The incidence and prognostic implications of dysphagia in elderly patients institutionalized: A multicenter study in Spain

Sarabia‐Cobo, Carmen; Pérez, Victoria; Lorena, Pablo de; Domínguez, Esther; Hermosilla, Carmen; Núñez, Mónica; Vigueiro, María; Rodríguez, Luis Fernando Briceño

doi:10.1016/j.apnr.2015.07.001

Cited by 59 publications

(71 citation statements)

References 24 publications

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“…Male patients had an OR of 1.67 (95% CI, 1.33–2.10). A higher prevalence of dysphagia among male patients has been reported in several studies (Wakabayashi & Matsushima, ; Yang, Kim, Lim, & Paik, ); nevertheless, an association between dysphagia and gender was not supported by the findings of other studies (Carrión et al, ; Rofes et al, ; Sarabia‐Cobo et al, ). Even though the male patients in our sample had a higher risk of dysphagia than the females, the correlation between dysphagia and gender has not yet received sufficient support and this could be an area of important future research.…”

Section: Discussionmentioning

confidence: 78%

Dysphagia and factors associated with malnutrition risk: A 5‐year multicentre study

Blanař

Hoedl

Lohrmann

et al. 2019

Journal of Advanced Nursing

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Aims To describe the associations between dysphagia and malnutrition risk and to identify predictors for dysphagia in a group of persons at risk of malnutrition in hospitals and nursing homes. Design A secondary analysis of cross‐sectional data from the years 2012–2016. Methods The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool for Adults (MUST). The data were compared regarding malnutrition risk and dysphagia. Regression analyses were conducted to identify variables that were associated with the risk of malnutrition and dysphagia. Results Patients (N = 17,580) were included in the study sample. The prevalence of dysphagia was 6.6% and the prevalence of malnutrition risk was 18.9%. A multivariable logistic regression analysis resulted in the identification of dysphagia and cancer as variables with the highest odds ratios with regard to malnutrition risk. Patients with cancer, stroke or respiratory diseases represent a high‐risk group for the co‐occurrence of dysphagia and risk of malnutrition. Conclusions Screening for dysphagia should be carried out on patients at risk of malnutrition as an integral part of their admission to a healthcare institution and especially on the higher risk group of patients with cancer, a stroke or a respiratory disease. Impact What problem did the study address? This study identified the relationship between dysphagia and malnutrition risk and associated factors. What were the main findings? Dysphagia among patients in the research sample was associated with more than two times higher prevalence of the malnutrition risk. Where and on whom will the research have an impact? Thorough malnutrition risk and dysphagia screening lead to better nursing care.

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Section: Discussionmentioning

confidence: 78%

Dysphagia and factors associated with malnutrition risk: A 5‐year multicentre study

Blanař

Hoedl

Lohrmann

et al. 2019

Journal of Advanced Nursing

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“…Several studies confirm that the presence of dysphagia in nursing home residents is a risk factor for aspiration, which may lead to aspiration pneumonia and, possibly, death [5, 6, 9–14]. The prevalence of dysphagia in nursing homes varies between 38% and 69.6% [15–17] and up to 30% of the elderly with dysphagia develop aspiration [18]. …”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, a systematic review suggested a 0.12% chlorhexidine oral rinse as an effective hygiene method for intensive care unit (ICU) patients in order to reduce nosocomial pneumonia, and the use of chlorhexidine was suggested as more favorable than tooth brushing only [32]. However, because of the high prevalence of dysphagia and aspiration pneumonia and the absence of evidence regarding which oral hygiene care program or which interventions are most effective in reducing pneumonia in frail elderly, more studies are needed to establish an evidence-based oral hygiene care protocol in order to protect nursing home residents from aspiration pneumonia [15–17, 33]. It is unknown whether the daily application of a 0.05% chlorhexidine oral rinse solution is effective in reducing the risk of aspiration pneumonia in nursing home residents.…”

