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de Oliveira GD, Vicente LCC, Mourão AM, Dos Santos SHGP, de Lima Friche AA, Bicalho MAC. Dysphagia Screening in Brazilian Older Adults with Dementia: Content Development and Validation of a Questionnaire for Caregivers - RaDID-QC. J Cross Cult Gerontol 2024:10.1007/s10823-024-09510-z. [PMID: 39042243 DOI: 10.1007/s10823-024-09510-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 07/24/2024]
Abstract
This study aims to develop and validate the content and response processes of a questionnaire intended for caregivers to screen for dysphagia in Brazilian older adults with dementia due to Alzheimer's disease and/or vascular dementia. The instrument items were developed in Brazilian Portuguese language based on the theoretical framework. A committee of speech-language-hearing therapists analyzed the relevance, objectivity, clarity, and understandability of the items with the Delphi method. The content validity index cutoff agreement score for experts' answers to validate each item in the questionnaire was 0.78; in the intraclass correlation coefficient, it was 0.75 for all items. For response process validity evidence, the questionnaire was applied to 30 caregivers of older adults with dementia, who judged the clarity and understandability of the items. Each item was validated when understood by at least 95% of participants. The first version of the instrument had 29 items. After two expert assessments, the last version had 24 items. The intraclass correlation coefficient was 0.85. Only one item needed semantic adjustments in the pre-test. The dysphagia screening instrument applied to caregivers of older adults with dementia was developed with adequate content and response process validity evidence, enabling adjustments in its construct. Future studies will analyze the remaining evidence of validity and reliability.
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Affiliation(s)
- Grazielle Duarte de Oliveira
- Sciences Applied to Adult Health at the Federal University of Minas Gerais (UFMG), Avenida Professor Alfredo Balena, 190/246 - Santa Efigênia, Belo Horizonte, MG, Brazil.
| | - Laélia Cristina Caseiro Vicente
- Department of Speech-Language-hearing Sciences of the Medical School at UFMG, Avenida Professor Alfredo Balena, 190/251 - Santa Efigênia, Belo Horizonte, MG, Brazil
| | - Aline Mansueto Mourão
- Department of Speech-Language-hearing Sciences of the Medical School at UFMG, Avenida Professor Alfredo Balena, 190/251 - Santa Efigênia, Belo Horizonte, MG, Brazil
| | | | - Amélia Augusta de Lima Friche
- Department of Speech-Language-hearing Sciences of the Medical School at UFMG, Avenida Professor Alfredo Balena, 190/251 - Santa Efigênia, Belo Horizonte, MG, Brazil
| | - Maria Aparecida Camargos Bicalho
- Department of Medicine of the Medical School at UFMG, Geriatrician at the Jenny de Andrade Faria Institute for Older Adult Healthcare at the Clinics Hospital of the Federal University of Minas Gerais, UFMG - Avenida Professor Alfredo Balena, 190/246 - Santa Efigênia, Belo Horizonte, MG, Brazil
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Mittal A, Patel M, Wang D, Khrais A, Chyn ETY. Does Dysphagia Predict Inpatient Morbidity and Mortality in Geriatric Patients Admitted for Aspiration Pneumonia? Cureus 2023; 15:e39223. [PMID: 37337491 PMCID: PMC10276973 DOI: 10.7759/cureus.39223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/21/2023] Open
Abstract
Background Aspiration pneumonia is common in older adults admitted for community-acquired pneumonia and is associated with significant morbidity and mortality. Factors that put this population at higher risk of aspiration include cognitive impairment, neuromuscular dysfunction, and dysphagia. This study aimed to determine whether a concurrent diagnosis of dysphagia conferred a higher risk of complications in the elderly admitted for aspiration pneumonia. Methods The National Inpatient Sample 2001-2013 database was queried for patients, aged 65 or older, with a diagnosis of aspiration pneumonia using International Classification of Diseases, Ninth Revision (ICD-9) codes. Sepsis, respiratory failure, and intubation were identified with their respective ICD-9 codes. A chi-square test and binary logistic regression analysis were used to examine socio-demographic and complication variables, with a significance level of α <0.001. Results A total of 1,097,325 patients were admitted for aspiration pneumonia, of which 349,861 (24.2%) had dysphagia. After incorporating socio-demographic variables, the dysphagia group had a significantly lower likelihood of having sepsis (OR=0.72), respiratory failure (OR=0.92), intubation (OR=0.52), and inpatient mortality (OR = 0.59). Patients with dysphagia had a significantly higher likelihood of increased length of stay (OR=1.24). Conclusions Elderly patients admitted with aspiration pneumonia with a co-diagnosis of dysphagia were less likely to have inpatient morbidity and mortality compared to their counterparts. This may be due to improved speech evaluation and treatment in patients with dysphagia allowing for better control of macro and micro aspiration. Future research is needed to examine if universal speech therapy can reduce hospitalization and long-term mortality for such patients.
