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Nishio K, Yoshida T, Arai Y, Ito T, Okada S, Ikeda T, Abe Y, Takayama M, Iinuma T. Relationship between malnutrition according to the global leadership initiative on malnutrition criteria and oral health among community-dwelling elderly aged 85 years and older: a cross-sectional study. BMC Oral Health 2024; 24:887. [PMID: 39097715 PMCID: PMC11297638 DOI: 10.1186/s12903-024-04568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 07/03/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND A new diagnostic criterion for malnutrition, the Global Leadership Initiative on Malnutrition (GLIM) criteria, has been proposed. Despite a recognized link between malnutrition and oral health, further clarification is needed regarding this association when using the GLIM criteria. This study examined the association between malnutrition and oral health in community-dwelling older adults aged ≥ 85. METHODS This study was conducted using data from the Tokyo Oldest Old Survey on Total Health study, and altogether 519 participants ≥ 85 years were enrolled. Malnutrition was assessed using the GLIM criteria. Oral health information, on the number of teeth, maximum occlusal force (MOF), saliva production, denture-related questions (dissatisfaction and frequency of use), dental visit history in the past year, whether participants enjoyed meals, and oral-related quality of life was assessed using the Geriatric Oral Health Assessment Index (GOHAI) were collected. MOF was assessed the average values of three measurements and lower tertile by sex as decline in MOF. For GOHAI, the score for each items (Q1-Q12) was also evaluated, and further, the decline in each item (score: 1-2 points on a 5-point scale) was assessed as a "problem with each items." Oral health factors differing between those with and without malnutrition were analyzed. For differing items, malnutrition risk was evaluated using Cox regression. RESULTS Eighty-nine (17.1%) participants experienced malnutrition. Significant differences were observed in the decline in MOF, enjoyment of meals, individual scores for Q2, Q4, and Q6, and the problem with Q3, Q6, Q7, and Q11. Cox regression analysis showed that decline in MOF (odds ratio [OR]: 1.728, 95% confidence interval [CI]: 1.010-2.959), enjoyment of meals (OR: 0.502, 95% CI: 0.289-0.873), problem with Q3 (OR: 5.474, 95% CI: 1.301-23.028), Q6 (OR: 5.325, 95% CI: 1.026-27.636), and Q7 (OR: 2.867, 95% CI: 1.397-5.882) were associated with ORs of malnutrition. CONCLUSION Decline in MOF, enjoyment of meals, swallowing problem (problem with Q3), limit contact due to oral condition (problem with Q6), and esthetics problem (problem with Q7) were associated with malnutrition as assessed using the GLIM criteria.
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Affiliation(s)
- Kensuke Nishio
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan.
| | - Takamasa Yoshida
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Tomoka Ito
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Shinji Okada
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Takayuki Ikeda
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
| | - Yukiko Abe
- 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
| | - Toshimitsu Iinuma
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
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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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Wu X, Xu Y, Liu Y, Ma A, Zhong F, Gao T, Cai J, Chen Y, Wang Y, Zhou W, Ma Y. Relationships between oral function, dietary intake and nutritional status in older adults aged 75 years and above: a cross-sectional study. BMC Public Health 2024; 24:1465. [PMID: 38822295 PMCID: PMC11143706 DOI: 10.1186/s12889-024-18906-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 05/21/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Malnutrition is related to impaired oral health and function that causes poor dietary intake, declining the general health of older adults. The role of dietary intake in the association between oral function and nutritional status of Chinese older adults (aged 75 and above) was examined in this cross-sectional study. METHODS Through the randomized cluster sampling method, 267 older adults living in rural areas of Qingdao, Shandong (aged 81.4 ± 4.3, 75-94 years) were chosen as the primary research participants. A Mini Nutritional Assessment - Short Form was used to determine nutritional status, and Food Frequency Questionnaire and 24-hour Food Intake Recall were used to assess dietary intake. The oral function was evaluated by analyzing the teeth, oral problems, bite force, tongue pressure, lip sealing pressure, chewing function questionnaire, whole saliva flow rate, 10-Item Eating Assessment Tool, and water swallow test. RESULTS Based on the MNA-SF score, it was divided into a well-nourished group and a malnutrition group, with the malnutrition group comprising 40.6% of participants. The participants in the malnutrition group showed a higher rate of xerostomia, lower bite force, tongue pressure, and lip sealing pressure, and higher Chewing Function Questionnaire and 10-Item Eating Assessment Tool scores. Furthermore, their plant fat, iron, cereals and potatoes, vegetables, fruits, and seafood intake were relatively low. The regression model indicated that exercise frequency, stroke, chewing and swallowing function, intake of vegetables and fruits were risk factors for nutritional status of older adults. CONCLUSION Malnutrition was relatively common among the Chinese older adults aged 75 and above, and it was significantly correlated with exercise frequency, stroke, chewing and swallowing function, and intake of vegetables and fruits. Therefore, nutrition management should be carried out under the understanding and guidance of the oral function and dietary intake of the older adults.
