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Audag N, Toussaint M, Prigent H, Reychler G. Interpretation of Sydney Swallow Questionnaire results using the oropharyngeal dysphagia risk matrix. Neurogastroenterol Motil 2024:e14916. [PMID: 39301584 DOI: 10.1111/nmo.14916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 08/19/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Oropharyngeal dysphagia (OD) commonly occurs in neuromuscular diseases (NMD). Appropriate management involves early detection, clinical evaluation, and tailored follow-up to minimize complications. Various assessment tools exist, including the Sydney Swallow Questionnaire (SSQ), a patient-reported outcome measure for assessing OD severity in adult patients. This paper proposes utilizing an innovative risk matrix (OD-Risk-Matrix) to enhance SSQ interpretation. This matrix categorizes OD risk for each SSQ question, offering valuable assistance to clinicians. METHODS This study analyzes SSQ results from a cohort of individuals with NMD (n = 57). Patients filled in the SSQ during outpatient visits at our neuromuscular center. Subsequently, SSQ scores were grouped by NMD conditions and interpreted using the OD-Risk-Matrix categorizing each question's risk as low, moderate, or high. This matrix is based on the SSQ results by categorizing the risk of OD for each question, as well as the likelihood of occurrence of OD. KEY RESULTS In light of the OD-Risk-Matrix, the interpretation of SSQ scores revealed various risk categories associated with each question, while also highlighting distinct OD characteristics and discrepancies among the different NMDs. CONCLUSION AND INFERENCES In conclusion, the OD-Risk-Matrix offers a framework for interpreting the SSQ, revealing variations in the risks of OD among different questions in patients with NMD. This novel approach could be a valuable tool in SSQ interpretation to identify specific fields of OD and could lead to a tailored management plan, prioritizing interventions aimed at reducing the risk of aspiration, ensuring proper nutrition, and enhancing swallowing safety and efficiency.
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Affiliation(s)
- Nicolas Audag
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL (airways) & Dermatologie (skin), Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium
- Service de kinésithérapie et ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Haute École Léonard de Vinci, PARNASSE-ISEI, Brussels, Belgium
| | - Michel Toussaint
- Department of Neurology, Centre de Référence Neuromusculaire, ULB Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Brussels, Belgium
| | - Hélène Prigent
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, GHU Paris Saclay, Hôpital Raymond Poincaré, Garches, France
- End:icap, U1179 Inserm, UVSQ-Université Paris-Saclay, Versailles, France
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL (airways) & Dermatologie (skin), Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium
- Service de kinésithérapie et ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Haute École Léonard de Vinci, PARNASSE-ISEI, Brussels, Belgium
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Audag N, Liistro G, Vandervelde L, van den Bogaert E, Toussaint M, Reychler G. Development of a Dutch Version of the Sydney Swallow Questionnaire: Assessing Oropharyngeal Dysphagia Severity in Dutch-Speaking Populations. Indian J Otolaryngol Head Neck Surg 2024; 76:2361-2366. [PMID: 38883452 PMCID: PMC11169218 DOI: 10.1007/s12070-024-04484-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/31/2023] [Indexed: 06/18/2024] Open
Abstract
Aims The oropharyngeal dysphagia (OD) poses substantial health risks and affects quality of life. Patient-reported outcome measures (PROMs) are gaining prominence for their crucial role in early detection and adapting rehabilitation and management decisions. This highlights the need for culturally pertinent versions in different languages, especially when addressing conditions like OD. This study aimed to translate, culturally adapt, and assess the test-retest reliability of the Sydney Swallow Questionnaire (SSQ), a PROM designed to detect the risk of OD, for Dutch-speaking populations. Materials and Methods The SSQ was translated and adapted based on Beaton's guidelines. Validity and test-retest reliability were assessed in 100 healthy participants, with a subset of 30 participants assessed over a 15-day interval. Intra-class correlation coefficient (ICC) values were calculated to determine test-retest reliability. Results The SSQ-Dutch was well received and well understood, with a median total score of 65.5/1700. Notably, 95% of participants scored below the established dysphagia risk cut-off, consistent with previous validations. The 15-day interval ICC for the SSQ-Dutch total scores was 0.82 (CI 95%: 0.66-0.91), indicating good reliability. While most questions had moderate-to-good reliability, five showed slightly lower ICC. Conclusion The SSQ-Dutch emerges as a validated and reliable tool for assessing OD risk in Dutch-speaking individuals. Future studies should evaluate its efficacy in symptomatic populations and consider cultural variations in Dutch-speaking regions. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-024-04484-3.
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Affiliation(s)
- Nicolas Audag
- Service de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Avenue Hippocrate, 10, Brussels, 1200 Belgium
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Louvain, Belgium
- Haute École Léonard de Vinci, PARNASSE-ISEI, Brussels, Belgium
| | - G Liistro
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Louvain, Belgium
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - L Vandervelde
- Haute École Léonard de Vinci, PARNASSE-ISEI, Brussels, Belgium
| | | | - M Toussaint
- Centre de Référence Neuromusculaire, Department of Neurology, ULB Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Brussels, Belgium
| | - G Reychler
- Service de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Avenue Hippocrate, 10, Brussels, 1200 Belgium
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Louvain, Belgium
- Haute École Léonard de Vinci, PARNASSE-ISEI, Brussels, Belgium
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Agnes CS, Nayak S, Devadas U. Prevalence of oropharyngeal dysphagia symptoms in community-dwelling older adults: A community survey. Indian J Gastroenterol 2024; 43:616-627. [PMID: 38105373 DOI: 10.1007/s12664-023-01476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/23/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Dysphagia is a common clinical condition in older adults with significant implications for health and quality of life (QOL). However, its prevalence and associated factors in the Indian community-dwelling older adults remain understudied. The present study aims at identifying the prevalence of oropharyngeal dysphagia symptoms in Indian community-dwelling older adults and identifying the age-related comorbid variables associated with an increased risk of oropharyngeal dysphagia in this population. METHODS Total 384 community-dwelling older adults (60 years of age or older) who were independent in performing daily activities were included in the present study. The Malayalam version of the Eating Assessment Tool-10 (EAT-10) questionnaire was used to assess individuals at risk for dysphagia. Additionally, they also completed a self-report questionnaire addressing age-related comorbid variables associated with an increased risk of oropharyngeal dysphagia. RESULT Using the Malayalam version of the EAT-10, the present study identified the prevalence of oropharyngeal dysphagia symptoms in 9.9% of community-dwelling older adults. Among the EAT-10 symptoms, cough while/after swallowing, difficulty swallowing solids and difficulty swallowing liquids were the most prevalent symptoms reported by participants. Increase in age and age-related comorbidities such as tooth loss, history of heart failure and digestive diseases were found to be significantly associated with the reporting of risk for dysphagia symptoms. CONCLUSION As dysphagia symptoms significantly impact the social, psychological and QOL of community-dwelling older adults, it is important to develop awareness about these symptoms among older adults, caretakers and physicians. Early detection and appropriate management of community-dwelling older adults at risk for dysphagia can contribute to better health outcomes and improved QOL.
