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

Banda, Kondwani Joseph; Chu, Hsin; Chen, Ruey; Kang, Xiao Linda; Jen, Hsiu‐Ju; Liu, Doresses; Hsiao, Shu-Tai Shen; Chou, Kuei‐Ru

doi:10.1159/000520326

Cited by 40 publications

(18 citation statements)

References 57 publications

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“…We found a substantial prevalence of OD estimated at 35%, with a 6.41 times risk of mortality among hospitalized COVID-19 patients. Previous study findings have shown a higher prevalence rate of OD in post-extubated critically ill patients, acute stroke patients, and older adults, with prevalence rates being closer to 50% [ 4 , 5 , 34 ]. McIntyre et al [ 34 ] found an incidence rate of 41% for OD among hospitalized critically-ill patients secondary to intubation, while the prevalence of OD has been estimated at 42% among acute stroke patients [ 4 ] and 46% among older adults [ 5 ].…”

Section: Discussionmentioning

confidence: 98%

“…Growing evidence revealed oropharyngeal dysphagia (OD) as one of the digestive complications among hospitalized COVID-19 patients. Moreover, OD has been shown to be highly correlated with a risk of aspiration pneumonia, malnutrition, and mortality in acute stroke and older adults without COVID-19 [ 4 , 5 ]. Exploring and understanding the prevalence of OD in COVID-19 patients would provide plausible evidence crucial for the management of COVID-19-associated OD in clinical settings.…”

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confidence: 99%

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

et al. 2022

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Background 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. Methods 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, τ 2 , and the I 2 statistic to assess heterogeneity and conducted a moderator analysis to identify moderator variables. Results 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. Conclusions 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. Registration PROSPERO CRD42022337597

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Section: Discussionmentioning

confidence: 98%

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

et al. 2022

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“…Additionally, we surveyed caregivers about their attention to feeding tubes and the eating habits of their care receivers. The caregivers were asked to provide multiple responses from among the following items 1 : preparation of a suitable diet for swallowing function; 2 nutritional balance of dietary intake; 3 assistance with eating; 4 time required for meals and feeding tubes; 5 number of meals per day; 6 oral exercise before mealtimes; 7 supervision during mealtime and feeding tube; 8 oral care; 9 aspiration and choking; 10 reflux and vomiting after meals and feeding tube; 11 nutrition status; and 12 fever and increased sputum production.…”

Section: Methodsmentioning

confidence: 99%

“…Dysphagia, a medical condition commonly caused by stroke, neuromuscular disease or head and neck cancer, has a reported prevalence of 40–81% among individuals with chronic stroke, 9 82% among those with Parkinson's disease, 10 and 38.5% among those with head and neck cancer 11 . Because dysphagia can lead to adverse events, such as aspiration pneumonia, choking and malnutrition, 12 it has been speculated that dysphagia might contribute to the exacerbation of caregiver burden. In fact, 71% of caregivers of patients with dysphagia have experienced caregiver burden, 13 which is multifaceted, and includes physical, mental 14 and emotional burden 15 .…”

Section: Introductionmentioning

confidence: 99%

The effect of care receivers' dysphagia severity on caregiver burden among family caregivers