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Affiliation(s)
- Xiaoqing Wu
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Yanqiu Xu
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Yajun Liu
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Aiguo Ma
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Feng Zhong
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Tianlin Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Jing Cai
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Yong Chen
- School of Food Science and Biotechnology, Food Oral Processing Laboratory, Zhejiang Gongshang University, Hangzhou, Zhejiang, China
| | - Yali Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Wenkai Zhou
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Yan Ma
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China.
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Javorszky SM, Palli C, Domkar S, Iglseder B. Combined systematic screening for malnutrition and dysphagia in hospitalized older adults: a scoping review. BMC Geriatr 2024; 24:445. [PMID: 38773449 PMCID: PMC11110417 DOI: 10.1186/s12877-024-05070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Dysphagia affects about 40% of patients admitted to acute geriatric wards, as it is closely associated with diseases that rise in prevalence with advancing age, such as stroke, Parkinson's disease, and dementia. Malnutrition is a highly associated predictive factor of dysphagia as well as one of the most common symptoms caused by dysphagia. Thus, the two conditions may exist simultaneously but also influence each other negatively and quickly cause functional decline especially in older adults. The purpose of this review was to determine whether institutions have established a protocol combining screenings for dysphagia and malnutrition on a global scale. If combined screening protocols have been implemented, the respective derived measures will be reported. METHODS A scoping review was conducted. A systematic database search was carried out in January and February 2024. Studies were included that examined adult hospitalized patients who were systematically screened for dysphagia and malnutrition. The results were managed through the review software tool Covidence. The screening of titles and abstracts was handled independently by two reviewers; conflicts were discussed and resolved by consensus between three authors. This procedure was retained for full-text analysis and extraction. The extraction template was piloted and revised following feedback prior to extraction, which was carried out in February 2024. RESULTS A total of 2014 studies were found, 1075 of which were included for abstract screening, 80 for full text screening. In the end, 27 studies were extracted and reported following the reporting guideline PRISMA with the extension for Scoping Reviews. CONCLUSION Most of the studies considered the prevalence and association of dysphagia and malnutrition with varying outcomes such as nutritional status, pneumonia, oral nutrition, and swallowing function. Only two studies had implemented multi-professional nutrition teams.
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Affiliation(s)
- Susanne M Javorszky
- Institute of Nursing Science and Research, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
- FH Campus Wien, Department of Health Sciences, Favoritenstraße, 226, 1100, Vienna, Austria.