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Affiliation(s)
- Anmol Mittal
- Department of Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Mansi Patel
- Department of Geriatrics, Mount Sinai Hospital, New York, USA
| | - Daniel Wang
- Department of Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Ayham Khrais
- Department of Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Eric Tien Yen Chyn
- Department of Geriatrics, Rutgers University New Jersey Medical School, Newark, USA
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Cordier R, Speyer R, Martinez M, Parsons L. Reliability and Validity of Non-Instrumental Clinical Assessments for Adults with Oropharyngeal Dysphagia: A Systematic Review. J Clin Med 2023; 12:jcm12020721. [PMID: 36675650 PMCID: PMC9861493 DOI: 10.3390/jcm12020721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/12/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
This systematic review on non-instrumental clinical assessment in adult oropharyngeal dysphagia (OD) provides an overview of published measures with reported reliability and validity. In alignment with PRISMA, four databases (CINAHL, Embase, PsycINFO, and PubMed) were searched, resulting in a total of 16 measures and 32 psychometric studies included. The included measures assessed any aspect of swallowing, consisted of at least one specific subscale relating to swallowing, were developed by clinical observation, targeted adults, and were developed in English. The included psychometric studies focused on adults, reported on measures for OD-related conditions, described non-instrumental clinical assessments, reported on validity or reliability, and were published in English. Methodological quality was assessed using the standard quality assessment QualSyst. Most measures targeted only restricted subdomains within the conceptual framework of non-instrumental clinical assessments. Across the 16 measures, hypothesis testing and reliability were the most reported psychometrics, whilst structural validity and content validity were the least reported. Overall, data on the reliability and validity of the included measures proved incomplete and frequently did not meet current psychometric standards. Future research should focus on the development of comprehensive non-instrumental clinical assessments for adults with OD using contemporary psychometric research methods.
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Affiliation(s)
- Reinie Cordier
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne NE7 7XA, UK
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa
| | - Renée Speyer
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Department Special Needs Education, Faculty of Educational Sciences, University of Oslo, 0318 Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 1233 XA Leiden, The Netherlands
- Correspondence:
| | - Matthew Martinez
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne NE7 7XA, UK
| | - Lauren Parsons
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
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Magalhães Junior HV, Pernambuco LDA, Cavalcanti RVA, Silva RGD, Lima KC, Ferreira MAF. Accuracy of an epidemiological oropharyngeal dysphagia screening for older adults. Gerodontology 2021; 39:418-424. [PMID: 34913514 DOI: 10.1111/ger.12613] [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: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine the accuracy of an epidemiological screening questionnaire for oropharyngeal dysphagia in older people. BACKGROUND Determining the cut-off point and the accuracy of the self-reported epidemiological questionnaire for screening oropharyngeal dysphagia in older adults is important for mass screening, which may estimate the prevalence of oropharyngeal dysphagia. MATERIALS AND METHODS This was a cross-sectional diagnostic study with a convenience sample of 70 older adults over 60 years of age of both sexes, aged between 60 and 90 years (mean age 69.2; SD, 7.6). It used a screening questionnaire with nine ordered items response options resulted in a score ranging from 0 to 18. The criterion test was the fiberoptic endoscopic evaluation of swallowing, with analysis of the receiver operating characteristic (ROC), with a 5% significance level. RESULTS Oropharyngeal dysphagia frequency by the criterion test was 73%, with no significant difference between age and sex. The area under the ROC curve was 0.88 (95% confidence interval: 0.79-0.98) above the cut-off point 3. This screening questionnaire showed good parameters of sensitivity (80%), specificity (89%), positive predictive value (95%), negative predictive value (63%), positive likelihood ratio (7.64), negative likelihood ratio (0.22) and accuracy (83%). CONCLUSIONS This questionnaire may be a satisfactory screening tool for estimating the prevalence of oropharyngeal dysphagia in older adults.