Suzuki

Kimura

Otobe

et al. 2022

Geriatrics Gerontology Int

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Introduction: Dysphagia has received much attention as a factor that affects caregiver burden. However, few studies have examined how its severity can affect caregiver burden. This study aimed to examine the effect of dysphagia severity on caregiver burden.Methods: A cross-sectional online survey was carried out among family caregivers. We assessed caregiver burden using the Zarit Burden Interview. The dysphagia severity was assessed using the Functional Oral Intake Scale, and the caregivers were divided into three groups based on care receivers' oral intake status (levels 1-3: tube-feeding group; levels 4-6: texture-modified food group; level 7: normal group). To investigate the relationship between caregiver burden and dysphagia severity, univariable and multivariable logistic regression analyses were applied to caregiver burden.Results: The Zarit Burden Interview was significantly higher in the texture-modified food group, and the proportions of high caregiver burden reached 25.2%, 39.5% and 23.4% in the normal group, texture-modified food group and tube-feeding group, respectively. The multivariable analyses applied to caregiver burden (reference, normal group) showed that the texture-modified food group was significantly associated with caregiver burden (OR 1.55, 95% CI 1.04-2.32), whereas the tube-feeding group had no relationship with caregiver burden (OR 0.68, 95% CI 0.31-1.49).Conclusions: Our study showed that the intake of texture-modified food significantly affected caregiver burden even after adjusting for confounding factors, whereas the use of tube feeding did not increase caregiver burden. These results suggest that it is necessary to consider dysphagia severity to reduce dysphagia-related caregiver burden. Geriatr Gerontol Int 2022; 22: 870-875.

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“…Furthermore, previous studies reported that aspiration pneumonia is associated with dysphagia [ 5 , 6 ] and sarcopenia [ 7 ]. Based on the deep relationship between them [ 8 ], which is related to declining activities of daily living (ADL) [ 9 , 10 ] and increased mortality [ 11 , 12 ], improving dysphagia and sarcopenia is important for improving the prognosis of older inpatients with aspiration pneumonia.…”

Section: Introductionmentioning

confidence: 99%

The degree of recovery in swallowing ability in older inpatients with aspiration pneumonia is related to intramuscular adipose tissue of the quadriceps than to muscle mass

Akazawa

Kishi²,

Hino³

et al. 2022

PLoS ONE

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Background & aim A recent study reported that the increase in intramuscular adipose tissue of the quadriceps in older inpatients is related to a decreasing degree of recovery in swallowing ability compared to the loss of muscle mass. However, whether the association remains true in case of aspiration pneumonia is unclear. Therefore, this study aimed to examine the relationship between the degree of recovery in swallowing ability and intramuscular adipose tissue in the quadriceps of older inpatients with aspiration pneumonia. Methods This prospective study included 39 older patients with aspiration pneumonia. Swallowing ability was assessed using the Food Intake Level Scale (FILS). The indicators for the degree of recovery in swallowing ability were FILS at discharge and change in FILS. A greater change in FILS indicates a greater improvement in swallowing ability. Intramuscular adipose tissue and muscle mass of the quadriceps were evaluated at admission using echo intensity and muscle thickness on ultrasound images, respectively. Multiple regression analysis was used to determine whether the echo intensity of the quadriceps was independently and significantly related to FILS at discharge and the change in FILS. Independent variables were age, sex, days from disease onset, echo intensity and muscle thickness of the quadriceps, subcutaneous fat thickness of the thigh, FILS at admission, and number of units of rehabilitation therapy. Results Echo intensity of the quadriceps (β = −0.363, p = 0.012) and FILS at admission (β = 0.556, p < 0.001) were independently and significantly associated with FILS at discharge (R2 = 0.760, f2 = 3.167, statistical power = 1.000). Similar variables (echo intensity of the quadriceps [β = −0.498, p = 0.012] and FILS at admission [β = −0.635, p < 0.001]) were independently and significantly related to change in FILS (R2 = 0.547, f2 = 1.208, statistical power = 0.998). Quadriceps muscle thickness was not independently and significantly related to FILS at discharge and change in FILS. Conclusion Our results indicate that intramuscular adipose tissue of the quadriceps in older inpatients with aspiration pneumonia is more strongly related to the degree of recovery in swallowing ability (that is, swallowing ability at discharge and change in swallowing ability) than muscle mass, and patients who have high intramuscular adipose tissue of the quadriceps at admission have a lower degree of recovery in swallowing ability.

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

Cited by 40 publications

References 57 publications

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

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

The effect of care receivers' dysphagia severity on caregiver burden among family caregivers

The degree of recovery in swallowing ability in older inpatients with aspiration pneumonia is related to intramuscular adipose tissue of the quadriceps than to muscle mass

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