| | - Christoph Palli
- FH Joanneum, Institute of Health and Nursing, Alte Post Straße 149, 8020, Graz, Austria
| | - Susanne Domkar
- FH Campus Wien, Department of Health Sciences, Favoritenstraße, 226, 1100, Vienna, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria
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Fan Y, Shi Y, Wu Y, Yang F, Zhang C, Gu M, Hu P, Duan W, Wang H, Zhou Y. A nomogram-based prediction model for dysphagia in patients with chronic obstructive pulmonary disease: A cross-sectional study. J Clin Nurs 2024. [PMID: 38764243 DOI: 10.1111/jocn.17208] [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] [Received: 11/17/2023] [Revised: 03/21/2024] [Accepted: 04/27/2024] [Indexed: 05/21/2024]
Abstract
AIM AND OBJECTIVES To investigate the prevalence of dysphagia in patients with COPD, identify the risk factors for dysphagia, develop a visual clinical prediction model and quantitatively predict the probability of developing dysphagia. BACKGROUND Patients with COPD are at high risk of dysphagia, which is strongly linked to the acute exacerbation of their condition. The use of effective tools to predict its risk may contribute to the early identification and treatment of dysphagia in patients with COPD. DESIGN A cross-sectional design. METHODS From July 2021 to April 2023, we enrolled 405 patients with COPD for this study. The clinical prediction model was constructed according to the results of a univariate analysis and a logistic regression analysis, evaluated by discrimination, calibration and decision curve analysis and visualized by a nomogram. This study was reported using the TRIPOD checklist. RESULTS In total, 405 patients with COPD experienced dysphagia with a prevalence of 59.01%. A visual prediction model was constructed based on age, whether combined with cerebrovascular disease, chronic pulmonary heart disease, acute exacerbation of COPD, home noninvasive positive pressure ventilation, dyspnoea level and xerostomia level. The model exhibited excellent discrimination at an AUC of .879. Calibration curve analysis indicated a good agreement between experimental and predicted values, and the decision curve analysis showed a high clinical utility. CONCLUSION The model we devised may be used in clinical settings to predict the occurrence of dysphagia in patients with COPD at an early stage. RELEVANCE TO CLINICAL PRACTICE The model can help nursing staff to calculate the risk probability of dysphagia in patients with COPD, formulate personalized preventive care measures for high-risk groups as soon as possible to achieve early prevention or delay of dysphagia and its related complications and improve the prognosis. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Ying Fan
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Yuxin Shi
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, China
| | - Yunyun Wu
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Fang Yang
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Chao Zhang
- Xiangyang Hospital affiliated to of Hubei University of Chinese Medicine, Xiangyang, China
| | - Mengjun Gu
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Pengchao Hu
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | | | - Hongli Wang
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Yumei Zhou
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
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Verma H, Kumar S, Sharma A, Mishra R, Nagamani B. Swallowing dysfunction between the community-living older adults with and without comorbid conditions using Patient-Reported Outcome Measures (PROM). Geriatr Nurs 2024; 56:64-73. [PMID: 38301436 DOI: 10.1016/j.gerinurse.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The present study aimed to investigate older adults' perspective on their swallowing physiology using a PROM tool. The study further explored the swallowing issues among older adults with and without comorbid conditions. METHOD One hundred twenty-two (122) participants participated in the e-survey. A questionnaire was developed to assess the swallowing deficits among older adults, and Eating Assessment Tool-10 (EAT-10) was administered to assess the PROM. RESULTS The results revealed that 40% of older adults with comorbid conditions had EAT-10 scores greater than 3, suggesting swallowing deficits. A significant difference was observed between the two groups with respect to swallowing deficits, as reported on EAT-10. CONCLUSION Based on the results, it can be delineated that swallowing deficits emerge with aging. More of older adults with comorbid conditions reported swallowing deficits in comparison to those without comorbid conditions. Hence, their nutritional and health status gets compromised, leading to poor quality of life.
