Frequency and associated factors for swallowing impairment in community-dwelling older persons: a systematic review and meta-analysis

Abstract

Introduction Swallowing impairment (SI) is an underdiagnosed dysfunction frequently seen as an expected condition of aging. However, SI can lead to health complications and considerable social impact. Methods The objective of this systematic review with meta-analysis was to evaluate the frequency and associated factors with SI in community-dwelling older persons. Searches were performed in 13 electronic databases including MEDLINE and EMBASE (from inception to September 18, 2021). Data extraction and methodological quality assessment of included studies were performed by two independent reviewers. Meta-analysis of proportions with 95% confidence interval (CI) and prediction interval (PI) was used to pool estimates. Subgroup analysis by Country and Assessment Method was performed. General meta-analysis was used to pool measures of association between potential risk factors and SI occurrence (odds ratio [OR] or prevalence ratio [PR]). ResultsThe worldwide estimated frequency of SI in community-dwelling older persons was 20.35% (95%CI 16.61-24.68%, 95%PI 4.79-56.45, I 2 99%, n = 33,291). This estimation varied across assessment methods and by country. The main factors associated with SI were a dry mouth (OR 8.1, 95%CI 4.9-13.4), oral diadochokinesis (OR 5.3, 95%CI 1.0-27.3), ≥ 80 years old (OR 4.9, 95%CI 2.6-9.2), genetic factor (SNPrs17601696) (OR 4.8,, and partial dependence (OR 4.3, 95%CI 2.0-9.3). And the main factors associated with SI estimated by PR were dry mouth sensation (PR 4.1, 95%CI 2.6-6.5), oral sensorimotor alteration (PR 2.6, 95%CI 1.4-4.9), osteoporosis (PR 2.51, 95%CI 1.2-5.3), and heart diseases (PR 2.31, 95%CI 1.1-5.0). Conclusion One in five older adults worldwide are expected to experience SI and factors associated with this underdiagnosed dysfunction included biological and physiological changes related to aging, physical and psychological conditions, and poor oral health. Early assessment is paramount for the prevention of future clinical complications and should be a high priority in health care practices.

Can oral diadochokinesis be used as an assessment tool of oral function in older adults requiring care in nursing home?

“…Oral diadochokinesis examinations are considered inappropriate for older people under these conditions. It is appropriate as an oral function test for community‐dwelling people with maintained physical and cognitive functions 11,19–23 . However, OD test as a method to evaluate the oral function of nursing home residents with reduced physical and cognitive functions is considered unsatisfactory.…”

Feasibility of Oral Function Evaluation According to Dementia Severity in Older Adults with Alzheimer’s Disease

“…The difficulty in pronouncing the same syllable consecutively, even when assessing only the clarity of pronunciation, underlies this result. ODK is a measure of lip and tongue motor functions but is also associated with dysphagia [31] and tongue coating [32]. Therefore, if it is difficult to assess persons with severe dementia, other assessment methods should be considered depending on the purpose of assessment.…”

Fiberoptic endoscopic evaluation of swallowing in patients with cervical spinal cord injury: a retrospective study focused on oral intake at discharge

“…Regarding the relation between swallowing function and aging, a recent systemic review and metaanalysis indicated that the main factors associated with age-related dysphagia were dry mouth and oral sensorimotor alteration [20]. Another review suggested that esophageal sensation decays with age, and several neuromuscular and structural disorders may cause oropharyngeal dysphagia [18], which in turn causes vallecular residues and poor oral intake at discharge [18].…”