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Affiliation(s)
| | | | | | - Roberta Gonçalves da Silva
- Department of Speech, Language and Hearing Sciences, São Paulo State University (Unesp), School of Philosophy and Sciences, Marília Universtiy of São Paulo, Marília, Brazil
| | - Kenio Costa Lima
- Department of Dentistry, Postgraduate Public Health Program (PPGSCol-UFRN), Federal University of Rio Grande of Norte (UFRN), Natal, Brazil
| | - Maria Angela Fernandes Ferreira
- Department of Dentistry, Postgraduate Public Health Program (PPGSCol-UFRN), Federal University of Rio Grande of Norte (UFRN), Natal, Brazil
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Smithard D, Hansjee D, Henry D, Mitchell L, Sabaharwal A, Salkeld J, Yeung E, Younus O, Swaine I. Inter-Relationships between Frailty, Sarcopenia, Undernutrition and Dysphagia in Older People Who Are Admitted to Acute Frailty and Medical Wards: Is There an Older Adult Quartet? Geriatrics (Basel) 2020; 5:geriatrics5030041. [PMID: 32630034 PMCID: PMC7555188 DOI: 10.3390/geriatrics5030041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: With increasing age the prevalence of frailty, sarcopenia, undernutrition and dysphagia increases. These are all independent markers of outcome. This study explores the prevalence of these four and explores relationships between them. Methods: A convenience sample of 122 patients admitted to acute medical and frailty wards were recruited. Each was assessed using appropriate screening tools; Clinical Frailty Score (CFS) for frailty, SARC-F for sarcopenia, Nutritional Risk Tool (NRT) for nutritional status and 4QT for dysphagia. Results: The mean age of the participants was 80.53 years (65–99 years), and 50.37% (68) were female. Overall, 111 of the 122 (91.0%) reported the presence of at least one of the quartet. The median CFS was 5 (1–9), with 84 patients (68.9%) having a score of ≥5 (moderate or severely frail); The median SARC-F was 5 (0–10), with 64 patients (52.5%) having a score of ≥5; The median NRT was 0 (0–8) and 33 patients (27.0%) scored ≥ 1. A total of 77 patients (63.1%) reported no difficulty with swallowing/dysphagia (4QT ≥ 1) and 29 (23.7%) had only one factor. Sixteen patients (13.1%) had all four. There was a significant correlation between nutritional status and dysphagia, but not with frailty or sarcopenia. There were significant correlations between frailty and both sarcopenia and dysphagia. Conclusions: In our sample of acute medical and frailty ward patients, there was a much higher prevalence than expected (91%) of either: frailty, sarcopenia, undernutrition or dysphagia. The prevalence of all four was present in 13% of patients. We suggest that frailty, sarcopenia, nutritional risk and dysphagia comprise an “Older Adult Quartet”. Further study is required to investigate the effect of the “Older Adult Quartet” on morbidity and mortality.
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Affiliation(s)
- David Smithard
- Department Geriatric Medicine, Lewisham and Greenwich NHS Trust, London SE13 6LH, UK; (D.H.); (L.M.); (A.S.); (O.Y.)