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Affiliation(s)
- Himanshu Verma
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabh Kumar
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Sharma
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Roshani Mishra
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Banumathy Nagamani
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Multidisciplinary Assessment and Individualized Nutritional Management of Dysphagia in Older Outpatients. Nutrients 2023; 15:nu15051103. [PMID: 36904102 PMCID: PMC10004837 DOI: 10.3390/nu15051103] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION The evidence on the efficacy of nutrition therapy to prevent complications of dysphagia is based on observational studies that used different tools for nutritional and dysphagia assessment, and different scales for the definition of diet textures, rendering their results incomparable and the knowledge on dysphagia management inconclusive. METHODS This retrospective observational study was performed in 267 older outpatients who were assessed for dysphagia and nutritional status by a multidisciplinary team at the Clinical Nutrition Unit of IRCCS INRCA geriatric research hospital (Ancona, Italy) from 2018 to 2021. GUSS test and ASHA-NOMS measurement systems were used for dysphagia assessment, GLIM criteria for the assessment of nutritional status, and the IDDSI framework to describe the texture-modified diets. Descriptive statistics were used to summarize the characteristics of the subjects evaluated. Sociodemographic, functional and clinical parameters were compared between patients with and without BMI improvement overtime by an unpaired Student's t test, Mann-Whitney U test or Chi square test, as appropriate. RESULTS Dysphagia was diagnosed in more than 96.0% of subjects; 22.1% (n = 59) of dysphagic subjects were also malnourished. Dysphagia was treated exclusively by nutrition therapy, prevalently by individualized texture-modified diets (77.4%). For the classification of diet texture, the IDDSI framework was used. The follow-up visit was attended by 63.7% (n = 102) of subjects. Aspiration pneumonia was registered only in one patient (less than 1%), and BMI improved in 13 of 19 malnourished subjects (68.4%). The improvement of nutritional status was primarily reached in subjects whose energy intake was increased and texture of solids modified, in younger subjects, and in those taking less drugs and not reporting any weight loss before the first assessment. CONCLUSIONS The nutritional management of dysphagia must guarantee both an adequate consistency and energy-protein intake. Evaluations and outcomes should be described with universal scales, in order to allow for comparison between studies and contribute to the collection of a critical mass of evidence on the efficacy of texture-modified diets in the management of dysphagia and its complications.
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Das S, Prasad J. Gender Differences in Determinants of the Components of the Frailty Phenotype among Older Adults in India: Findings from LASI Wave-1. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3055. [PMID: 36833748 PMCID: PMC9965095 DOI: 10.3390/ijerph20043055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
This study examines the gender-specific determinants of the components of frailty in a community-dwelling setting in India. Using data from the Longitudinal Ageing Study in India (LASI) Wave-1, this study employed 30,978 (14,885 male and 16,093 female) older adults (aged 60+) to fulfil the study objective. The modified Fried frailty phenotype criteria defines frailty by the five components: exhaustion, weak grip strength, slow walking speed, unintentional weight loss, and low physical activity. The result showed grip strength (79.1%) as the most discriminant component among males, and physical activity (81.6%) as the most discriminant component among females. The results also indicated that grip strength (male: 98.0%, female: 93.5%) and physical activity (male: 94.8%, female: 96.9%) showed a sensitivity of more than 90%, which appears to be a good indicator of frailty. Combining this dual marker increased the accuracy to 99.97% among male and 99.98% among female samples. The findings suggested adding grip strength and physical activity as a proxy measure of frailty, which can increase the precision of screening without a large additional investment of time, training, or cost.
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Affiliation(s)
- Sayani Das
- International Institute of Health Management Research, Delhi 110075, India
| | - Jitender Prasad
- International Institute for Population Sciences, Mumbai 400088, India
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Saez LR, Harrison J, Hill J. How common is dysphagia in older adults living at home and what are the potential risk factors? Br J Community Nurs 2023; 28:16-20. [PMID: 36592087 DOI: 10.12968/bjcn.2023.28.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Dysphagia, or difficulty swallowing food or drink, can lead to poorer health outcomes and serious complications such as aspiration pneumonia. Dysphagia can often go undetected and is known to be common amongst hospitalised older adults and those living in institutional care. Less is known about the prevalence of dysphagia amongst older adults who live at home. This commentary critically appraises a systematic review that determines prevalence rates and risk factors for dysphagia in the community-dwelling elderly.