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Affiliation(s)
- C S Agnes
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576 104, India
| | - Srikanth Nayak
- Department of Audiology and Speech-Language Pathology, Yenepoya Medical College, Yenepoya University (Deemed to Be University), Mangalore, 575 018, India
| | - Usha Devadas
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576 104, India.
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Dodderi T, Sreenath D, Shetty MJ, Chilwan U, Rai SPV, Moolambally SR, Balasubramanium RK, Kothari M. Prevalence of Self-Reported Swallowing Difficulties and Swallowing-Related Quality of Life Among Community-Dwelling Older Adults in India. Dysphagia 2024:10.1007/s00455-024-10696-0. [PMID: 38637434 DOI: 10.1007/s00455-024-10696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
Self-reported swallowing difficulties are highly prevalent but underreported among older adults. The aging population in India is increasing, yet there is a lack of empirical data on self-reported swallowing difficulties in older adults. In the present study, we aimed to estimate the prevalence of self-reported swallowing difficulties and assess the swallowing-related quality of life (QOL) among community-dwelling older adults in India. We recruited 361 older adults (60-91 years) from the community. Participants completed the Eating Assessment Tool-10 (EAT-10) to assess self-reported swallowing difficulties and the Dysphagia Handicap Index (DHI) to assess swallowing-related QOL. Participants rated the EAT-10 from 0 for 'no problem' to 4 for 'severe problem'. The DHI rating included 0 for 'never', 2 for 'sometimes', and 4 for 'always'. The total scores of EAT-10 and DHI were summarised using descriptive statistics. Statistically significant differences between pass-fail groups of EAT-10 and DHI were evaluated using an independent t-test and multivariate analysis of variance test, respectively. The overall mean score for EAT-10 was 3.34, and 7.56 for DHI, with higher scores observed among females. 36.6% of older adults self-reported experiencing swallowing difficulties, while 47.4% self-reported having poor swallowing-related QOL at p < 0.05. A strong positive correlation (r = 0.86) was found between EAT-10 and total DHI scores at p < 0.001. The present study sheds light on the widespread yet underreported issue of self-reported swallowing difficulties and the impact on swallowing-related QOL among older adults in India. These findings emphasize the urgent need for early swallowing screening programs among older adults.
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Affiliation(s)
- Thejaswi Dodderi
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Drishti Sreenath
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Mahima Jayaram Shetty
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Uzair Chilwan
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Santosh P V Rai
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Sheetal Raj Moolambally
- Department of General Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Radish Kumar Balasubramanium
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - Mohit Kothari
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
- Hammel Neurorehabilitation Center and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
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Zhang H, Ye C, Zhang S, Yang D, Gong X, Li S, Xue W, Su J, Zhao L, Qiu Y, He X, Zhang Y, Tang M. Association between health literacy and dysphagia in the community-dwelling older population: a cross-sectional study. Aging Clin Exp Res 2023; 35:2165-2172. [PMID: 37505395 PMCID: PMC10520086 DOI: 10.1007/s40520-023-02499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Dysphagia, or swallowing disorders, has become a growing concern due to the aging population, and health literacy plays a crucial role in active aging. However, the relationship between them remains unclear. AIMS To investigate the association between health literacy and dysphagia among community-dwelling older adults in China. METHODS A survey was conducted on 4462 older adults aged 65 and above in a community in Yiwu City, China, from May 2021 to January 2022. Swallowing problems were assessed using a 30 ml water swallowing test (WST) and the Eating Assessment Tool-10 questionnaire (EAT-10). The participants' health literacy was evaluated using the Chinese Health Literacy Scale (CHLS). Logistic regression and t tests were employed to measure the association between them. RESULTS The prevalence of dysphagia was 5.70% and 7.85% as determined by EAT-10 and 30 ml-WST, respectively. The health literacy level of community-dwelling older adults was 24.4 ± 4.93 (9-45). Participants with dysphagia exhibited lower levels of health literacy (p < 0.05). The logistic regression model demonstrated an inverse association between health literacy and dysphagia (OR = 0.94, 95%CI = 0.91-0.96 for EAT-10, and OR = 0.93, 95%CI = 0.92-0.95 for WST). Moreover, this association remained significant even after adjusting for covariates. DISCUSSION Older adults with dysphagia have lower levels of health literacy, particularly in terms of their ability to seek medical advice, acquire and evaluate medical information, and access social support resources. CONCLUSIONS Health literacy is associated with dysphagia among community-dwelling older adults. Effective interventions should be implemented to provide support in terms of both medical services and social support for this population.
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Affiliation(s)
- Huafang Zhang
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, China
| | - Chenxi Ye
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, China
| | - Simei Zhang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Dan Yang
- Zhejiang Nursing Association, Hangzhou, 310003, China
| | - Xiaolan Gong
- Futian Community Health Service Center, Yiwu, 322000, China
| | - Sihan Li
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, China
| | - Wenfeng Xue
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, China
| | - Jie Su
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, China
| | - Lancai Zhao
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, China
| | - Yufeng Qiu
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, China
| | - Xiaona He
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, China
| | - Yongming Zhang
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, China.
| | - Mengling Tang
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, China.
