Definition, Prevalence and Burden of Oropharyngeal Dysphagia: A Serious Problem among Older Adults Worldwide and the Impact on Prognosis and Hospital Resources

Abstract

Oropharyngeal dysphagia describes difficulty with eating and drinking. This benign statement does not reflect the personal, social, and economic costs of the condition. Dysphagia has an insidious nature in that it cannot be 'seen' like a hemiplegia or a broken limb. It is often a comorbid condition, most notably of stroke, and many other neurodegenerative disorders. Conservative estimates of annual hospital costs associated with dysphagia run to USD 547 million. Length of stay rises by 1.64 days. The true prevalence of dysphagia is difficult to determine as it has been reported as a function of care setting, disease state and country of investigation. However, extrapolating from the literature, prevalence rises with admission to hospital and affects 55% of those in aged care settings. Consequences of dysphagia include malnutrition, dehydration, aspiration pneumonia and potentially death. The mean cost for an aspiration pneumonia episode of care is USD 17,000, rising with the number of comorbid conditions. Whilst financial costs can be objectively counted, the despair, depression, and social isolation are more difficult to quantify. Both sufferers and their families bear the social and psychological burden of dysphagia. There may be a cost-effective role for screening and early identification of dysphagia, particularly in high-risk populations.

Diagnostic value of “dysphagia limit” for neurogenic dysphagia: 17years of experience in 1278 adults

“…Further, the financial burden of chronic dysphagia is very high. Thus, screening and early diagnosis of dysphagia in high-risk populations can be significantly cost-saving (Cichero and Altman, 2012). Early diagnosis of neurogenic dysphagia is important for the quality of life and survival of affected patients.…”

Swallowing Tablets and Capsules Increases the Risk of Penetration and Aspiration in Patients with Stroke-Induced Dysphagia

“…Swallowing is far more challenging for patients with dysphagia. It is well known that dysphagia negatively interferes with preparation and ingestion of food and fluids in the oral cavity [3,4], may critically impair subsequent swallowing and, thus, may cause aspiration pneumonia [5] and thereby worsen the patients' condition [6,7]. However, it is often insufficiently considered that dysphagic patients do not only experience difficulties swallowing food and liquids, but often also have difficulties swallowing conventional tablets and even orodispersible tablets [8].…”

Screening Accuracy for Aspiration Using Bedside Water Swallow Tests

“…3 These data, combined with the generally accepted belief that dysphagia is underreported, 3,4,12 suggest that patients on medical (ie, not neurologic or oncology) floors may not be recognized as having dysphagia, leading to increased hospitalization lengths and increased health-care costs. 13 Screening for aspiration can, therefore, reduce morbidity, mortality, and costs while increasing health-care quality.…”