Dysphagia among geriatric trauma patients: A population-based study

Abstract

Objective To determine the significance of dysphagia on clinical outcomes of geriatric trauma patients. Methods This is a retrospective population-based study of geriatric trauma patients 65 years and older utilizing the Florida Agency for Health Care Administration dataset from 2010 to 2019. Patients with pre-admission dysphagia were excluded. Multivariable regression was used to create statistical adjustments. Primary outcomes included mortality and the development of dysphagia. Secondary outcomes included length of stay and complications. Subgroup analyses included patients with dementia, patients who received transgastric feeding tubes (GFTs) or tracheostomies, and speech language therapy consultation. Results A total of 52,946 geriatric patients developed dysphagia after admission during a 9-year period out of 1,150,438 geriatric trauma admissions. In general, patients who developed dysphagia had increased mortality, length of stay, and complications. When adjusted for traumatic brain and cervical spine injuries, the addition of mechanical ventilation decreased the mortality odds. This was also observed in the subset of patients with dysphagia who had GFTs placed. Of the three primary risk factors for dysphagia investigated, mechanical ventilation was the most strongly associated with later development of dysphagia and mortality. Conclusion The geriatric trauma population is vulnerable to dysphagia with a large number associated with traumatic brain injury, cervical spine injury, and polytraumatic injuries that lead to mechanical ventilation. Earlier intubation/mechanical ventilation in association with GFTs was found to be associated with decreased inpatient hospital mortality. Tracheostomy placement was shown to be an independent risk factor for the development of dysphagia. The utilization of speech language therapy was found to be inconsistently utilized.

Benefits and harms of oral anticoagulants for atrial fibrillation in nursing home residents with advanced dementia

“…Prescription medications associated with increased bleeding risk (antiplatelet agents and prescription nonsteroidal anti‐inflammatory drugs) and total count of prescribed medications were measured in the 90 days prior to cohort entry using Part D claims. Feeding tube placement and dysphagia were determined using claims definitions with 1‐year lookback 22,23 . Other markers of decline were ascertained using MDS data.…”

“…Feeding tube placement and dysphagia were determined using claims definitions with 1-year lookback. 22,23 Other markers of decline were ascertained using MDS data. Data missingness was minimal.…”

Comprehensive assessment and treatment strategies for dysphagia in the elderly population: Current status and prospects

“…A study conducted in the US revealed that Parkinson's disease was diagnosed in over 50% of individuals age 85 and over (48), with 60% of Parkinson's patients experiencing pharyngeal dysphagia (7,47). In addition, other neurological disorders such as traumatic brain injury and neurological tumors can also affect the neural control of the pharynx, consequently impacting swallowing (49)(50)(51). Moreover, oral health issues such as tooth loss and dry mouth, cervical and laryngeal tumors, and postoperative esophageal stenosis can exacerbate dysphagia (52,53).…”

The role of pH-impedance monitoring in swallowing disorders

“…Elderly patients reported higher rates of dysphagia than younger adults. The prevalence of dysphagia significantly increased over the past decades regarding the worldwide population aging [2 ▪▪ ,9]. Based on age, several comorbidities may be associated with a high prevalence of dysphagia, including dementia, Parkinson disease, head and neck cancer and stroke [2 ▪▪ ,10].…”