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Hazelwood RJ, Armeson KE, Hill EG, Bonilha HS, Martin-Harris B. Relating Physiologic Swallowing Impairment, Functional Swallowing Ability, and Swallow-Specific Quality of Life. Dysphagia 2023; 38:1106-1116. [PMID: 36229718 PMCID: PMC10097835 DOI: 10.1007/s00455-022-10532-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/03/2022] [Indexed: 11/24/2022]
Abstract
Many studies include functional swallowing ability and quality of life information to indicate a response to a specific swallowing intervention or to describe the natural history of dysphagia across diseases and conditions. Study results are difficult to interpret because the association between these factors and actual swallowing impairment is not understood. We set out to test the associations between components of physiologic swallowing impairment, functional swallowing ability, and swallow-specific quality of life using standardized and validated measurement tools: Modified Barium Swallow Impairment Profile (MBSImP), Functional Oral Intake Scale (FOIS), Eating Assessment Tool (EAT-10), and Dysphagia Handicap Index (DHI). We specifically aimed to understand which factors may contribute to the overall relationships between these measurement tools when analyzed using total scores and item-level scores. This study included a heterogeneous cohort of 273 outpatients who underwent a modified barium swallow study (MBSS). We found significant correlations between MBSImP total scores and FOIS scores and DHI total scores, but not between MBSImP total scores and EAT-10 total scores. Significant correlations were also found between MBSImP item-level component scores and FOIS scores, EAT-10 total scores, and DHI total scores. Detailed item-level analyses revealed the MBSImP components of bolus transport/lingual motion, oral residue, and tongue base retraction were correlated with EAT-10 item-level scores and DHI item-level scores. The clinically modest associations between physiologic swallowing impairment, functional swallowing ability, and swallow-specific quality of life reveal different factors that uniquely contribute to patients' overall dysphagic profile, emphasizing the clinical impact of a comprehensive swallowing assessment.
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Affiliation(s)
- R Jordan Hazelwood
- Department of Rehabilitation Sciences, Beaver College of Health Sciences, Appalachian State University, Boone, NC, USA.
| | - Kent E Armeson
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Heather Shaw Bonilha
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
- Department of Otolaryngology-Head and Neck Surgery and Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Edward Hines, Jr. VA Hospital, Hines, IL, USA
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Hollinghurst J, Smithard DG. Identifying Dysphagia and Demographic Associations in Older Adults Using Electronic Health Records: A National Longitudinal Observational Study in Wales (United Kingdom) 2008-2018. Dysphagia 2022; 37:1612-1622. [PMID: 35212847 PMCID: PMC9643178 DOI: 10.1007/s00455-022-10425-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
Dysphagia is increasingly being recognised as a geriatric syndrome (giant). There is limited research on the prevalence of dysphagia using electronic health records. To investigate associations between dysphagia, as recorded in electronic health records and age, frailty using the electronic frailty index, gender and deprivation (Welsh index of multiple deprivation). A Cross-sectional longitudinal cohort study in over 400,000 older adults was undertaken (65 +) in Wales (United Kingdom) per year from 2008 to 2018. We used the secure anonymised information linkage databank to identify dysphagia diagnoses in primary and secondary care. We used chi-squared tests and multivariate logistic regression to investigate associations between dysphagia diagnosis and age, frailty (using the electronic Frailty index), gender and deprivation. Data indicated < 1% of individuals were recorded as having a dysphagia diagnosis per year. We found dysphagia to be statistically significantly associated with older age, more severe frailty and individuals from more deprived areas. Multivariate analyses indicated increased odds ratios [OR (95% confidence intervals)] for a dysphagia diagnosis with increased age [reference 65-74: aged 75-84 OR 1.09 (1.07, 1.12), 85 + OR 1.23 (1.20, 1.27)], frailty (reference fit: mild frailty 2.45 (2.38, 2.53), moderate frailty 4.64 (4.49, 4.79) and severe frailty 7.87 (7.55, 8.21)] and individuals from most deprived areas [reference 5. Least deprived, 1. Most deprived: 1.10 (1.06, 1.14)]. The study has identified that prevalence of diagnosed dysphagia is lower than previously reported. This study has confirmed the association of dysphagia with increasing age and frailty. A previously unreported association with deprivation has been identified. Deprivation is a multifactorial problem that is known to affect health outcomes, and the association with dysphagia should not be a surprise. Research in to this relationship is indicated.
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Affiliation(s)
| | - David G. Smithard
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Road, Woolwich, London, SE18 4QH UK
- University of Greenwich, Avery Hill Campus, Bexley Rd, London, SE9 2PQ UK
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Lu HY, Zhang R, Chang Y, Zhang XN, Zhao J, Li XD, Feng XK. A structural equation model-based study on the status and influencing factors of acute exacerbation readmission of elderly patients with chronic obstructive pulmonary disease within 30 days. BMC Pulm Med 2022; 22:299. [PMID: 35927662 PMCID: PMC9354368 DOI: 10.1186/s12890-022-02093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the circumstances that lead to acute exacerbation readmission of elderly patients with chronic obstructive pulmonary disease (COPD) within 30 days and to explore the influencing factors of readmission using a structural equation model to provide evidence for medical staff so that effective intervention measures can be taken. Methods The convenience sampling method was used to select 1120 elderly patients with COPD from the respiratory departments of thirteen general hospitals in the Ningxia region, China, from April 2019 to August 2020, who then completed a survey questionnaire. The survey questionnaire contained a general data questionnaire and the modified Medical Research Council, activities of daily living, geriatric depression scale and COPD assessment test scales. Results The readmission rate of patients with COPD presenting with acute exacerbation within 30 days was determined to be 21.52%. Therefore, the modified model measures data accurately. The results showed that seasonal factors, family rehabilitation, age factors and overall health status were direct factors in the acute exacerbation readmission of patients with COPD within 30 days of hospital discharge. Smoking is not only a direct factor for acute exacerbation readmission within 30 days but also an indirect factor through disease status; disease status and chronic disease are not only direct factors for acute exacerbation readmission within 30 days but also indirect factors through the patient’s overall health status. Conclusions The rate of patients with COPD presenting with acute exacerbation within 30 days is high; while taking measures to prevent readmission based on influencing factors that directly impact admission rates, attention should also be paid to the interaction between these factors.
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Affiliation(s)
- Hong-Yan Lu
- Department of Nursing, The General Hospital of Ningxia Medical University, No. 804 Shengli Street, Xingqing District, Yinchuan, 750004, China.
| | - Rui Zhang
- Department of Nursing, The General Hospital of Ningxia Medical University, No. 804 Shengli Street, Xingqing District, Yinchuan, 750004, China.