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Affiliation(s)
- Lucy Roebuck Saez
- Clinical Lead Speech and Language Therapist, Speech and Language Therapy, Lancashire Teaching Hospitals NHS Foundation Trust
| | - Joanna Harrison
- Research Fellow, Synthesis, Economic Evaluation and Decision Science Group (SEEDS), University of Central Lancashire, Preston
| | - James Hill
- Research Fellow, Synthesis, Economic Evaluation and Decision Science Group (SEEDS), University of Central Lancashire, Preston
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Sella‐Weiss O. The Test of Mastication and Swallowing Solids and the Timed Water Swallow Test: Reliability, associations, age and gender effects, and normative data. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:67-81. [PMID: 36036753 PMCID: PMC10087873 DOI: 10.1111/1460-6984.12768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Quantitative measures can increase precision in describing swallowing function, improve interrater and test-retest reliability, and advance clinical decision-making. The Test of Mastication and Swallowing Solids (TOMASS) and the Timed Water Swallow Test (TWST) are functional tests for swallowing that provide quantitative results. AIMS To explore the relationship between TOMASS and TWST; evaluate test-retest and interrater reliability; explore age and gender effects; and gather normative data. METHODS & PROCEDURES Healthy community dwelling participants (n = 298, ≥ 20 years old) were recruited. Of those, 126 were included in the reliability study. Participants completed the TWST and TOMASS. OUTCOMES & RESULTS Associations between TWST and TOMASS measures were found using Pearson's correlation coefficient. Age was positively associated with an increase in the number of bites (n = 292, r = 0.15, p = 0.009), masticatory cycles (n = 291, r = 0.33, p < 0.0001) and duration (n = 292, r = 0.32, p < 0.0001) for the TOMASS. For the TWST, age was positively associated with an increase in duration (n = 296, r = 0.23, p < 0.0001), and negatively associated with volume (n = 296, r = -0.205, p < 0.0001), and swallowing capacity (n = 296, r = -0.24, p < 0.0001). Females required more bites, masticatory cycles, swallows and longer time than males in TOMASS. In TWST, females required more swallows, longer time, and had lower volume per swallow and reduced swallowing capacity than males. Intraclass correlation coefficient (ICC) revealed good test-retest reliability and moderate to excellent interrater reliability. CONCLUSIONS & IMPLICATIONS This study provides support for the validity of the TOMASS and TWST. Reduced efficiency in one of the tests might indicate a need to evaluate performance in the other. Extended chewing time and increased number of masticatory cycles might be compensatory behaviours for reduced oral processing abilities that are motor, sensory and/or mechanical. WHAT THIS PAPER ADDS The TOMASS and TWST are functional tests of swallowing that provide quantitative results. They are easy to incorporate as part of the clinical evaluation of swallowing due to low cost and quick administration. Age and gender effects were found for the TWST and TOMASS, but they were only tested on relative measures rather than absolute measures. Different types of crackers used for TOMASS led to differences in performance and in normative values. What is already known on the subject Associations between performance during TWST and TOMASS were found: time, number of swallows and time per swallow were correlated, meaning that need for more time and more swallows is reflected in both drinking and chewing. The study provides further support for age and gender effects in TWST and TOMASS, on both relative and also on absolute measures, which were not investigated previously. Longer durations in TOMASS and TWST with an increase in age, are likely to be the result of compensatory behaviours to allow safe swallowing. Normative data for a country-specific cracker are presented (Israel). What are the potential or actual clinical implications of this work? Reduced efficiency in one of the tests might indicate a need to evaluate performance in the other. Establishing country specific norms for commonly available crackers is necessary, since crackers size and ingredients, such as fat content and moisture, influence chewing and swallowing. There is a balancing act between safety and efficiency in older adults' swallowing behaviour. Reducing pace in eating and drinking probably supports safer swallowing.
