The risk of dysphagia is associated with malnutrition and poor functional outcomes in a large population of outpatient older individuals

Abstract

Oropharyngeal dysphagia (OD) is a widespread clinical condition among older adults. Although it represents a risk factor for malnutrition, dehydration and aspiration pneumonia, its assessment and contribution to functional decline is often ignored. The aim of the present study was to estimate the prevalence of OD in a large population of non-institutionalized older people and to evaluate its relationship with malnutrition and physical function. 10-item Eating Assessment Tool (EAT-10) and Mini Nutritional Assessment Short Form (MNA-SF) were used to identify the risk of dysphagia and malnutrition. Short Physical Performance Battery (SPPB) and hand-grip strength were used as functional endpoints. The relationship between risk of dysphagia and functional outcomes was tested in a multivariate regression analysis adjusted for age and sex (Model 1) and for other confounders including Mini Mental State Examination (MMSE) and polypharmacy (Model 2). Mean age of 773 subjects (61.3% female) was 81.97 years. The percentage of participants at risk of dysphagia (EAT ! 3) was 30.1%, 37.8% of subjects was malnourished (MNA-SF < 8), 46.2% was at risk of malnutrition (MNA-SF:8e11). EAT-10 was significantly and negatively associated to MNA-SF (b ¼ À0.47 ± 0.06, p < 0.0001) and the strength of the relationship was attenuated but still statistically significant in the multivariate model (b ¼ À0.28 ± 0.07, p < 0.0001). A significant and negative relationship was found between EAT-10 and SPPB and hand-grip strength in Model 1 (b ¼ À0.25 ± 0.05, p < 0.0001) and Model 2 (b ¼ À0.07 ± 0.03, p < 0.0001). After categorization of risk of dysphagia in two groups (at risk and not at risk), MNA-SF, SPPB and hand-grip strength were independently associated with higher risk of dysphagia (OR ¼ 0.91, 95%CI ¼ 0.83e0.99, p ¼ 0.03; OR ¼ 0.83, 95%CI ¼ 0.77e0.89, p < 0.0001; OR ¼ 0.96, 95%CI ¼ 0.92e0.99, p ¼ 0.02, respectively). In a large group of outpatient older individuals, we observed a significant negative association between risk of dysphagia and nutritional and physical performance, suggesting that the screening of OD, possibly supported by its assessment, should be implemented in the geriatric setting to potentially prevent the functional decline.

Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population

“…Providing nutritious and safe texture modified foods are key elements in mitigating dysphagia impacts ( Figure 1). Dysphagia is known to result in detrimental health effects and has been associated with overlooked undernutrition [17][18][19]. The cornerstone of dysphagia treatment is often the modification of food texture and liquid consistency [20].…”

“…To date, research looking at efficacy of the nutritional treatment to circumvent dysphagia is insufficient [20,32,33]. Quantifiable descriptors of food texture and liquid consistency, Dysphagia is known to result in detrimental health effects and has been associated with overlooked undernutrition [17][18][19]. The cornerstone of dysphagia treatment is often the modification of food texture and liquid consistency [20].…”

Rastreio do risco de disfagia em pacientes internados em um hospital universitário

“…Originalmente o EAT-10 foi desenvolvido como um instrumento para documentar a gravidade inicial da disfagia e monitorar o tratamento em pessoas com distúrbios da deglutição 11 . No entanto, observa-se na literatura seu uso com finalidades de rastreio [12][13][14] , avaliação e auto-avaliação 2, 10,11,15 .…”

Prognostic Significance of Oral Frailty on the All-Cause Mortality

“…Dysphagia was signi cantly correlated with community acquired pneumonia [39]. A relationship of dysphagia with poor physical performance and nutritional status was also observed [40]. Di culty swallowing was reported to have higher risk of malnutrition, frailty and mortality [17].…”