| | - Yan Chang
- Department of Nursing, The General Hospital of Ningxia Medical University, No. 804 Shengli Street, Xingqing District, Yinchuan, 750004, China
| | - Xiao-Na Zhang
- Department of Nursing, The General Hospital of Ningxia Medical University, No. 804 Shengli Street, Xingqing District, Yinchuan, 750004, China
| | - Jie Zhao
- Department of Nursing, The General Hospital of Ningxia Medical University, No. 804 Shengli Street, Xingqing District, Yinchuan, 750004, China
| | - Xin-Dan Li
- Department of Nursing, The General Hospital of Ningxia Medical University, No. 804 Shengli Street, Xingqing District, Yinchuan, 750004, China
| | - Xiang-Kai Feng
- Department of Nursing, XiangYang First People's Hospital, XiangYang, 441002, China
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Atar S, Atar Y, Ilgin C, Uygan U, Demirhan E, Anarat MEA, Tutar B, Sari H, Berkiten G, Kuru Ö. Validity and Reliability of the Turkish Version of the Sydney Swallow Questionnaire. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1726-1735. [PMID: 35549458 DOI: 10.1044/2022_ajslp-21-00268] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE This study aimed to assess the validity and reliability of the Turkish version of the Sydney Swallow Questionnaire (SSQ-T) and calculate a cutoff value to help clinicians to suspect/predict oropharyngeal dysphagia (OPD). METHOD The original questionnaire was translated into Turkish by two bilingual English Turkish translators. The study included 170 Turkish adult subjects. Half of the participants were patients presenting with OPD, and half were healthy controls. Fiberoptic endoscopic evaluation of swallowing (FEES) was administered to all subjects. Patients were evaluated using the Turkish Penetration Aspiration Scale and the Yale Pharyngeal Residue Severity Rating Scale. Additionally, the final version of the SSQ-T questionnaire and the Turkish Eating Assessment Tool were administered to all subjects. RESULTS Internal consistency was high on all questions (Cronbach's α = .974). Test-retest reliability was also high (intraclass correlation coefficient = .975, p < .001; 95% confidence interval [.948-.988]). The SSQ-T score range was 0-1,240 for all participants, 57-1,240 for the patients with OPD, and 0-152 for the healthy controls. The cutoff value was 174 with 85.96% sensitivity and 99.12% specificity. CONCLUSION The SSQ-T was demonstrated to be a valid and reliable assessment to assess the self-perceived severity of OPD.
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Affiliation(s)
- Sevgi Atar
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Yavuz Atar
- Department of Otorhinolaryngology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Can Ilgin
- Infectious Diseases and Environmental Health Division, Sirnak Province Health Directory, Turkey
| | - Ugur Uygan
- Department of Otorhinolaryngology, University of Health Sciences, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Esma Demirhan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Melis Ece Arkan Anarat
- Department of Otorhinolaryngology, University of Health Sciences, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Belgin Tutar
- Göktürk Florence Nightingale Medical Centre, Istanbul, Turkey
| | - Hüseyin Sari
- Department of Otorhinolaryngology, University of Health Sciences, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Güler Berkiten
- Department of Otorhinolaryngology, University of Health Sciences, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ömer Kuru
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
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Chang MC, Seo Y, Kwak S. Deterioration of the Corticobulbar Tract in Older Dysphagic Patients Without Neurologic Diseases. Am J Phys Med Rehabil 2022; 101:353-357. [PMID: 35302528 DOI: 10.1097/phm.0000000000001826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Less is known how dysphagia affects older patients without neurologic diseases and whether the symptoms of dysphagia have any association with impaired central control of swallowing. This study investigated the state of the corticobulbar tract, the surrogate marker for the central control of swallowing, in older dysphagic patients without any neurologic diseases, using diffusion tensor tractography. DESIGN This retrospective observational study was conducted at a tertiary university hospital including 10 patients 60 yrs or older with oropharyngeal dysphagia without neurological disease and 11 age- and sex-matched control participants. The corticobulbar tract was reconstructed, and the fractional anisotropy and tract volume were measured using diffusion tensor tractography. RESULTS The corticobulbar tracts of the dysphagia group were narrowed and not reconstructed by their configurations and had lower fractional anisotropy and tract volume values when compared with those of control group. Significant asymmetry between the left and the right corticobulbar tract hemispheres was found in the dysphagia group, whereas no asymmetry was found in the control group. CONCLUSIONS A deteriorated corticobulbar tract could be associated with the development of dysphagia in older adults without neurological diseases. Our findings might help establish more appropriate treatment strategies, such as targeted neuromodulation therapies in the future.
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Affiliation(s)
- Min Cheol Chang
- From the Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Madhavan A. Preclinical Dysphagia in Community Dwelling Older Adults: What Should We Look For? AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:833-843. [PMID: 33684295 DOI: 10.1044/2020_ajslp-20-00014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Purpose Traditionally, etiology of dysphagia is thought to be related to multiple medical diagnoses including stroke, head and neck cancer, degenerative neurological conditions, and so forth. However, community dwelling older adults (CDOA) can present with dysphagia in the absence of any specific etiology. The purpose of this research was to develop a multidimensional framework to help identify those CDOA at risk for dysphagia of nonspecific etiology. Method Pertinent literature was examined to identify support for the proposed framework and to explain how the various elements support the model. Results Several factors that are not traditionally thought to be associated with dysphagia can both initiate and exacerbate symptoms of swallowing difficulties. Swallowing difficulties may be subtle and underreported. Monitoring for symptoms related to preclinical dysphagia may be helpful for early identification. Conclusions Dysphagia in CDOA is complex and multidimensional. Clinicians working with older adults will benefit from considering elements described in this multidimensional framework to better understand the etiology of swallowing deficits and improve management. Supplemental Material https://doi.org/10.23641/asha.14150078.
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Affiliation(s)
- Aarthi Madhavan
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
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Kurosu A, Osman F, Daggett S, Peña-Chávez R, Thompson A, Myers SM, VanKampen P, Koenig SS, Ciucci M, Mahoney J, Rogus-Pulia N. Factors Associated with Self-Reported Dysphagia in Older Adults Receiving Meal Support. J Nutr Health Aging 2021; 25:1145-1153. [PMID: 34866141 PMCID: PMC8653989 DOI: 10.1007/s12603-021-1700-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Dysphagia is common in older adults. However, there are no current estimates of dysphagia in community-dwelling older adults those receiving meal support. It is unknown whether dysphagia is associated with other measures of physical function (activities of daily living [ADL] ability or nutrition status). The study purposes were to determine the prevalence of self-reported dysphagia and to identify factors associated with self-reported dysphagia in community-dwelling older adults receiving meal support. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS 476 community-dwelling older adults (78.5±0.51 years) across five Elder Nutrition Program meal services in Wisconsin participated in the study. MEASUREMENTS Data were collected through administration of validated ADL and nutrition questionnaires (nutritional status, functional status with ADLs, chewing ability, dental conditions, and prior diagnoses of dysphagia, pneumonia, and dementia). For self-reported dysphagia, the validated 10-item eating assessment tool (EAT-10) was used. RESULTS The prevalence of self-reported dysphagia (EAT-10 score of ≥ 3) was 20.4%. Multivariate logistic regression results indicated that poor nutritional status (OR=3.1, p=0.04), difficulty chewing (OR=2.2, p=0.03), prior dysphagia diagnosis (OR=34.8, p<0.001), prior pneumonia diagnosis (OR=2.1, p=0.04), and meal service site (OR=2.68, p=0.02) were associated with self-reported dysphagia. CONCLUSION Approximately one in five community-dwelling older adults receiving meal support had self-reported dysphagia. Increased risk for poor nutrition, reduced chewing ability, prior dysphagia and pneumonia diagnosis, and meal service site were identified as factors associated with dysphagia on the EAT-10. Results highlight the need for further studies across more sites to identify dysphagia risk indicators in community-dwelling older adults receiving meal support state-wide.