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Affiliation(s)
- Oshrat Sella‐Weiss
- Department of Communication Sciences and DisordersUniversity of HaifaHaifaIsrael
- Department of Communication DisordersOno Academic CollageKiryat OnoIsrael
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Rech RS, de Goulart BNG, Dos Santos KW, Marcolino MAZ, Hilgert JB. Frequency and associated factors for swallowing impairment in community-dwelling older persons: a systematic review and meta-analysis. Aging Clin Exp Res 2022; 34:2945-2961. [PMID: 36207669 DOI: 10.1007/s40520-022-02258-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/13/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Swallowing impairment (SI) is an underdiagnosed dysfunction frequently seen as an expected condition of aging. However, SI can lead to health complications and considerable social impact. METHODS The objective of this systematic review with meta-analysis was to evaluate the frequency and associated factors with SI in community-dwelling older persons. Searches were performed in 13 electronic databases including MEDLINE and EMBASE (from inception to September 18, 2021). Data extraction and methodological quality assessment of included studies were performed by two independent reviewers. Meta-analysis of proportions with 95% confidence interval (CI) and prediction interval (PI) was used to pool estimates. Subgroup analysis by Country and Assessment Method was performed. General meta-analysis was used to pool measures of association between potential risk factors and SI occurrence (odds ratio [OR] or prevalence ratio [PR]). RESULTS The worldwide estimated frequency of SI in community-dwelling older persons was 20.35% (95%CI 16.61-24.68%, 95%PI 4.79-56.45, I2 99%, n = 33,291). This estimation varied across assessment methods and by country. The main factors associated with SI were a dry mouth (OR 8.1, 95%CI 4.9-13.4), oral diadochokinesis (OR 5.3, 95%CI 1.0-27.3), ≥ 80 years old (OR 4.9, 95%CI 2.6-9.2), genetic factor (SNPrs17601696) (OR 4.8, 95%CI 2.7-8.3), and partial dependence (OR 4.3, 95%CI 2.0-9.3). And the main factors associated with SI estimated by PR were dry mouth sensation (PR 4.1, 95%CI 2.6-6.5), oral sensorimotor alteration (PR 2.6, 95%CI 1.4-4.9), osteoporosis (PR 2.51, 95%CI 1.2-5.3), and heart diseases (PR 2.31, 95%CI 1.1-5.0). CONCLUSION One in five older adults worldwide are expected to experience SI and factors associated with this underdiagnosed dysfunction included biological and physiological changes related to aging, physical and psychological conditions, and poor oral health. Early assessment is paramount for the prevention of future clinical complications and should be a high priority in health care practices.
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Affiliation(s)
- Rafaela Soares Rech
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - Karoline Weber Dos Santos
- Graduate Studies Program in Dentistry, Faculty of Dentistry, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Miriam Allein Zago Marcolino
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Juliana Balbinot Hilgert
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil. .,Graduate Studies Program in Dentistry, Faculty of Dentistry, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil. .,Department of Preventive and Social Dentistry, Faculty of Dentistry, Universidade Federal Do Rio Grande Do Sul, Brazil, Rio Grande do Sul, Porto Alegre, Santa Cecília, Ramiro Barcelos, 2492.
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Relating food choice determinants with sociodemographic variables, health status and nutritional risk among community living older adults. Clin Nutr ESPEN 2022; 51:397-403. [DOI: 10.1016/j.clnesp.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022]
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13
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Sakai K, Nakayama E, Yoneoka D, Sakata N, Iijima K, Tanaka T, Hayashi K, Sakuma K, Hoshino E. Association of Oral Function and Dysphagia with Frailty and Sarcopenia in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. Cells 2022; 11:cells11142199. [PMID: 35883642 PMCID: PMC9316124 DOI: 10.3390/cells11142199] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 12/11/2022] Open
Abstract
Studies investigating the associations of oral function and dysphagia with frailty and sarcopenia in community-dwelling older adults are increasing; however, they have not been systematically summarized. We conducted a systematic review to investigate these associations. We searched electronic databases and synthesized relevant data using conventional (frequentist-style) and Bayesian meta-analyses. Twenty-four studies were found to be eligible for our review, including 20 cross-sectional and four prospective cohort studies. Older adults with frailty or sarcopenia had lower tongue pressure, according to the results of conventional meta-analysis (mean difference [95% confidence interval or credible interval]: −6.80 kPa [−10.22 to −3.38] for frailty and −5.40 kPa [−6.62 to −4.17] for sarcopenia) and Bayesian meta-analysis (−6.90 kPa [−9.0 to −4.8] for frailty, −5.35 kPa [−6.78 to −3.89] for sarcopenia). People with frailty had a higher odds ratio (OR) for dysphagia according to the results of conventional meta-analysis (3.99 [2.17 to 7.32]) and Bayesian meta-analysis (1.38 [0.77 to 1.98]). However, the results were inconclusive for people with sarcopenia. A prospective association could not be determined because of the lack of information and the limited number of studies. Decreased oral function and dysphagia can be important characteristics of frailty and sarcopenia in community-dwelling older adults.
