Signs for Early Detection of Dysphagia in Older Adults with Severe Alzheimer's Disease

Relationship Between Subjective Questionnaires and Videofluoroscopy of Dysphagia Evaluation: A Systematic Review and Meta-Analysis

BACKGROUND

Early detection of dysphagia is important for preventing aspiration pneumonia. Although videofluoroscopy is currently the primary diagnostic tool for dysphagia, access to this tool may be limited because of radiation exposure risk, high cost, and other factors.

PURPOSE

In this study, a meta-analysis was used to determine the strength of the correlation between dysphagia detection outcomes obtained using subjective questionnaires and videofluoroscopy.

METHODS

The PubMed and Embase databases were searched for original articles up to December 2022. Studies published in English that used cross-sectional designs to assess the correlation between subjective questionnaires and videofluoroscopy were considered eligible for inclusion. The search terms used included "dysphagia," "questionnaire," and "videofluoroscopy." Two reviewers critically appraised and extracted the correlation coefficient r values. In addition, a random-effects meta-analysis was conducted. The Q statistic was used to assess the heterogeneity among the included studies. Publication bias was checked using the funnel plot and Egger's tests. Multilevel analysis was used to determine sensitivity to consider within-study correlations. In addition, subgroup analyses were conducted based on type of questionnaire, head and neck cancer, and English-speaking regions.

RESULTS

The meta-analysis included five studies and 856 patients using the Eating Assessment Tool-10 and one study and 27 patients using the Sydney Swallow Questionnaire. The results of the random-effects meta-analysis showed a moderate relationship between the subjective questionnaires and videofluoroscopy ( r = .35, 95% CI [0.20, 0.48]). Similar results were also obtained using multilevel analysis ( r = .34, 95% CI [0.25, 0.42]). No publication bias was found for any of the studies ( p = .88). In the subgroup analyses, a moderate relationship between Eating Assessment Tool-10 and videofluoroscopy ( r = .31, 95% CI [0.19, 0.42]) and an ultrahigh relationship between Sydney Swallow Questionnaire and video-fluoroscopy ( r = .74, 95% CI [0.50, 0.87]) were found. Furthermore, moderate associations were observed within each head and neck cancer and English-speaking regions subgroup. However, no significant differences were found between these two subgroups.

CONCLUSIONS

These results indicate the subjective questionnaires considered in this study share a moderate relationship with videofluoroscopy. Subjective questionnaires may be used as an auxiliary tool by nurses and homecare givers for the early assessment of dysphagia risk in patients.

Feasibility of Oral Function Evaluation According to Dementia Severity in Older Adults with Alzheimer's Disease

Oral function evaluation in older adults with dementia is important for determining appropriate and practical dietary support plans; however, it can be challenging due to their difficulties in comprehending instructions and cooperating during assessments. The feasibility of oral function evaluation has not been well studied. This cross-sectional study aimed to determine the feasibility of oral function evaluation in older adults with Alzheimer's disease (AD) according to Functional Assessment Staging of Alzheimer's Disease (FAST) stages. In total, 428 older adults with AD (45 men and 383 women; mean age: 87.2 ± 6.2 years) were included. Multilevel logistic regression models were used to examine the prevalence of participants who were unable to perform oral function evaluations, including oral diadochokinesis (ODK), repeated saliva swallow test (RSST), and modified water swallow test (MWST). In comparison to the reference category (combined FAST stage 1-3), FAST stage 7 was associated with the infeasibility of ODK (adjusted odds ratio, 95% confidence interval = 26.7, 4.2-168.6), RSST (5.9, 2.2-16.1), and MWST (8.7, 1.6-48.5, respectively). Oral function evaluation is difficult in older adults with severe AD. Simpler and more practical swallowing function assessments and indicators that can be routinely observed are required.

The prevalence of dysphagia at risk among older adults in nursing homes: a meta-analysis

To estimate the prevalence of dysphagia at risk among older adults in nursing homes. Electronic databases of PubMed, Web of Science, CINAHL and Embase for English language, WanFang, VIP and CNKI for Chinese language were systematically searched to identify relevant observational studies published not later than July 4, 2021. Studies conducted in nursing homes and reported dysphagia screening or assessment methods were included. In total, 43 studies involving 56 746 participants were included in this meta-analysis. The overall pooled crude prevalence of dysphagia at risk was 35.9% (95% CI: 29.0-43.4%), with high heterogeneity (I2  = 99.5%). There was a statistically significant difference in prevalence estimates with respect to study locations, dysphagia assessment staff and representativeness of samples. The prevalence of dysphagia among older adults in nursing homes is relatively high. Routine screening strategy for dysphagia is necessary for older adults in nursing homes.