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Affiliation(s)
- A Kurosu
- Nicole Rogus-Pulia, Division of Otolaryngology- Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA,
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Fernández-Ruiz VE, Paredes-Ibáñez R, Armero-Barranco D, Sánchez-Romera JF, Ferrer M. Analysis of Quality of Life and Nutritional Status in Elderly Patients with Dysphagia in Order to Prevent Hospital Admissions in a COVID-19 Pandemic. Life (Basel) 2020; 11:22. [PMID: 33396486 PMCID: PMC7824070 DOI: 10.3390/life11010022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Oropharyngeal dysphagia (OD) is currently recognized as one of the geriatric syndromes due to its high frequency in older people and its associated complications, which have a direct impact on quality of life. The main objective is to determine the effectiveness of telehealth consultation for the re-evaluation of nutritional status and quality of life assessment in older people diagnosed with OD associated with active use of thickeners to prevent hospital admissions in a COVID-19 pandemic. (2) Methods: an observational, descriptive, and longitudinal study that included a sample of 33 subjects with age equal or superior to 65 years diagnosed with OD with conserved cognitive capacity. The nutritional status was evaluated through the Mini-Nutritional Assessment (MNA) questionnaire and biochemical parameters and, the quality of life was determined through the Swallowing Quality of Life (SWAL-QOL) questionnaire. (3) Results: Thirty-three older patients with OD were recruited (54.5% women), with a mean age of 83.5 ± 7.6 years. The main cause of OD in the study population was neurodegenerative disease (51.5%), followed by cerebrovascular disease (33.3%), and other causes (15.2%). Sixty point six percent of patients were found to be at risk of malnutrition. The MNA score was significantly correlated to albumin (r: 0.600, p < 0.001) and total proteins (r: 0.435, p = 0.015), but not to total cholesterol (r: -0.116, p = 0.534) or lymphocytes (r: -0.056, p = 0.758). The mean total score of the SWAL-QOL was 75.1 ± 16.4 points. (4) Conclusions: the quality of life of the subjects related to the use of a thickener is good. Although the body mass index (BMI) and average biochemical, nutritional parameters of the subjects are within the range of normality, the MNA has detected a high percentage of subjects with the risk of malnutrition, which suggests the need for continuous re-evaluation in these patients, demonstrating the viability of the telematic route in this research.
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Affiliation(s)
- Virginia E. Fernández-Ruiz
- Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Clinic Hospital, 30120 Murcia, Spain; (V.E.F.-R.); (M.F.)
- Faculty of Nursing, Calle Campus Universitario, University of Murcia, 11, 30100 Murcia, Spain;
| | - Rocío Paredes-Ibáñez
- Community and Family Nursing Specialist, Calle Campus Universitario, University of Murcia, 11, 30100 Murcia, Spain
| | - David Armero-Barranco
- Faculty of Nursing, Calle Campus Universitario, University of Murcia, 11, 30100 Murcia, Spain;
| | - Juan Francisco Sánchez-Romera
- Department of Human Anatomy and Psychobiology, Calle Campus Universitario, University of Murcia, 11, 30100 Murcia, Spain;
| | - Mercedes Ferrer
- Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Clinic Hospital, 30120 Murcia, Spain; (V.E.F.-R.); (M.F.)
- Endocrinology and Nutrition Department, Calle Campus Universitario, University of Murcia, 11, 30100 Murcia, Spain
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Mateos-Nozal J, Montero-Errasquín B, Sánchez García E, Romero Rodríguez E, Cruz-Jentoft AJ. High Prevalence of Oropharyngeal Dysphagia in Acutely Hospitalized Patients Aged 80 Years and Older. J Am Med Dir Assoc 2020; 21:2008-2011. [DOI: 10.1016/j.jamda.2020.04.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 02/02/2023]
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Is Dysphagia Under Diagnosed or is Normal Swallowing More Variable than We Think? Reported Swallowing Problems in People Aged 18-65 Years. Dysphagia 2020; 36:910-918. [PMID: 33226473 PMCID: PMC7680995 DOI: 10.1007/s00455-020-10213-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022]
Abstract
Purpose Dysphagia prevalence in younger community dwelling adults and across nations is sparse. We investigated the prevalence of swallowing problems in an unselected cohort of people aged 18–65 years. Methods The EAT-10 Assessment Tool was converted into an anonymized online survey. Invitations were e-mailed to author contacts and onwards dispersal encouraged. Analysis was performed using non-parametric test for group comparison (Mann–Whitney U) and Spearman’s rho correlation. Results From March 2014 to October 2017: 2054 responses (32 reported ages outside of 18–65 or undeclared) from Africa, Asia, Australasia/Oceania, Europe, and North and South America. Responses: 1,648 female, 364 male, (10 reported as both), median age 34, (range 18–65, mean 37.12, SD 12.40) years. Total EAT-10 scores: median 0 (range 0–36, mean 1.57, SD 3.49). EAT-10 score ≥ 3 (337) median 5 (range 3–36, mean 7.02 SD 5.91). Median age 36 (range 19–65, mean 37.81, SD 13.21) years. Declared sex was not statistically significantly associated with non-pathological vs. pathological EAT-10 score (p = 0.665). Female scores (median 0.00, mean 1.56, SD 3.338) were significantly higher than for males (median 0.00, mean 1.62, SD 4.161): U (Nfemale = 1648, Nmale = 364) = 275,420.000, z = − 2.677, p = 0.007. Age and EAT-10 score were not associated: females rs = − 0.043, p = 0.079, N = 1648, males rs = − 0.003, p = 0.952, N = 364. Considerable impact on people: “I take ages to eat a main course … This is embarrassing and I often leave food even though I am still hungry.” (no diagnosis, EAT-10 = 17). Conclusion Concerns regarding swallowing exist in people undiagnosed with dysphagia, who may feel uncomfortable seeking professional help. Dysphagia may be under reported resulting in a hidden population. Subtle changes are currently seen as subtle markers of COVID-19. Further work is required to ensure that what is an essentially normal swallow does not become medicalized.
