 0.917 via Cronbach's alpha. The Dutch EAT-10 questionnaire is well applicable in a clinical environment with a mean duration of 2 minutes and 28 seconds (± 1 minute and 32 seconds) to complete the test. Validation of the Dutch EAT-10 questionnaire makes screening of OD in the Dutch (elderly) population possible.

Prevalence of dysphagia in a regional hospital setting: Acute care hospital and a geriatric sociosanitary care hospital: A cross-sectional study

Oropharyngeal Dysphagia (OD) is a symptom commonly found in hospitalized patients and related to a vast array of clinical diagnosis and to high morbidity and mortality that is becoming very important to identify. Our aim was to assess the prevalence of OD in our hospital setting. Cross-sectional randomized study to determine the prevalence of dysphagia in an acute care hospital (ACH) and long term care hospital (LTCH). Multiquestionnaire test performed to assess dysphagia with the bedside validated volume-viscosity swallow test (V-VST test), in those with the validated swallowing ability test, eating assessment tool (EAT-10)>3. Variables; sex, age (>65y), diagnosis, mininutritional assessment (MNA), previous diagnosis of dysphagia (including any recommendations given before), EAT-10, V-VST, presence of dysphagia, type of diet prescribed (basal or therapeutic), use of thickener and diet texture (pureed with liquids allowed, pureed without liquids, soft diet, normal). N=200 patients (100 in each centre). 49% male; Age=81.1 [65-101] years; Diagnostics: medical 70%/surgery 30%. Dysphagia analysis: 42% patients showed an EAT-10>3 so the V-VST test was done in these patients resulting in global prevalence of 28.5% (95% CI: 22.7-35.1). Among centres no significant differences were observed: ACH 30% (95% CI: 14-34) and LTCH 27% (95% CI: 19-36). Highlighting a greater concentration of dysphagia in Orthogeriatric and Neurological patients in the LTCH than in ACH (Pneumology, Internal Medicine and Cardiology). MNA analysis: 27% normal 44% risk 29% malnutrition. Malnutrition present in 50.9% of patients diagnosed with dysphagia, 44% in those at risc (EAT-10+) and 27.6% in those without risc or dysphagia (p=0.020). From the novo patients, 75.4% did not have adequate complete adapted treatment (diet and thickener). Only 13.3% had their thickener prescribed. In those with history of dysphagia 37% had an inappropriate treatment. Prevalence of OD matches with what is described in the literature. There is a high proportion of infradiagnostic and overall inadequate treatment, more than a third of patients do not have their diet adapted correctly. It is important to identify this symptom to treat it properly and to raise awareness among sanitary professionals for best adaptation of treatment.

The risk of dysphagia is associated with malnutrition and poor functional outcomes in a large population of outpatient older individuals

Oropharyngeal dysphagia (OD) is a widespread clinical condition among older adults. Although it represents a risk factor for malnutrition, dehydration and aspiration pneumonia, its assessment and contribution to functional decline is often ignored. The aim of the present study was to estimate the prevalence of OD in a large population of non-institutionalized older people and to evaluate its relationship with malnutrition and physical function. 10-item Eating Assessment Tool (EAT-10) and Mini Nutritional Assessment Short Form (MNA-SF) were used to identify the risk of dysphagia and malnutrition. Short Physical Performance Battery (SPPB) and hand-grip strength were used as functional endpoints. The relationship between risk of dysphagia and functional outcomes was tested in a multivariate regression analysis adjusted for age and sex (Model 1) and for other confounders including Mini Mental State Examination (MMSE) and polypharmacy (Model 2). Mean age of 773 subjects (61.3% female) was 81.97 years. The percentage of participants at risk of dysphagia (EAT≥3) was 30.1%, 37.8% of subjects was malnourished (MNA-SF<8), 46.2% was at risk of malnutrition (MNA-SF:8-11). EAT-10 was significantly and negatively associated to MNA-SF (β=-0.47±0.06, p<0.0001) and the strength of the relationship was attenuated but still statistically significant in the multivariate model (β=-0.28±0.07, p<0.0001). A significant and negative relationship was found between EAT-10 and SPPB and hand-grip strength in Model 1 (β=-0.25±0.05, p<0.0001) and Model 2 (β=-0.07±0.03, p<0.0001). After categorization of risk of dysphagia in two groups (at risk and not at risk), MNA-SF, SPPB and hand-grip strength were independently associated with higher risk of dysphagia (OR=0.91, 95%CI=0.83-0.99, p=0.03; OR=0.83, 95%CI=0.77-0.89, p<0.0001; OR=0.96, 95%CI=0.92-0.99, p=0.02, respectively). In a large group of outpatient older individuals, we observed a significant negative association between risk of dysphagia and nutritional and physical performance, suggesting that the screening of OD, possibly supported by its assessment, should be implemented in the geriatric setting to potentially prevent the functional decline.