- School of Health Science, University of Greenwich, London SE9 2UG, UK;
- Correspondence: ; Tel.: +44-(0)208-836-6000
| | - Dharinee Hansjee
- Department Geriatric Medicine, Lewisham and Greenwich NHS Trust, London SE13 6LH, UK; (D.H.); (L.M.); (A.S.); (O.Y.)
| | - Darrien Henry
- Department Medicine, Royal Halamshire Hospital, Sheffield S10 2JF, UK;
| | - Laura Mitchell
- Department Geriatric Medicine, Lewisham and Greenwich NHS Trust, London SE13 6LH, UK; (D.H.); (L.M.); (A.S.); (O.Y.)
| | - Arjun Sabaharwal
- Department Geriatric Medicine, Lewisham and Greenwich NHS Trust, London SE13 6LH, UK; (D.H.); (L.M.); (A.S.); (O.Y.)
| | - Jo Salkeld
- Department Medicine, St Thomas’ Hospital, London SE1 7EH, UK;
| | - Eirene Yeung
- Department Acute Medicine, King’s College Hospital, London SE5 9RS, UK;
| | - Osman Younus
- Department Geriatric Medicine, Lewisham and Greenwich NHS Trust, London SE13 6LH, UK; (D.H.); (L.M.); (A.S.); (O.Y.)
| | - Ian Swaine
- School of Health Science, University of Greenwich, London SE9 2UG, UK;
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Shin J, Han SH, Choi J, Kim YS, Lee J. Importance of Geriatric Syndrome Screening within 48 Hours of Hospitalization for Identifying Readmission Risk: A Retrospective Study in an Acute-Care Hospital. Ann Geriatr Med Res 2020; 24:83-90. [PMID: 32743328 PMCID: PMC7370791 DOI: 10.4235/agmr.20.0017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/20/2020] [Accepted: 05/01/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Given the association between geriatric syndrome and hospital readmission, we evaluated the suitability of geriatric syndrome screening for care (GSC) in identifying readmission risk and suggested the appropriate time for GSC. METHODS GSC considering cognitive impairment, depression, polypharmacy (five or more medications), functional mobility, dysphagia, malnutrition, pain, and incontinence was performed among 2,663 general ward inpatients aged 65 years or older within 48 hours after admission and again before discharge between November 2016 and October 2017. From each patient, fall events, pressure ulcers, potentially inappropriate medication use, and delirium were assessed at admission. Patients were divided into two groups on the basis of readmission within 1 year after the first admission. According to the screening period (at admission and before discharge) and in-hospital decline, we applied receiver operating characteristic curve analysis to compare the prevalence of clinical concerns between the readmission and no-readmission groups. We also used multiple logistic regression analysis to evaluate the risk of readmission according to the presence of geriatric syndrome and clinical outcomes. RESULTS The 782 readmitted patients (29.4%) showed a higher rate of poor GSC than those who were not readmitted. Polypharmacy at admission was significantly correlated with readmission risk (area under the receiver operating characteristic curve=0.602). Fall events (odds ratio [OR]=4.36; 95% confidence interval [CI], 2.36-8.05), urinary incontinence (OR=4.21; 95% CI, 3.28-5.39), and depressive mood (OR=3.88; 95% CI, 2.69-5.59) at admission were risk factors for readmission. CONCLUSION Geriatric syndromes assessed by GSC at admission was associated with an increased risk of readmission.