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Etter NM, Madhavan A. Changes in Motor Skills, Sensory Profiles, and Cognition Drive Food Selection in Older Adults With Preclinical Dysphagia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2723-2730. [PMID: 32692607 DOI: 10.1044/2020_jslhr-20-00098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Self-selection and self-avoidance of certain foods is one possible indicator of preclinical (prior to any clinical intervention) dysphagia in healthy older adults. Self-selection of food choices is influenced by changes in a combination of factors, including neuromuscular, sensory, and individual patient characteristics. Changes to these factors occur both centrally or peripherally and can be part of typical, healthy aging. Alterations in motor, sensory, or cognitive skills may lead to self-imposed modifications to food choices and, therefore, highlight potential risk for dysphagia. Conclusions For effective screening and assessments procedures in healthy aging adults, the diagnosis of preclinical dysphagia will likely require a multifaceted assessment. A combination of assessment methods using objective and subjective measurements of neuromuscular, sensory, and individual patient factors, as well as knowledge of food avoidance, may provide insight for identifying community-dwelling older adults at risk for dysphagia and allow for earlier monitoring and intervention.
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Affiliation(s)
- Nicole Michele Etter
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
| | - Aarthi Madhavan
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
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Kim H, Lee SH, Cho NB, You H, Choi T, Kim J. User-Dependent Usability and Feasibility of a Swallowing Training mHealth App for Older Adults: Mixed Methods Pilot Study. JMIR Mhealth Uhealth 2020; 8:e19585. [PMID: 32663161 PMCID: PMC7418014 DOI: 10.2196/19585] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Swallowing difficulties (ie, dysphagia) are common among older adults, with a 13% to 54% prevalence. Adequate interventions to improve the swallowing function of older adults would reduce morbidity and enhance health-related quality of life outcomes. Mobile health (mHealth) apps may help alleviate dysphagia symptoms by providing programs that maximize the intensity and frequency of training without requiring high costs or regular clinic visits. OBJECTIVE The aim of this pilot study was to assess the usability of swallowing training apps by quantitatively and qualitatively evaluating older adults' self-reported data, taking into consideration their educational levels and exposure to mobile technology. We conducted surveys and brief interviews while the participants used a swallowing intervention app we developed. We subsequently identified and resolved individual-specific usability issues to improve future implementation of the app protocol for older persons with swallowing difficulties. METHODS A total of 11 participants (10 women, 91%; mean age 75.7 years, SD 3.93) from two district-run senior welfare centers took part in this study. The participants were divided into a high-potential group and a low-potential group based on their total number of years of education and smart device usage. To investigate the usability of the app twice (ie, in the second week of the intervention and the postintervention stage), we used mixed methods consisting of both quantitative approaches, namely the System Usability Scale (SUS) and modified Computer Self-Efficacy Scale (mCSES) surveys, and qualitative approaches (ie, interviews). RESULTS The quantitative results of the SUS and mCSES surveys revealed that the high-potential group was more inclined to adopt and learn new technology than the low-potential group. Specifically, within the high-potential group, a Wilcoxon signed-rank test indicated that the postintervention mCSES scores (median 65.50) were significantly higher than those in the second week of intervention (median 54.00; z=-2.023, P=.04). Additionally, the usability scores in the low-potential group were within the "marginal acceptability" range even after completion of an 8-week intervention program. Qualitative analyses via semi-structured interviews yielded promising outcomes regarding app acceptability, training program utilization, emotional responses, and learning experience. CONCLUSIONS To the best of the authors' knowledge, this usability and feasibility study is the first report of a swallowing training app designed to improve the swallowing function of older adults. Future research should consider several issues, such as user characteristics, pretraining education, and the intensity and innate characteristics of the intervention program.
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Affiliation(s)
- HyangHee Kim
- Graduate Program in Speech-Language Pathology, Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Lee
- Graduate Program in Speech-Language Pathology, Yonsei University, Seoul, Republic of Korea
| | - Nam-Bin Cho
- Graduate Program in Speech-Language Pathology, Yonsei University, Seoul, Republic of Korea
| | - Heecheon You
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | | | - Jinwon Kim
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
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Zhang H, Guo F, Tang M, Dai H, Sheng J, Chen L, Liu S, Wang J, Shi Y, Ye C, Hou G, Wu X, Jin X, Chen K. Association between Skeletal Muscle Strength and Dysphagia among Chinese Community-Dwelling Elderly Adults. J Nutr Health Aging 2020; 24:642-649. [PMID: 32510118 DOI: 10.1007/s12603-020-1379-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Swallowing disorder is a health burden for the elderly in China. This study aimed to investigate the prevalence of dysphagia and to test the association between skeletal muscle strength and swallowing problems among community-dwelling older adults. DESIGN A cross-sectional study. SETTING Community-dwelling Chinese elderly in China. PARTICIPANTS 3361 adults aged 65 years or above were involved, among which 1740 (51.8%) were female, with average age of 72.64 (Standard deviation, SD=6.10) years old. MEASUREMENTS Handgrip strength (HGS) was used to evaluate skeletal muscle strength. Dysphagia assessment was performed using the Eating Assessment Tool-10 (EAT-10) and the 30mL water swallow test (WST). Binary logistic regression was used to evaluate the relationship between skeletal muscle strength and dysphagia, and covariates as age, gender, material status, etc. were adjusted. RESULTS The prevalence of dysphagia were 5.5% and 12.9%, screened by EAT-10 and 30mL WST respectively. Participants with dysphagia showed lower HGS (21.73 ± 9.20 vs. 25.66 ± 11.32, p<0.001, by EAT-10; 20.26 ± 9.88 vs. 26.22 ± 11.28, p<0.001, by WST). The adjusted model suggested that muscle strength is a protective factor for swallowing disorders (adjusted OR=0.974, 95%CI: 0.950-0.999, by EAT-10; adjusted OR=0.952, 95%CI: 0.933-0.972, by WST). Subgroup analyses of WST found the effects were significant among participants aged in 70-74 years group and ≥75 years group, rather than those aged under 70. CONCLUSION Dysphagia was significantly associated with skeletal muscle strength among the community-dwelling elderly population. Effective interventions should be taken to manage the decline of muscle strength for the older adults, especially early prevention before 70 years old.