Prevalence of dysphagia in China: An epidemiology survey among 6102 participants

Dysphagia is relatively common among older population and patients with stroke, head and neck cancer or neurodegenerative diseases and can have a negative impact on their quality of life. The aim of this study was to explore the prevalence of dysphagia among these people. The survey used three-step approach consisting of questionnaire screening (Sydney or Ohkuma Swallowing Questionnaire) and clinical evaluation (Kubota's Water Swallow Test) and instrumental assessment (videofluoroscopic swallowing study). The subjects consisted of elderly persons 65 years and older living in the communities/nursing home and three relative phenotypes of patients (stroke, head and neck cancer, neurodegenerative diseases) in the hospitals. We studied these participants whose dysphagia could be assessed by the three-step approach and compared the prevalence of deglutition disorders with age, gender and three Chinese economic regions. A total of 6102 persons met inclusion criteria. Of all the participants, 2363 (38.7%) were identified as having swallowing abnormalities and showed increased risk of oropharyngeal dysphagia with age. Dysphagia was found 46.3% in stroke patients of acute phase, 56.9% in stroke patients of chronic phase, 40.8% in Alzheimer's disease, 46.2% in Parkinson's disease, 12.5% in Multiple Sclerosis, 50.0% in Amyotrophic Lateral Sclerosis, 35.5% in head/neck cancer. The prevalence of oropharyngeal dysphagia has also been calculated in older persons across different settings, with rates 26.4% in nursing home and 13.9% in community-dwelling older people. This study demonstrates that dysphagia of male is higher prevalent than female in these populations. Comparing three Chinese economic regions, the average prevalence rate of deglutition disorder in the midland (55.0%) was obviously higher than east coast (37.1%) and west (32.5%) of China. This study demonstrates that dysphagia is highly prevalent among patients with stroke, head and neck cancer or neurodegenerative diseases and the elderly in China. The prevalence of dysphagia were significant correlations with age, gender and economic region.

Oropharyngeal Dysphagia in Community-Dwelling Older Patients with Dementia: Prevalence and Relationship with Geriatric Parameters

ObjectivesTo define the prevalence of oropharyngeal dysphagia (OD) in community-dwelling older persons with dementia, using V-VST (Volume-Viscosity Swallow Test), the reference clinical screening test for swallowing disorders, to assess the feasibility of the V-VST in an ambulatory care setting, to search for associations between geriatric parameters and OD, and to identify a relationship between severities of cognitive impairment and OD. DesignProspective, monocentric study. SettingPopulation from a geriatric outpatients clinic. ParticipantsPatients older than 70 with a diagnosis of dementia (NINCDS-ADRDA criteria), effective cough, and ability of voluntary swallowing for testing. MeasurementsOD screening was realized using V-VST during consultation. Severity of cognitive impairment was estimated by the MMSE and severity of OD by the Dysphagia Outcome Severity Scale (DOSS). Six geriatric domains were evaluated (comorbidities, functional abilities, cognition, nutrition, mood disorders, frailty). Results117 patients participated in the study (77 women, mean age = 84.5 ± 5.1 years). Prevalence of OD was 86.6%. Among the 97 patients with OD, 3 (3.1%) had only safety impairment, 52 (53.6%) had only efficacy impairment and 42 (43.3%) had both. The mean time necessary to realize V-VST was 8.7 ± 2.7 minutes with a rate of success of 96%. Dependency was independently associated with OD [odds ratio (OR) 4.8; 95% confidence interval (CI) 1.5-15.9; P < .05], and age and grip strength were associated with safety impairment (OR 1.1; 95% CI 1.0-1.2 and OR 1.9; 95% CI 1.2-3.2 respectively; both P < .05). No significant relationship was found between severity of OD and severity of cognitive impairment. ConclusionOD is very frequent in community-dwelling older persons with dementia and is associated with dependency and frailty. The V-VST is an easy-to-perform and well tolerated screening test in this population and therefore should be systematically included in the geriatric assessment of older persons with dementia. The role of V-VST in therapeutic strategies of OD remains to be evaluated.