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Affiliation(s)
- Kotomi Sakai
- Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, Kyoto 600-8815, Japan;
- Heisei Medical Welfare Group Research Institute, Tokyo 151-0053, Japan;
- Correspondence:
| | - Enri Nakayama
- Department of Dysphagia Rehabilitation, Nihon University School of Dentistry, Tokyo 101-8310, Japan;
| | - Daisuke Yoneoka
- Infectious Disease Surveillance Center at the National Institute of Infectious Diseases, Tokyo 162-8640, Japan;
- Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo 160-8582, Japan
- Tokyo Foundation for Policy Research, Tokyo 106-6234, Japan
| | - Nobuo Sakata
- Heisei Medical Welfare Group Research Institute, Tokyo 151-0053, Japan;
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8654, Japan; (K.I.); (T.T.)
- Institute for Future Initiatives, The University of Tokyo, Tokyo 113-8654, Japan
| | - Tomoki Tanaka
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8654, Japan; (K.I.); (T.T.)
| | - Kuniyoshi Hayashi
- Institute of Religion and Culture, Kyoto Women’s University, Kyoto 605-8501, Japan;
| | - Kunihiro Sakuma
- Institute for Liberal Arts, Environment and Society, Tokyo Institute of Technology, Tokyo 152-8550, Japan;
| | - Eri Hoshino
- Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, Kyoto 600-8815, Japan;
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Malnutrition, dysphagia, frailty and health risk in community dwelling older people. Clin Nutr ESPEN 2022; 50:340. [DOI: 10.1016/j.clnesp.2022.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/29/2022] [Indexed: 11/18/2022]
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Usefulness of the Modified Videofluoroscopic Dysphagia Scale in Determining the Allowance of Oral Feeding in Patients with Dysphagia Due to Deconditioning or Frailty. Healthcare (Basel) 2022; 10:healthcare10040668. [PMID: 35455844 PMCID: PMC9024941 DOI: 10.3390/healthcare10040668] [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: 02/21/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: In patients with dysphagia due to deconditioning or frailty, as with other disorders that cause swallowing disorders, the videofluoroscopic swallowing study (VFSS) is the gold standard for dysphagia evaluation. However, the interpretation of VFSS results is somewhat complicated and requires considerable experience in the field. Therefore, in this study we evaluated the usefulness of the modified videofluoroscopic dysphagia scale (mVDS) in determining whether to allow oral feeding in patients with dysphagia due to deconditioning or frailty. Methods: Data from the VFSS of 50 patients with dysphagia due to deconditioning or frailty were retrospectively collected. We evaluated the association between mVDS and the selected feeding method based on VFSS findings, and between mVDS and the presence of aspiration pneumonia. Results: Multivariate logistic analysis showed that the mVDS total score had a significant association with oral feeding methods based on VFSS findings in patients with dysphagia due to deconditioning or frailty (p < 0.05). In the receiver operating characteristic (ROC) curve analysis, the area under the ROC curve for the selected feeding method was 0.862 (95% confidence interval, 0.747−0.978; p < 0.0001). Conclusions: mVDS seems a valid scale for determining the allowance of oral feeding, and it can be a useful tool in the clinical setting and in studies that aim to interpret VFSS findings in patients with dysphagia due to deconditioning or frailty. However, studies involving a more general population of patients with dysphagia due to deconditioning or frailty are needed.