Section: Introductionmentioning

confidence: 99%

The effect of a daily application of a 0.05% chlorhexidine oral rinse solution on the incidence of aspiration pneumonia in nursing home residents: a multicenter study

et al. 2017

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BackgroundDysphagia and potential respiratory pathogens in the oral biofilm are risk factors for aspiration pneumonia in nursing home residents. The aim of the study was to examine if the daily application of 0.05% chlorhexidine oral rinse solution is effective in reducing the incidence of aspiration pneumonia in nursing home residents with dysphagia. Associations between background variables (age, gender, dysphagia severity, care dependency, medication use, number of medical diagnoses, teeth and dental implants, and wearing removable dentures) and the incidence of aspiration pneumonia were also examined.MethodsThis study is a multicenter study in which for 1 year participants with dysphagia in the intervention group received the usual oral hygiene care with the addition of a 0.05% chlorhexidine oral rinse solution, whereas participants in the control group received only oral hygiene care.ResultsData of 103 participants in 17 nursing homes were analyzed. Survival analysis showed no significant difference in the incidence of pneumonia between both groups (Cox regression, HR = 0.800; 95% CI [0.368–1.737], p = 0.572). Cox regression analysis for Functional Oral Intake Scale (FOIS)-level showed a significant risk of the incidence of pneumonia (HR = 0.804; 95% CI [0.656–0.986], p = 0.036). After adjustment for Group and FOIS-level, Cox multivariate proportional hazard regression analysis showed that the variables age, gender, Care-dependency Scale-score (CDS) number of diseases, medication use, number of teeth, and the presence of dental implants or removable dentures were not significantly associated with the incidence of pneumonia.ConclusionsChlorhexidine oral rinse solution 0.05% as an adjunctive intervention in daily oral hygiene care was not found to reduce incidence of aspiration pneumonia. The requested number of participants to achieve sufficient power was not established and high drop-out rate and non-structural compliance was present. The power was considered to be sufficient to analyze the associations between the background variables and the incidence of pneumonia in the included nursing home residents with dysphagia. Dysphagia was found to be a risk factor for aspiration pneumonia.Trial registrationRegistration in The Netherlands National Trial Register: TC = 3515. Approval for the study was obtained from the Medical Ethical Committee of the Radboud University Medical Center (NL. nr:41,990.091.12).

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“…It is difficult to distinguish aspiration pneumonia from other nursing home acquired pneumonia; however, high proportion of aspiration pneumonia is estimated due to high prevalence of dysphagia among this population. The prevalence of oropharyngeal dysphagia is around 60% in nursing homes, and aspiration of food is recognised as a risk factor for aspiration pneumonia . Insufficient food bolus formation can also be a risk factor for aspiration pneumonia, and insufficient chewing due to loss of teeth and deteriorated tongue movement in elderly people causes difficulty of food bolus formation .…”

Section: Introductionmentioning

confidence: 99%

Food bolus‐forming ability predicts incidence of aspiration pneumonia in nursing home older adults: A prospective observational study

Hase

Miura

Nakagami

et al. 2019

J of Oral Rehabilitation

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Background Food boluses in the pharynx without enough bolus formation sometimes cause aspiration among older adults; however, the relationship between food bolus‐forming ability and incidence of aspiration pneumonia is unclear. Objective To investigate the relationship between food bolus‐forming ability and incidence of aspiration pneumonia by evaluating the condition of chew‐swallow managing food transported into the pharynx. Methods A prospective observational study conducted in a nursing home for the elderly between April 2016 and February 2018. Seventy‐three residents who swallowed thickened liquids and consistent boluses without aspiration were included. Food boluses were graded into three categories in the pharynx using videoendoscopic evaluation. Boluses that retained their original shape were defined as Grade 1. A mixture of large and small boluses was defined as Grade 2. Boluses that had completely transformed into a paste were defined as Grade 3. The relationship between the bolus formation grade and incidence of aspiration pneumonia over 6‐month follow‐up was investigated. Results Seventeen residents developed aspiration pneumonia. The incidence rate of aspiration pneumonia was highest among residents with Grade 1 boluses, at an incidence rate of .187 cases per person‐month (95% confidence interval (CI): 0.097‐0.359). Cox regression showed residents with Grade 1 boluses had a hazard ratio of 4.548 (1.393‐14.85) for incidence of aspiration pneumonia compared with residents who had Grade 2 or 3 boluses. Conclusion Insufficient food bolus‐forming ability predicted high incidence of aspiration pneumonia. Healthcare professionals should evaluate the food bolus‐forming ability, as well as swallowing function, to prevent aspiration pneumonia.

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The incidence and prognostic implications of dysphagia in elderly patients institutionalized: A multicenter study in Spain

Cited by 59 publications

References 24 publications

Dysphagia and factors associated with malnutrition risk: A 5‐year multicentre study

Dysphagia and factors associated with malnutrition risk: A 5‐year multicentre study

The effect of a daily application of a 0.05% chlorhexidine oral rinse solution on the incidence of aspiration pneumonia in nursing home residents: a multicenter study

Food bolus‐forming ability predicts incidence of aspiration pneumonia in nursing home older adults: A prospective observational study

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