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Published in: Dysphagia 6/2022

Open Access 25-02-2022 | Dysphagia | Original Article

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

Authors: Joe Hollinghurst, David G. Smithard

Published in: Dysphagia | Issue 6/2022

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Abstract

Dysphagia is increasingly being recognised as a geriatric syndrome (giant). There is limited research on the prevalence of dysphagia using electronic health records. To investigate associations between dysphagia, as recorded in electronic health records and age, frailty using the electronic frailty index, gender and deprivation (Welsh index of multiple deprivation). A Cross-sectional longitudinal cohort study in over 400,000 older adults was undertaken (65 +) in Wales (United Kingdom) per year from 2008 to 2018. We used the secure anonymised information linkage databank to identify dysphagia diagnoses in primary and secondary care. We used chi-squared tests and multivariate logistic regression to investigate associations between dysphagia diagnosis and age, frailty (using the electronic Frailty index), gender and deprivation. Data indicated < 1% of individuals were recorded as having a dysphagia diagnosis per year. We found dysphagia to be statistically significantly associated with older age, more severe frailty and individuals from more deprived areas. Multivariate analyses indicated increased odds ratios [OR (95% confidence intervals)] for a dysphagia diagnosis with increased age [reference 65–74: aged 75–84 OR 1.09 (1.07, 1.12), 85 + OR 1.23 (1.20, 1.27)], frailty (reference fit: mild frailty 2.45 (2.38, 2.53), moderate frailty 4.64 (4.49, 4.79) and severe frailty 7.87 (7.55, 8.21)] and individuals from most deprived areas [reference 5. Least deprived, 1. Most deprived: 1.10 (1.06, 1.14)]. The study has identified that prevalence of diagnosed dysphagia is lower than previously reported. This study has confirmed the association of dysphagia with increasing age and frailty. A previously unreported association with deprivation has been identified. Deprivation is a multifactorial problem that is known to affect health outcomes, and the association with dysphagia should not be a surprise. Research in to this relationship is indicated.
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Literature
3.
go back to reference World Health Organization European Health Information Gateway. European Mortality Database. World Health Organization World Health Organization European Health Information Gateway. European Mortality Database. World Health Organization
7.
go back to reference Dodds WJ, Stewart ET, Logemann JA. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. Am J Roentgenol. 1990;154(5):953–63.CrossRef Dodds WJ, Stewart ET, Logemann JA. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. Am J Roentgenol. 1990;154(5):953–63.CrossRef
8.
go back to reference Martin BJW, et al. Coordination between respiration and swallowing: respiratory phase relationships and temporal integration. J Appl Physiol. 1994;76(2):714–23.PubMedCrossRef Martin BJW, et al. Coordination between respiration and swallowing: respiratory phase relationships and temporal integration. J Appl Physiol. 1994;76(2):714–23.PubMedCrossRef
9.
go back to reference Roden DF, Altman KW. Causes of dysphagia among different age groups: a systematic review of the literature. Otolaryngol Clin N Am. 2013;46(6):965–87.CrossRef Roden DF, Altman KW. Causes of dysphagia among different age groups: a systematic review of the literature. Otolaryngol Clin N Am. 2013;46(6):965–87.CrossRef
10.
go back to reference Daniels SK, et al. Mechanism of sequential swallowing during straw drinking in healthy young and older adults. J Speech Lang Hear Res. 2004;47(1):33–45.PubMedCrossRef Daniels SK, et al. Mechanism of sequential swallowing during straw drinking in healthy young and older adults. J Speech Lang Hear Res. 2004;47(1):33–45.PubMedCrossRef
12.
