Sarcopenia is an independent risk factor of dysphagia in hospitalized older people

Maeda, Keisuke; Akagi, Junji

doi:10.1111/ggi.12486

Cited by 198 publications

(158 citation statements)

References 18 publications

Supporting

Mentioning

146

Contrasting

Unclassified

Order By: Relevance

“…Unlike some previous reports on smaller patient populations [1, 23], but similar to another recent publication [22], dysphagic patients were on average 5 years older ( p < 0.001) in our study, indicating age as a clear risk factor for swallowing impairment after stroke. This may be explained by a limited functional reserve and sarcopenia in the aged population [24, 25]. …”

Section: Discussionmentioning

confidence: 99%

The Effect of Improved Dysphagia Care on Outcome in Patients with Acute Stroke: Trends from 8-Year Data of a Large Stroke Register

et al. 2018

View full text Add to dashboard Cite

Background: Early dysphagia screening and appropriate management are recommended by current guidelines to reduce complications and case fatality in acute stroke. However, data on the potential benefit of changes in dysphagia care on patient outcome are limited. Our objective was to assess the degree of implementation of dysphagia guidelines and determine the impact of modifications in dysphagia screening and treatment practices on disease complications and outcome in stroke patients over time. Methods: In this prospective register-based study (“Stroke Register of Northwestern Germany”), all adult stroke patients admitted to 157 participating hospitals between January, 2008 and December, 2015 were included (n = 674,423). Dysphagia incidence upon admission, the proportion of patients receiving a standardized swallowing screening, and the percentage of dysphagic patients being referred to a speech language therapist (SLT) for treatment were obtained per year. Pneumonia rate, modified Rankin Scale (mRS) at discharge, and in-hospital mortality were compared between groups of dysphagic vs. non-dysphagic patients over time. Results: Screening proportions continuously increased from 47.2% in 2008 to 86.6% in 2015. But the proportion diagnosed with dysphagia remained stable with about 19%. The number of dysphagic patients receiving SLT treatment grew from 81.6 up to 87.0%. Pneumonia incidence was higher in dysphagic stroke cases (adjusted OR 5.4 [5.2–5.5], p < 0.001), accompanied by a worse mRS at discharge (adjusted OR for mRS ≥3: 3.1 [3.0–3.1], p < 0.001) and higher mortality (adjusted OR 3.1 [3.0–3.2], p < 0.001). The order of magnitude of these end points did not change over time. Conclusion: Although advances have been made in dysphagia care, prevalent screening and treatment practices remain insufficient to reduce pneumonia rate, improve functional outcome, and decrease case fatality in dysphagic stroke patients. More research is urgently needed to develop more effective swallowing therapies.

show abstract

Section: Discussionmentioning

confidence: 99%

The Effect of Improved Dysphagia Care on Outcome in Patients with Acute Stroke: Trends from 8-Year Data of a Large Stroke Register

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Upper limits of tongue capability were investigated by Alsanei et al [23]: maximum isometric tongue pressure (MITP) was well-correlated to the maximum hardness of mashed potato or vege-gel which could be crushed by the tongue alone. Decreased MITP resulting from sarcopenia was identified as an independent risk factor for dysphagia [24], [25*] so there is a potential risk of inadequate nutritional intake worsening swallowing function, but the vicious cycle could be halted by nutritional supplements and effective dysphagia management.…”

Section: Research In Swallowing and Rheologymentioning

confidence: 99%

A review of diet standardization and bolus rheology in the management of dysphagia

