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

Abstract

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.

Analysis of Quality of Life and Nutritional Status in Elderly Patients with Dysphagia in Order to Prevent Hospital Admissions in a COVID-19 Pandemic

“…Accordingly, OD has been considered an indicator of frailty [ 3 ] and dependence [ 4 ] and is currently recognized as a geriatric syndrome [ 5 , 6 ]. Currently, the prevalence of OD in the world population is 16–23% and increases to 30% in older people [ 7 , 8 , 9 ]; it increases even further in the presence of dementia [ 4 , 6 ], reaching a prevalence of up to 85.9% in Spain [ 10 ]. In Europe, the prevalence of OD in the over-65s is 40%, and in institutionalized elderly people, it is more than 60% [ 11 ].…”

Associations of Oral Health-Related Quality of Life with Age, Oral Status, and Oral Function among Psychiatric Inpatients in Japan: a cross-sectional study

“…They developed reduced pharyngeal clearance, reduced upper esophageal opening, and penetration and/or aspiration as the disease progresses [49]. Some epidemiological studies reported that dementia was one of the main risk factors for dysphagia and aspiration pneumonia [17,50]. Moreover, the prevalence of dysphagia was high among schizophrenic patients due to the nature of schizophrenia and the side effects of antipsychotic medication [44, 51, and52].…”

“…Several original international studies [5][6][7][8][9][10][11][12][13][14] and one meta-analysis [15] reported that the oral health status of psychiatric patients was poor compared to that of the general population. In addition, some previous studies reported that patients with schizophrenia and dementia had poor swallowing function and were at risk for aspiration pneumonia [16,17].…”

Associations between Age, Oral Health-Related Quality of Life, and Oral and Swallowing Function among Psychiatric Inpatients in Japan : a cross-sectional study

“…They developed reduced pharyngeal clearance, reduced upper esophageal opening, and penetration and/or aspiration as the disease progresses [44]. Some epidemiological studies reported that dementia was one of the main risk factors for dysphagia and aspiration pneumonia [45,46]. Moreover, the prevalence of dysphagia was high among schizophrenic patients due to the nature of schizophrenia and the side effects of antipsychotic medication [39, 47, and 48].…”