go back to reference Boss GR, Seegmiller JE. Age-related physiological changes and their clinical significance. West J Med. 1981;135:434–40.PubMedPubMedCentral Boss GR, Seegmiller JE. Age-related physiological changes and their clinical significance. West J Med. 1981;135:434–40.PubMedPubMedCentral
15.
go back to reference Madhaven A, Lagorio LA, Crary MA, Dahl WJC, Carnaby GD. Prevalence and risk factors for dysphagia in the community dwelling elderly: a systematic review. J Nutr Aging Health. 2016;20:806–15.CrossRef Madhaven A, Lagorio LA, Crary MA, Dahl WJC, Carnaby GD. Prevalence and risk factors for dysphagia in the community dwelling elderly: a systematic review. J Nutr Aging Health. 2016;20:806–15.CrossRef
20.
go back to reference Adkins C, et al. Prevalence and characteristics of dysphagia based on a population-based survey. Clin Gastroenterol Hepatol. 2020;18(9):1970–9.PubMedCrossRef Adkins C, et al. Prevalence and characteristics of dysphagia based on a population-based survey. Clin Gastroenterol Hepatol. 2020;18(9):1970–9.PubMedCrossRef
21.
go back to reference Kertscher B, et al. Prevalence of oropharyngeal dysphagia in the Netherlands: a telephone survey. Dysphagia. 2015;30(2):114–20.PubMedCrossRef Kertscher B, et al. Prevalence of oropharyngeal dysphagia in the Netherlands: a telephone survey. Dysphagia. 2015;30(2):114–20.PubMedCrossRef
22.
go back to reference Nimmons D, et al. A longitudinal study of symptoms of oropharyngeal dysphagia in an elderly community-dwelling population. Dysphagia. 2016;31(4):560–6.PubMedPubMedCentralCrossRef Nimmons D, et al. A longitudinal study of symptoms of oropharyngeal dysphagia in an elderly community-dwelling population. Dysphagia. 2016;31(4):560–6.PubMedPubMedCentralCrossRef
23.
go back to reference Cho SY, et al. Prevalence and risk factors for dysphagia: a USA community study. Neurogastroenterol Motil. 2015;27(2):212–9.PubMedCrossRef Cho SY, et al. Prevalence and risk factors for dysphagia: a USA community study. Neurogastroenterol Motil. 2015;27(2):212–9.PubMedCrossRef
24.
go back to reference Wilkins T, et al. The prevalence of dysphagia in primary care patients: a HamesNet research network study. J Am Board Fam Med. 2007;20(2):144–50.PubMedCrossRef Wilkins T, et al. The prevalence of dysphagia in primary care patients: a HamesNet research network study. J Am Board Fam Med. 2007;20(2):144–50.PubMedCrossRef
25.
go back to reference Eslick GD, Talley NJ. Dysphagia: epidemiology, risk factors and impact on quality of life: a population-based study. Aliment Pharmacol Ther. 2008;27(10):971–9.PubMedCrossRef Eslick GD, Talley NJ. Dysphagia: epidemiology, risk factors and impact on quality of life: a population-based study. Aliment Pharmacol Ther. 2008;27(10):971–9.PubMedCrossRef
26.
go back to reference Holland G, Jayaseker V, Pendleton N, Horan M, Jones M, Hamdy S. Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus. 2011;24:476–80.PubMedCrossRef Holland G, Jayaseker V, Pendleton N, Horan M, Jones M, Hamdy S. Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus. 2011;24:476–80.PubMedCrossRef
28.
go back to reference Khader FA, Gangadhara SKS. Swallowing difficulties among healthy elderly: prevalence and aetiology. Int J Otorhinolaryngol Head Neck Surg. 2018;4:494.CrossRef Khader FA, Gangadhara SKS. Swallowing difficulties among healthy elderly: prevalence and aetiology. Int J Otorhinolaryngol Head Neck Surg. 2018;4:494.CrossRef
33.
go back to reference Bhattacharyya N. The prevalence of dysphagia among adults in the United States. Otolaryngol Head Neck Surg. 2014;151(5):765–9.PubMedCrossRef Bhattacharyya N. The prevalence of dysphagia among adults in the United States. Otolaryngol Head Neck Surg. 2014;151(5):765–9.PubMedCrossRef
34.
go back to reference Andersen O, Zweidorff OK, Hjelde T, Rødland EA. Problems when swallowing tablets. A questionnaire study for general practice. Tidsskrift Norske Laegeforening. 1995;115(8):947–9. Andersen O, Zweidorff OK, Hjelde T, Rødland EA. Problems when swallowing tablets. A questionnaire study for general practice. Tidsskrift Norske Laegeforening. 1995;115(8):947–9.
39.