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Association between Oral Frailty and Physical Frailty among Rural Middle-Old Community-Dwelling People with Cognitive Decline in Taiwan: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052884. [PMID: 35270577 PMCID: PMC8909940 DOI: 10.3390/ijerph19052884] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022]
Abstract
This cross-sectional study was conducted to clarify the association between oral frailty (OF) and physical frailty (PF). In total, 308 Taiwanese middle-old (75−84 years) community-dwelling people with cognitive decline were recruited from random rural community health care centers. Eight items were considered for the evaluation of their OF status. The Study of Osteoporotic Fracture index was used for frailty assessment, which revealed that 22% of the participants had PF. In an adjusted model, PF was significantly associated with the OF subdomains of difficult to eat hard food (p = 0.009), choking (p = 0.008), denture use (p = 0.008), and inability to chew hard food (p = 0.001); and high risk of OF (OR = 3.03; p = 0.002). After eight steps with elimination of the least significant independent variable, age (p= 0.008), self-reported health status of fair (p = 0.000) and poor (p = 0.000), mild cognitive impairment (p < 0.001) and denture use (p = 0.011) were found to be the indispensable predictors for PF. The logistic regression model with 5 indispensable variables had a predictive value of 78.2%. Longitudinal analyses are needed to examine whether OF is a risk factor for PF onset.
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Taguchi K, Wakabayashi H, Fujimoto M, Obayashi S, Yamamoto M, Nishioka S, Momosaki R. Association between Malnutrition Severity and Swallowing Function in Convalescent Rehabilitation Wards: A Multi-Center Cohort Study in Malnourished Patients with Sarcopenic Dysphagia. J Nutr Health Aging 2022; 26:469-476. [PMID: 35587759 DOI: 10.1007/s12603-022-1782-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the characteristics of sarcopenic dysphagia (SD) and the prognosis of swallowing function in convalescent rehabilitation hospital patients; and to investigate the association between malnutrition severity and SD. DESIGN A prospective, multi-center, cohort study. SETTING We extracted registry data from the Japanese Sarcopenic Dysphagia Database, focusing on patients admitted to convalescent rehabilitation hospitals. PARTICIPANTS A total of 207 participants were recruited and stratified according to the presence or absence of SD. Next, the participants were divided into groups based on nutrition status using the Global Leadership Initiative on Malnutrition criteria: normal nutrition, moderate malnutrition, and severe malnutrition. We also compared the outcomes between patients with SD (SD group) and those without SD (no-SD group) according to malnutrition status. MEASUREMENTS The Food Intake LEVEL Scale (FILS) score was the outcome measure. Higher scores on the FILS indicate better swallowing function. We compared the patient characteristics between the SD and non-SD groups among all patients and then according to the severity of malnutrition. RESULTS A total of 207 patients were recruited. 11 were diagnosed with normal nutrition, 72 with moderate malnutrition, and 124 with severe malnutrition. There were 128 participants with SD and 79 participants without SD; the prevalence of SD was 61.8%. Hip fracture was the most common disease among the SD patients (34.4%). The median time to the end of follow-up was 73.5 days for the SD group and 84.0 days for the no-SD group. There was no significant difference in the FILS score between the SD and no-SD groups, but the increase in the FILS score was significantly lower in the SD group than the no-SD group among patients with severe malnutrition after adjusting for confounding factors (age, sex, FILS at admission, BMI, cognitive functional independence measure, and care level before onset) (β = -0.206, p = 0.011, 95% confidence interval = -0.723, -0.098). CONCLUSION Orthopedic diseases are the most common type of disease among SD patients in convalescent rehabilitation hospitals. Swallowing dysfunction was particularly severe in malnourished patients with SD. This result suggests the importance of the definition of SD for malnourished patients. We should practice nutritional management as soon as possible in severely malnourished patients diagnosed with SD.
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Affiliation(s)
- K Taguchi
- Hidetaka Wakabayashi, MD, PhD, Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan. Code; 162-0054, Tel: +81-3-3353-8111, Fax: +81-3-5269-7639, E-mail:
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