Dysphagia Prevalence, Time Course, and Association with Probable Sarcopenia, Inactivity, Malnutrition, and Disease Status in Older Patients Admitted to an Emergency Department: A Secondary Analysis of Cohort Study Data

Malnutrition and cachexia may affect death but not functional improvement in patients with sarcopenic dysphagia

PURPOSE

To investigate whether two factors, malnutrition and cachexia, affect swallowing function, activities of daily living (ADL), and death in sarcopenic dysphagia.

METHODS

Of 467 patients enrolled in the Japanese Sarcopenic Dysphagia Database, 271 met the study eligibility criteria in a retrospective cohort study. Patients were divided into four groups based on whether they had cachexia according to the Asian Working Group for Cachexia (AWGC) criteria and malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Multivariate analyses were performed to investigate the differences in changes in the Food Intake LEVEL Scale (FILS) and Barthel Index (BI) and death after follow-up between the malnutrition and cachexia group and the other groups.

RESULTS

The mean age was 83.7 ± 8.3 years, 119 (44%) were men and 152 (56%) were women. The median FILS at baseline was 7 and the median BI was 25. A total of 120 (44%) had malnutrition only, 54 (20%) had neither cachexia nor malnutrition, 12 (4%) had cachexia only, and 85 (31%) had both cachexia and malnutrition. Multivariate analyses showed no significant difference between the change in BI (P = 0.688) and the change in FILS (P = 0.928) between the malnutrition and cachexia group and the other groups; however, death increased significantly (P = 0.010).

CONCLUSION

Some patients diagnosed with cachexia were not malnourished, although many patients with cachexia were malnourished. While patients with both cachexia and malnutrition did not show significant improvement in ADL and swallowing function compared with patients without both conditions, the number of deaths increased significantly.

Consequences of Anorexia of Aging in Hospital Settings: An Updated Review

The anorexia of aging is a widespread problem amongst older people, particularly in the hospital setting with up to 60% affected. Despite its high prevalence anorexia often goes undiagnosed in hospital, due to a lack of standardized assessment and evidence-based management, but also lack of knowledge regarding consequences. This review summarizes current evidence for anorexia of aging specific to the hospital setting, giving an overview of correlates of appetite in hospital and consequences of anorexia. It highlights an overall scarcity of research on this important clinical problem for hospitalized cohorts. The few studies point to the importance of anorexia of aging in major health burdens for older people, namely malnutrition, sarcopenia and reduced physical performance, as well as higher mortality. Further research is needed to assess temporal sequence in pathways of causality and to develop effective interventions to combat anorexia.

Dysphonia Outperforms Voice Change as a Clinical Predictor of Dysphagia

PURPOSE

Changes in voice quality after consuming food or drink have been used as a clinical indicator of dysphagia during the clinical swallowing evaluation (CSE); however, there is conflicting evidence of its efficacy. This study investigated if dysphonia and/or voice change after swallowing are valid predictors of penetration, aspiration, or pharyngeal residue. Our approach aimed to improve current methodologies by collecting voice samples in the fluoroscopy suite, implementing rater training to improve interrater reliability and utilizing continuous measurement scales, allowing for regression analyses.

METHOD

In this prospective study, 30 adults (aged 49-97 years) referred for a videofluoroscopic swallowing study (VFSS) were audio-recorded completing a sustained /i/ prior to VFSS and again after swallowing each bolus during the VFSS. Swallowing function was measured using the reorganized Penetration-Aspiration Scale and the Normalized Residue Ratio Scale. Following listener training, 84 voice samples were perceptually rated using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Ordinal and logistic regression were used to determine whether voice quality and voice quality change after swallowing were predictors of airway invasion and pharyngeal clearance.

RESULTS

Results indicated that the presence of dysphonia at baseline during a sustained /i/ task as measured by the CAPE-V predicted airway invasion but not pharyngeal residue. Voice change after swallowing associated with vowel /i/ production as measured by the CAPE-V did not predict either dysphagia measure.

CONCLUSION

These results indicate that voice change during a sustained /i/ after swallowing appears unrelated to airway invasion or pharyngeal residue; however, in the absence of known laryngeal pathology, dysphonia prior to a CSE should alert speech-language pathologists of a possible comorbid dysphagia.