Hanson

2016

Current Opinion in Otolaryngology & Head and Neck Surgery

View full text Add to dashboard Cite

Purpose: Texture modification is a widespread practice as a strategy for the management of dysphagia and can be very effective in individual cases. However, it is often performed in a qualitative, subjective manner and practices vary internationally according to multiple sets of national guidelines. This paper aims to identify best practice by reviewing the theory and practice of texture modification, focussing on recent advances. Recent findings:Instrumental assessment of texture modification in-vivo is challenging, but studies including rheology and perception have indicated that fluid viscosity is only one of many factors affecting texture modification in practice. Systematic reviews have identified a historical lack of high-quality clinical evidence, but recent controlled studies are beginning to identify positive and negative aspects of thickened fluids. Research and practice to date have been limited by the lack of control and standardisation of foods and drinks. However in 2015 a notfor-profit organisation, the International Dysphagia Diet Standardisation Initiative, has published a framework for texture modification from thin liquids to solid foods based on all the existing documentation and guidance, and the -limited-available clinical evidence. Summary:Rheology exists in the lab, however normal practice is often subjective or lacking control and standardisation. In the near future, cohesion of practice and the availability of practical standardisation tools may increase awareness and use of rheology. KeywordsDysphagia, Swallowing, Rheology, Viscosity, Texture modification Key points •The relationships between rheology and swallowing are beginning to be characterised using oral pressure sensing and videofluoroscopy, together with careful control of bolus rheology.• It is becoming clearer that viscosity alone is not sufficient to categorise texture modification.• Literature to date shows a trend for reduced aspiration with increased thickness of liquids, and increased residue with some thicker consistencies, however evidence is scarce.• An inconsistent approach to definition of texture modification techniques has been limiting the collation of a coherent evidence base.• A new international standard (IDDSI) has been created, drawing on available evidence and including practical objective measures.

show abstract

“…Furthermore, T‐EAT‐10 scores were analyzed by dysphagia status. In the normal group the T‐EAT‐10 score median (IQR) was 2, in the penetration‐positive group the median (IQR) was 2, and in the aspiration‐positive group the median was 11 . T‐EAT‐10 scores were highest in the aspiration‐positive group compared with others ( P = 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Elderly subjects with both sarcopenia and dysphagia may have not only disease‐related dysphagia but also sarcopenic dysphagia. The prevalence of swallowing disorders in older individuals ranges from 13% to 38%, and a few studies reported the prevalence of sarcopenic dysphagia to be between 30% and 42.2% . Signs and symptoms associated with dysphagia may include odynophagia, drooling, hoarseness, regurgitation, heartburn, coughing or gagging, and frequent pulmonary infections.…”

Section: Introductionmentioning

confidence: 99%

Timing of Dysphagia Screening in Alzheimer's Dementia

Özsürekçi

Arslan

Demir

et al. 2019

J Parenter Enteral Nutr

View full text Add to dashboard Cite

Background Dysphagia is an important and frequent symptom in Alzheimer's dementia (AD). We hypothesized that dysphagia could be seen in the early stages of AD and sarcopenia presence rather than the severity of the AD affecting dysphagia. The main aim of this study was to investigate swallowing functions in AD patients according to stages. The second aim was to investigate the correlation between sarcopenia and dysphagia in AD. Methods This study involved 76 probable AD patients. For all participants, diagnosis of sarcopenia was based on definitions from the revised version of European Working Group on Sarcopenia in Older People at 2018. Dysphagia symptom severity was evaluated by the Turkish version of the Eating Assessment Tool, a videofluoroscopic swallowing study (VFSS) was performed for instrumental evaluation of swallowing. The patients were divided into 3 groups according to the clinical dementia rating (CDR) scale as CDR 1 (mild dementia), CDR 2 (moderate dementia), and CDR 3 (severe dementia). Swallowing evaluation parameters were analyzed between these groups. Results Mean age was 78.9 ± 6.4 years, and 56.4% were female. Twenty‐six patients had mild dementia, 31 patients had moderate dementia, 19 patients had severe dementia (CDR 3). We found that sarcopenia rates were similar between AD stages according to CDR in our study population and dysphagia could be seen in every stage of AD. In a multivariate analysis, polypharmacy and sarcopenia were found to be independently associated factors for dysphagia, irrespective of stage of AD (OR: 6.1, CI: 1.57‐23.9, P = 0.009; OR: 4.9, CI: 1.24‐19.6, P = 0.023, respectively). Conclusion Aspirations may be subtle so that AD patients and caregivers may not be aware of swallowing difficulties. Therefore, all AD patients, especially those who have polypharmacy and/or sarcopenia (probable‐sarcopenia‐severe sarcopenia), should be screened for dysphagia in every stage.

show abstract

Sarcopenia is an independent risk factor of dysphagia in hospitalized older people

Abstract: Sarcopenia was an independent risk factor for dysphagia among older individuals. However, further studies are required to define causality.

Cited by 198 publications

References 18 publications

The Effect of Improved Dysphagia Care on Outcome in Patients with Acute Stroke: Trends from 8-Year Data of a Large Stroke Register

The Effect of Improved Dysphagia Care on Outcome in Patients with Acute Stroke: Trends from 8-Year Data of a Large Stroke Register

A review of diet standardization and bolus rheology in the management of dysphagia

Timing of Dysphagia Screening in Alzheimer's Dementia

Contact Info

Product

Resources

About