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Affiliation(s)
- H Zhang
- Huafang Zhang, Department of Nursing, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, 322000, China. Tel: +86-15924187619. ; Kun Chen, Department of Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, 310058, China. Tel: +86-571-88208190
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Nishida T, Yamabe K, Ide Y, Honda S. Utility of the Eating Assessment Tool-10 (EAT-10) in Evaluating Self-Reported Dysphagia Associated with Oral Frailty in Japanese Community-Dwelling Older People. J Nutr Health Aging 2020; 24:3-8. [PMID: 31886801 DOI: 10.1007/s12603-019-1256-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of the present study was to verify the associations between dysphagia as screened by the Eating Assessment Tool-10 (EAT-10) and indicators in the 100-mL water swallowing test (WST) or medical history among community-dwelling older people. STUDY DESIGN A cross-sectional study. SETTING AND PARTICIPANTS The study participants were 202 community-dwelling older Japanese adults aged ≥65 years. MEASUREMENTS We investigated the participants' basic attributes, including age, sex, body mass index, medical history (cerebrovascular disease, respiratory disease: chronic obstructive pulmonary disease [COPD], and history of pneumonia within the previous year), and number of prescribed medications. Dysphagia assessment was performed using the EAT-10 and the 100-mL WST as subjective and objective examinations, respectively. The 100-mL WST used four indicators (SC: swallowing capacity, VS: volume per swallow, TS: time per swallow, and choking signs). Patients with and without dysphagia according to the EAT-10 were divided into two groups according to a cutoff score of 3, and the two groups were then compared in terms of their characteristics including medical history and 100-mL WST indicators. A multiple logistic regression model was used to determine whether the indicators of the 100-mL WST or medical history were independently associated with dysphagia in the EAT-10. RESULTS The multiple logistic regression analysis revealed that dysphagia in the EAT-10 was independently associated with male sex (odds ratio [OR] = 2.78; 95% confidence interval [CI] = 0.98-7.90), COPD (OR = 14.68; 95% CI = 3.14-68.85), and VS and TS in the 100-mL WST (OR = 0.85; 95% CI = 0.80-0.90 and OR = 3.03; 95% CI = 1.78-5.16, respectively). CONCLUSIONS Our results revealed that the EAT-10 was independently associated with the 100-mL WST and respiratory disease. We propose that swallowing rehabilitation incorporating respiratory training could be effective for older people screened using the EAT-10.
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Affiliation(s)
- T Nishida
- Sumihisa Honda, Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8520, Japan, TEL.: +81-95-819-7945, FAX.: +81-95-819-7907, E-mail:
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Nishida T, Yamabe K, Honda S. Dysphagia is associated with oral, physical, cognitive and psychological frailty in Japanese community-dwelling elderly persons. Gerodontology 2019; 37:185-190. [PMID: 31874118 DOI: 10.1111/ger.12455] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 10/15/2019] [Accepted: 12/01/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate which domains of frailty are associated with dysphagia in community-dwelling elderly persons. BACKGROUND Dysphagia is a common cause of aspiration pneumonia in frail elderly persons in Japan. Although frailty is considered to be multidimensional, it is unclear which domains of frailty affect dysphagia. METHODS The participants were 3475 independent Japanese elderly persons (≥65 years; 1555 men and 1920 women). A self-report questionnaire with a frailty checklist consisting of several domains (lifestyle, physical function, nutrition, oral function, homebound status, cognitive function and depressive mood) was used to determine the participants' characteristics. Dysphagia was defined as impaired swallowing in the oral function domain. To determine the associations between dysphagia and age, sex and the other domains on the frailty checklist, adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were calculated using multiple logistic regression analysis. RESULTS The multiple logistic regression analysis showed that dysphagia was independently associated with female sex (AOR = 1.35; 95% CI = 1.08-1.68), chewing ability (AOR = 1.70; 95% CI = 1.32-2.18), oral dryness (AOR = 1.94; 95% CI = 1.48-2.54), physical function (AOR = 2.19; 95% CI = 1.66-2.90), cognitive function (AOR = 1.68; 95% CI = 1.34-2.12) and depressive mood (AOR = 1.82; 95% CI = 1.41-2.35). CONCLUSION Dysphagia was independently associated with oral, physical, cognitive and psychological frailty. These results suggest that frailty prevention strategy including swallowing training might be useful for community-dwelling independent elderly persons aged ≥65 years.
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Affiliation(s)
- Takahiro Nishida
- Sasebo-Yoshii Community Comprehensive Support Center, Sasebo, Japan.,Yamabe Dental Clinic, Sasebo, Japan.,Department of Public Health Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Sumihisa Honda
- Department of Public Health Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Quek HC, Lee YS. Dentistry considerations for the dysphagic patient: Recognition of condition and management. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105819868252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dysphagia is a symptom of various underlying medical conditions. It can be attributed to age related changes, neurological, cognitive, respiratory and gastrointestinal diseases. These conditions may cause functional and anatomical changes along the swallowing tract. Impaired swallowing function and oromotor insufficiencies may result in inadvertent aspiration of fluids and/or particles during dental procedures. This article attempts to highlight the importance of identifying patients with dysphagia and discusses ways to reduce life threatening conditions that may arise during dental procedures.
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Affiliation(s)
- Heng Chuan Quek
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore
| | - Yan Shan Lee
- Speech Therapy Department, Singapore General Hospital, Singapore
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Yamamoto T, Aida J, Shinozaki T, Tsuboya T, Sugiyama K, Yamamoto T, Kondo K, Sasaki K, Osaka K. Cohort Study on Laryngeal Cough Reflex, Respiratory Disease, and Death: A Mediation Analysis. J Am Med Dir Assoc 2019; 20:971-976. [PMID: 30904458 DOI: 10.1016/j.jamda.2019.01.155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate quantitatively whether the presence of cough associated with dysphagia (laryngeal cough reflex) increased mortality through respiratory disease among community-dwelling older Japanese. DESIGN A 6-year follow-up prospective cohort study (from 2010 to 2017). SETTING Thirteen municipalities in Japan. PARTICIPANTS Community-dwelling individuals aged 65 years or older (N = 32,682). MEASURES The baseline survey was conducted through self-reported questionnaire. Exposure was experience of laryngeal cough reflex while drinking. The outcome was all-cause mortality. All covariates were selected from demographic, socioeconomic variables, baseline health and functional status, smoking, alcohol drinking, number of remaining teeth, and stroke. The mediator variable was respiratory disease. Cox proportional hazards regression was used to estimate hazard ratios (HRs) for mortality. Parametric mediation analysis was conducted to estimate the effect of laryngeal cough reflex on the mean residual time to death mediated through respiratory disease. RESULTS Among the 32,682 participants (mean age = 74.1 years, standard deviation = 5.9 years), 5550 (17.0%) experienced laryngeal cough reflex at baseline. A total of 4037 deaths occurred. Crude mortality rates of the participants with or without laryngeal cough reflex were 16.3% and 11.6%, respectively. After adjusting for covariates, laryngeal cough reflex [HR = 1.10; 95% confidence interval (CI) = 1.02 to 1.19] and respiratory disease (HR = 1.80; 95% CI = 1.62 to 2.00) were associated with mortality. The mediation analysis showed that respiratory disease significantly (P < .001) and partially mediated the association between laryngeal cough reflex, an indicator of 1 or more conditions such as chronic aspiration and mortality. CONCLUSIONS/IMPLICATIONS Laryngeal cough reflex was a prevalent condition, and it was associated with all-cause mortality in community-dwelling older Japanese individuals. Clinicians could contribute to reduce mortality risk by addressing swallowing function problems using their interprofessional collaboration team (speech-language pathologist, dentist, rehabilitation doctor, otolaryngologist, respiratory physician, and gerontologist).