Chewing and Swallowing Abilities of Persons Living With Dementia: A Systematic Review of Psychometric Properties of Instruments

Background and Objectives

It is critical to use validated instruments to diagnose and manage chewing and swallowing problems of persons living with dementia. The study aimed to synthesize the characteristics and psychometric quality of instruments that assess the chewing and swallowing abilities of persons living with dementia.

Research Design and Methods

The systematic review was used to conduct this study. We searched 5 electric databases for records published from January 1, 1980, to July 8, 2022. Records were eligible if they included any instrument to assess chewing ability or swallowing ability in the dementia population. Eight characteristics of eligible instruments were extracted from the records: (1) development process, (2) operationalized concept/construct, (3) sample and setting, (4) administration method, (5) items, (6) scoring format/interpretation, (7) reliability, and (8) validity. The psychometric assessment for self-report and observational tool was used to evaluate 12 psychometric properties of eligible instruments.

Results

In total, 11,074 records were reviewed. Thirty-five eligible instruments, including observational tools, self-report questionnaires, and physiological instruments, were identified from 60 records. All 8 instruments assessing chewing ability were evaluated as having low psychometric quality, and only 3 out of 27 instruments assessing swallowing ability were evaluated as having moderate psychometric quality. Fifteen instruments were tested for only 1 type of psychometric property, limiting the overall evaluation of psychometric evidence.

Discussion and Implications

The study findings inform the use and adaptation of appropriate instruments for practice and research. All existing instruments warrant further validation in larger samples to expand use in diverse care settings. This review described and evaluated current instruments measuring chewing and swallowing abilities and potential use in research and clinical practice to plan for and evaluate the effectiveness of mealtime and oral care practice and reduce health-related negative outcomes of persons living with dementia.

Dysphagia and its association with other health-related risk factors in institutionalized older people: A systematic review

BACKGROUND

Dysphagia is considered a geriatric syndrome that is characterized by inability to or difficulty in safely and effectively forming or moving the food bolus toward the esophagus. This pathology is very common and affects approximately 50% of institutionalized older people. Dysphagia is often accompanied by high nutritional, functional, social, and emotional risks. This relationship implies a higher rate of morbidity, disability, dependence, and mortality in this population. This review is aimed at studying the relationship between dysphagia and different health-related risk factors in institutionalized older people.

METHOD

We conducted a systematic review. The bibliographic search was performed in the Web of Science, Medline, and Scopus databases. Data extraction and methodological quality were evaluated by two independent researchers.

RESULTS

Twenty-nine studies met the inclusion and exclusion criteria. A clear relationship between the development and progression of dysphagia and a high nutritional, cognitive, functional, social, and emotional risk in institutionalized older adults was found.

CONCLUSIONS

There is an important relationship between these health conditions that shows the need for research and new approaches to considerations such as their prevention and treatment as well as the design of protocols and procedures that will help reduce the percentage of morbidity, disability, dependence, and mortality in older people.

The sensitivity and specificity of the modified volume-viscosity swallow test for dysphagia screening among neurological patients

Oropharyngeal dysphagia (OD) is a highly prevalent condition after stroke and other neurological diseases. The volume-viscosity swallow test (V-VST) is a screening tool for OD. Considering that the recommendations of volume and thickeners in the original V-VST limited the popularization and application of the test in the Chinese population, we provide the modified V-VST to detect OD among neurological patients. In addition, the accuracy of the modified V-VST to screen OD needs to be verified. We included 101 patients with neurological diseases. OD was evaluated by a modified V-VST and a videofluoroscopy swallowing study (VFSS) using 3 volumes (i.e., 3, 5, and 10 ml) and 4 viscosities (i.e., water, mildly thick, moderately thick, and extremely thick). In this study, to compare with the original V-VST results, a volume of 20 ml was also included. The discriminating ability of modified V-VST in detecting OD was assessed by the sensitivity and specificity values of clinical signs of impaired efficiency (impaired labial seal, piecemeal deglutition, and residue) and impaired safety of swallowing (cough, voice changes, and oxygen desaturation ≥3%) in comparison to the results of VFSS. The modified V-VST showed 96.6% sensitivity and 83.3% specificity for OD, 85.2% sensitivity and 70% specificity for impaired safety, and 90.9% sensitivity and 76.9% specificity for impaired efficacy. Our study suggests that the modified V-VST offers a high discriminating ability in detecting OD among neurological patients.