The Prevalence of Dysphagia in Primary Care Patients: A HamesNet Research Network Study

Abstract

Purpose: A number of disorders cause dysphagia, which is the perception of an obstruction during swallowing. The purpose of this study was to determine the prevalence of dysphagia in primary care patients.Methods: Adults 18 years old and older were the subjects of an anonymous survey that was collected in the clinic waiting room before patients were seen by a physician. Twelve family medicine offices in HamesNet, a research network in Georgia, participated.Results: Of the 947 study participants, 214 (22.6%) reported dysphagia occurring several times per month or more frequently. Those reporting dysphagia were more likely to be women (80.8% women vs 19.2% men, P ‫؍‬ .002) and older (mean age of 48.1 in patients with dysphagia vs mean age of 45.7 in patients without dysphagia, P ‫؍‬ .001). Sixty-four percent of patients with dysphagia indicated that they were concerned about their symptoms, but 46.3% had not spoken with their doctor about their symptoms. Logistic regression analyses showed that increased frequency [odds ratio (OR) ‫؍‬ 2.15, 95% CI 1.41-3.30], duration (OR ‫؍‬ 1.91, CI 1.24 -2.94), and concern (OR ‫؍‬ 2.64, CI 1.36 -5.12) of swallowing problems as well as increased problems eating out (OR ‫؍‬ 1.72, CI 1.19 -2.49) were associated with increased odds of having talked to a physician. Conclusions: This is the first report of the prevalence of dysphagia in an unselected adult primary care population. Dysphagia occurs commonly in primary care patients but often is not discussed with a physician. (J Am Board Fam Med 2007;20:144 -150.)Swallowing is a complex motor reflex requiring coordination among the neurologic system, the oropharynx, and the esophagus. A number of disorders, both benign and malignant, interfere with the swallowing process and cause dysphagia.1 Patients with dysphagia suffer significant social and psychological burdens associated with their symptoms of difficulty with swallowing, including anxiety with meals or avoidance of eating with others. 2The diagnosis of dysphagia is important because of the associated morbidity and mortality. Untreated dysphagia can lead to dehydration, malnutrition, respiratory infections, and death.2 The elderly with symptoms of dysphagia are at increased risk of the complications of dysphagia, including aspiration pneumonia. 3 Several studies have identified the elderly as being at risk for the development of dysphagia. 4,5 The prevalence of solid-food dysphagia was found to be 7% in elderly patients (62 years old and older) in a family medicine clinic in a medical university.

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“…However, the reported prevalence rates vary, mainly due to the exact definition of dysphagia (4) and the used diagnostic instrument (5). It is estimated to occur in up to 52.7% of the elderly (2), 44-53.6% of patients with stroke (6, 7), up to 32% of patients with Parkinson's disease (8), and 48.4% of patients with head and neck cancer (9).…”

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“…It has been reported that dysphagia affects approximately 20% of the adult primary care population in the USA (Wilkins et al, 2007). Approximately 15% to 30% of hospital patients have swallowing difficulties or aspirate oral contents (Cichero et al, 2009, Altman, 2011.…”