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Affiliation(s)
- Takafumi Yamamoto
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan; Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Jun Aida
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.
| | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Toru Tsuboya
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kemmyo Sugiyama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Tatsuo Yamamoto
- Division of Dental Sociology, Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan; Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Audag N, Goubau C, Danse E, Vandervelde L, Liistro G, Toussaint M, Reychler G. Validation and Reliability of the French Version of the Sydney Swallow Questionnaire. Dysphagia 2019; 34:556-566. [DOI: 10.1007/s00455-019-09978-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 01/18/2019] [Indexed: 01/05/2023]
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Madhavan A, Carnaby GD, Chhabria K, Crary MA. Preliminary Development of a Screening Tool for Pre-Clinical Dysphagia in Community Dwelling Older Adults. Geriatrics (Basel) 2018; 3:E90. [PMID: 31011125 PMCID: PMC6371185 DOI: 10.3390/geriatrics3040090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 11/30/2022] Open
Abstract
Evidence suggests that community dwelling older adults (CDOA) are at risk for dysphagia (swallowing difficulties). Dysphagia is often unidentified until related morbidities like under nutrition or pneumonia occur. These cases of unidentified dysphagia, prior to any clinical intervention, may be termed 'pre-clinical dysphagia'. Identifying pre-clinical dysphagia is challenged by the lack of validated tools appropriate for CDOA. This study addresses preliminary development of a novel patient reported outcome (PRO) screening tool for pre-clinical dysphagia. Initially, 34 questions were developed from literature review and expert opinion. Following pilot testing (n = 53), the questionnaire was revised and tested on 335 additional CDOA. Face validity, content validity, item analysis, reliability (internal consistency), and construct validity (exploratory factor analysis) measures were completed. Psychometric validation resulted in a 17-question PRO tool. Construct analysis identified a three-factor model that explained 67.345% of the variance. Emergent factors represented swallowing effort, physical function, and cognitive function. The results revealed strong construct validity and internal consistency (Cronbach's α = 0.90). A novel, simple PRO incorporating multiple function domains associated with aging demonstrated strong preliminary psychometric properties. This tool is more comprehensive and aging-focused than existing dysphagia screening tools. Inclusion of multiple domains may be key in early identification of pre-clinical dysphagia.
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Affiliation(s)
- Aarthi Madhavan
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, PA 16802, USA.
| | - Giselle D Carnaby
- Swallowing Research Laboratory, School of Communication Sciences and Disorders, University of Central Florida, Orlando, FL 32816, USA.
| | - Karishma Chhabria
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Michael A Crary
- Swallowing Research Laboratory, School of Communication Sciences and Disorders, University of Central Florida, Orlando, FL 32816, USA.
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Post-extubation Dysphagia: Does Timing of Evaluation Matter? Dysphagia 2018; 34:210-219. [DOI: 10.1007/s00455-018-9926-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
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Abstract
PURPOSE OF REVIEW The purpose of the review is to examine current research focused on upper oesophageal sphincter (UES) and cricopharyngeus muscle function, and how better understanding UES physiology will translate to improved management. RECENT FINDINGS Although much is known about UES function, new information describing the dynamics of the UES and cricopharyngeus is being identified through manometry, combined fluoromanometry, and anatomic study. Response of the UES to injury, reflux, and surgical interventions is reported. Direct surgical treatment of cricopharyngeus noncompliance with or without diverticuli continues to show benefit and long-term results support a sustained improvement in three-quarters of patients. SUMMARY UES and cricopharyngeus function is complex and dynamic. It is affected by internal signals such as posture and constitution of refluxate, aging, and interventions particularly radiation and surgery. Clear understanding of the triggers and responses of the UES will enable clinicians to choose the correct therapy for their dysphagic patients.
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Iinuma T, Hirata T, Arai Y, Takayama M, Abe Y, Fukumoto M, Fukui Y, Gionhaku N. Perceived swallowing problems and mortality risk in very elderly people ≥85 years old: Results of the Tokyo Oldest Old Survey on Total Health study. Gerodontology 2017; 34:313-319. [PMID: 28349594 DOI: 10.1111/ger.12265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to clarify whether perceived swallowing problems affect the life expectancy of very elderly individuals. BACKGROUND In an ageing society, oral function affects health status. In particular, a decline in swallowing function may increase the risk of various diseases, morbidity and malnutrition. MATERIALS AND METHODS We evaluated 526 elderly individuals aged ≥85 years. All participants completed a questionnaire and underwent oral, physical and mental health examinations. The comprehensive oral health assessment comprised a face-to-face interview that included a questionnaire on swallowing function. We estimated hazard ratios and 95% confidence intervals using the Cox proportional hazards model, adjusting for potential confounders between perceived swallowing problems and all-cause mortality over a 3-year period. RESULTS Over a 3-year follow-up period, 88 of 526 participants died and 68 participants complained of perceived swallowing problems. Perceived swallowing problems had statistically significant associations with physical status and function and nutrition. In the univariate analysis, perceived swallowing problems had statistically significant associations with an approximately 1.9-fold higher risk of all-cause mortality during the 3-year period (HR: 1.89, 95% CI: 1.14-3.14). In the multivariate analysis, the statistically significant association between perceived swallowing problems and all-cause mortality remained after adjusting for various confounding factors (HR: 1.73, 95% CI: 1.03-2.92). CONCLUSION Perceived swallowing disorders should be verified by a clinical examination, as they are associated with other health outcomes and increased all-cause mortality.
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Affiliation(s)
- Toshimitsu Iinuma
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Takumi Hirata
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Michiyo Takayama
- Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukiko Abe
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Motoko Fukumoto
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Yusuke Fukui
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Nobuhito Gionhaku
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
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