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Affiliation(s)
- Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
| | - Seol-Heui Han
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
| | - Jaekyung Choi
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
| | - Yoon-Sook Kim
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
- Department of Quality Improvement, Konkuk University Medical Center, Seoul, Korea
| | - Jongmin Lee
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Tsang K, Lau ESY, Shazra M, Eyres R, Hansjee D, Smithard DG. A New Simple Screening Tool-4QT: Can It Identify Those with Swallowing Problems? A Pilot Study. Geriatrics (Basel) 2020; 5:E11. [PMID: 32120993 PMCID: PMC7151188 DOI: 10.3390/geriatrics5010011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/12/2020] [Accepted: 02/25/2020] [Indexed: 12/21/2022] Open
Abstract
As people and the population age, the prevalence of swallowing problems (dysphagia) increases. The screening for dysphagia is considered good practice in stroke care, yet is not routinely undertaken in the management of frail older adults. A short swallow screen, the 4QT, was developed following a review of the literature. The screen has four questions relating to swallowing that can be asked by a member of the health care team. A convenience sample of 48 older frail patients on an acute frailty ward was recruited into a Quality Improvement project. Their swallow was screened using the EAT-10 and 4QT. A speech and language therapist assessed for the presence of dysphagia using a standardised assessment for dysphagia. The 4QT was as effective as the EAT-10 in identifying older frail adults with potential swallowing problems (Κ = 0.73). The 4QT has 100% sensitivity, 80.4% specificity and positive predictive value (PPV) 50%, negative predictive value (NPV) 100%. The 4QT is a highly sensitive but not specific swallow screen, only 50% of people reporting swallowing problems were confirmed to have a degree of dysphagia by the SLT. The 4QT is a simple screening tool that could be used by all staff, but requires further research/evaluation before it is widely accepted into clinical practice.
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Affiliation(s)
- Karwai Tsang
- St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH, UK;
| | - Esther SY Lau
- Royal Alexandra Hospital, Paisley, Renfrewshire PA2 9PJ, UK;
| | - Mariyam Shazra
- Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, UK;
| | - Ruth Eyres
- Guy’s Hospital, St Thomas’ Road, London SE1 9RS, UK;
| | | | - David G Smithard
- Queen Elizabeth Hospital, Stadium Road, Woolwich SE18 4QH, UK;
- Dept Sports Science, University of Greenwich, London SE9 2UG, UK
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Magalhães Junior HV, Pernambuco LDA, Cavalcanti RVA, Lima KC, Ferreira MAF. Validity Evidence of an Epidemiological Oropharyngeal Dysphagia Screening Questionnaire for Older Adults. Clinics (Sao Paulo) 2020; 75:e1425. [PMID: 31939561 PMCID: PMC6945292 DOI: 10.6061/clinics/2020/e1425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/24/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This research aimed to identify evidence of validity of a self-reported Oropharyngeal Dysphagia screening questionnaire for older adults based on test content, response processes, internal structure, relations to other variables, and reliability. METHOD This is a nonrandomized, cross-sectional study employing the concepts and principles of the Standards for Educational and Psychological Testing. Data were collected from 644 community-dwelling older adults (both genders, age: ≥60 years) who agreed to participate in some steps of the validation process. Statistical methods obtained the content representation of the construct, internal structure validation, discriminant and convergent evidence, and reliability, using a 5% significance level. RESULTS The screening tool was re-specified in nine questions that provided the best fit and robust reliability, with proper discriminant and convergent evidence. CONCLUSIONS The screening questionnaire presented valid and reliable results to identify oropharyngeal dysphagia symptoms in older adults, highlighting the importance of the validation process based on the standards to construct an epidemiological instrument.
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Affiliation(s)
| | - Leandro de Araújo Pernambuco
- Departamento de Fonoaudiologia, Centro de Ciencias da Saude, Universidade Federal da Paraíba (UFPB), Joao Pessoa, PB, BR
| | | | - Kenio Costa Lima
- Departamento de Odontologia, Programa de Pos-Graduacao em Saude Coletiva (PPGSCol-UFRN), Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, BR
| | - Maria Angela Fernandes Ferreira
- Departamento de Odontologia, Programa de Pos-Graduacao em Saude Coletiva (PPGSCol-UFRN), Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, BR
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The GUSS test as a good indicator to evaluate dysphagia in healthy older people: a multicenter reliability and validity study. Eur Geriatr Med 2019; 10:879-887. [DOI: 10.1007/s41999-019-00249-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/26/2019] [Indexed: 11/26/2022]
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Which swallowing difficulty of food consistency is best predictor for oropharyngeal dysphagia risk in older person? Eur Geriatr Med 2019; 10:609-617. [DOI: 10.1007/s41999-019-00206-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/15/2019] [Indexed: 12/17/2022]
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