Application of HPP for the Development of a Dessert Elaborated with Casein and Cocoa for a Dysphagia Diet

In this study, the application of high-pressure processing (HPP) for optimizing the texture of a cocoa dessert rich in casein and developed for people with dysphagia was investigated. Different treatments (250 MPa/15 min; 600 MPa/5 min) and protein concentrations (10-15%) were combined and evaluated for choosing the optimum combination leading to an adequate texture. The selected formulation was a dessert containing 4% cocoa and 10% casein and subjected to 600 MPa for 5 min. It showed a high nutritional value (11.5% protein) and high antioxidant capacity, which was slightly affected by the HPP processing. The rheological and textural properties showed that HPP had a clear effect on the dessert structure. The loss tangent decreased from 2.692 to 0.165, indicating the transition from a liquid to a gel-like structure, which is in a suitable range for dysphagia foods. During storage (14 and 28 days at 4 °C), progressive significant changes in the structure of the dessert were observed. A decrease in all rheological and textural parameters occurred, except for the loss of tangent, which increased its value. In any case, at 28 days of storage, samples maintained the weak gel-like structure (0.686 loss tangent) that is acceptable for dysphagia management.

Prevalencia de la disfagia orofaríngea en pacientes adultos. Revisión sistemática y metanálisis

Introducción y objetivo: La disfagia orofaríngea es un síntoma clínico de alta prevalencia, caracterizado por la dificultad en la deglución, que presenta diversos factores etiológicos. Su tratamiento se realiza de manera multidisciplinar, incluyendo diversos profesionales de ciencias de la salud. El objetivo es conocer la prevalencia de la disfagia orofaríngea en pacientes adultos.  Método: Se realizó una búsqueda bibliográfica de estudios relativos a la prevalencia de disfagia orofaríngea en pacientes adultos. El cribado y la selección de estudios se realizó a través del método Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Se realizó un análisis estadístico de las variables consideradas relevantes para el estudio.  Resultados: Un total de 29 estudios fueron seleccionados. La prevalencia total de la disfagia se presentó con una probabilidad de p = 0.39, en un intervalo de confianza de (IC 95% 0.303 – 0.476).  Discusión: Existe asociación o correlación entre la disfagia y diversos estados clínicos o patologías del paciente. Se ha encontrado una relación directa entre la prevalencia de la disfagia y una edad avanzada.  Conclusiones: La disfagia orofaríngea se presentó con una alta prevalencia según los estudios seleccionados. Las enfermedades neurológicas, la malnutrición y la neumonía fueron los principales estados comórbidos en los pacientes con disfagia. La función de enfermería permanece prácticamente ausente en los estudios seleccionados.  

Oropharyngeal dysphagia in elderly persons: Etiology, pathophysiology and symptomatology

Swallowing disorders can occur at any age, although they occur more often in old age when the physiology of swallowing changes due to aging. Oropharyngeal dysphagia is a very common clinical condition affecting 13% of the total population over 65 years of age and 51% of institutionalized older people. Given that oropharyngeal dysphagia can lead to increased morbidity and mortality in the elderly, it is necessary to prevent the occurrence of dysphagia in this population group as much as possible. In relation to this, the paper aims to provide insight into contemporary research into the etiology, pathophysiology, and symptomatology of oropharyngeal dysphagia in the elderly. In this review study, the electronic databases of Google Scholar Advanced Search and the Consortium of Serbian Libraries for Unified Procurement - KoBSON were searched. The following keywords and phrases were used in the search: swallowing, dysphagia, oropharyngeal dysphagia, aging, age and dysphagia, etiology of oropharyngeal dysphagia, the clinical picture of oropharyngeal dysphagia, pathophysiology of oropharyngeal dysphagia. This systematic review and meta-analysis of papers showed significant progress in the effective diagnostic approach of oropharyngeal dysphagia during the last years but also a significant lack of knowledge about adequate modifications of drugs applied during the treatment of patients with dysphagia. A good understanding of the etiology, pathophysiology, and symptomatology of oropharyngeal dysphagia would eliminate the harmful effects of pharmacological substances on the function of swallowing, given that the elderly, on the advice of a doctor, use them daily.

Identifying Dysphagia and Demographic Associations in Older Adults Using Electronic Health Records: A National Longitudinal Observational Study in Wales (United Kingdom) 2008-2018

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.