go back to reference Hoogendijke EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;294:1365–75.CrossRef Hoogendijke EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;294:1365–75.CrossRef
40.
go back to reference Fried LP, Tangen CM, Watson J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Frailty in older adults: evidence of phenotype. J Gerontol Med Sci. 2001;56A:M146–56.CrossRef Fried LP, Tangen CM, Watson J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Frailty in older adults: evidence of phenotype. J Gerontol Med Sci. 2001;56A:M146–56.CrossRef
41.
go back to reference Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. Sci World J. 2001;1:323–36.CrossRef Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. Sci World J. 2001;1:323–36.CrossRef
42.
go back to reference Morely JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, Cesari M, Chumlea WC, Doehner W, Evans J, Fried LP, Guralnik JM, Katz PR, Malmstrom TK, McCarter RJ, Robledo LMG, Rockwood K, von Haehling S, Vandewoude MF, Walston J. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;4:392–7. https://doi.org/10.1016/j.jamda.2013.03.022.CrossRef Morely JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, Cesari M, Chumlea WC, Doehner W, Evans J, Fried LP, Guralnik JM, Katz PR, Malmstrom TK, McCarter RJ, Robledo LMG, Rockwood K, von Haehling S, Vandewoude MF, Walston J. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;4:392–7. https://​doi.​org/​10.​1016/​j.​jamda.​2013.​03.​022.CrossRef
43.
go back to reference Dent E, Grande ED, Price K, Taylor AW. Frailty and usage of health care systems: results from the South Australian monitoring and surveillance system (SAMSS). Maturitas. 2017;104:36–43.PubMedCrossRef Dent E, Grande ED, Price K, Taylor AW. Frailty and usage of health care systems: results from the South Australian monitoring and surveillance system (SAMSS). Maturitas. 2017;104:36–43.PubMedCrossRef
44.
go back to reference Clegg A, Young J, Illife S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381:2–8.CrossRef Clegg A, Young J, Illife S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381:2–8.CrossRef
45.
go back to reference Carrion S, Roca M, Costa A, Arreola V, Ortega O, Palomera E, Serra-Pratt M, Cabre M, Clave P. Nutritional status of older people with oropharyngeal dysphagia in a chronic vs acute clinical situation. Clin Nutr. 2017;36:1110–6.PubMedCrossRef Carrion S, Roca M, Costa A, Arreola V, Ortega O, Palomera E, Serra-Pratt M, Cabre M, Clave P. Nutritional status of older people with oropharyngeal dysphagia in a chronic vs acute clinical situation. Clin Nutr. 2017;36:1110–6.PubMedCrossRef
46.
go back to reference Wang CH, Charlton B, Kohlwes J. The horrible taste of nectar and honeyinappropriate use of thickened liquids in dementia: a teachable moment. JAMA Intern Med. 2016;176:735–6.PubMedCrossRef Wang CH, Charlton B, Kohlwes J. The horrible taste of nectar and honeyinappropriate use of thickened liquids in dementia: a teachable moment. JAMA Intern Med. 2016;176:735–6.PubMedCrossRef
47.
go back to reference Dibello V, Zupo R, Sardone R, Lozupone M, Castellana F, Dibello A, Daniele A, De Pergola G, Bortone I, Lampignano L, Giannelli G, Panza F. Oral frailty and its determinates in older age: a systematic review. Lancet Health Longev. 2021;2:e507–20.CrossRef Dibello V, Zupo R, Sardone R, Lozupone M, Castellana F, Dibello A, Daniele A, De Pergola G, Bortone I, Lampignano L, Giannelli G, Panza F. Oral frailty and its determinates in older age: a systematic review. Lancet Health Longev. 2021;2:e507–20.CrossRef
49.
go back to reference Cha S, Kim W-S, Kim KW, Jang HK, Lim S, Paik N-J. Sarcopenia is an independent risk factor for dysphagia in community dwelling older adults. Dysphagia. 2019;34:692–7.PubMedCrossRef Cha S, Kim W-S, Kim KW, Jang HK, Lim S, Paik N-J. Sarcopenia is an independent risk factor for dysphagia in community dwelling older adults. Dysphagia. 2019;34:692–7.PubMedCrossRef
50.
go back to reference Hansen T, Nielsen RL, Houlind MB, Tavenier J, Rassmussen LJH, Jørgensen LM, Treldal C, Beck AM, Pedersen MM, Andersen O, Petersen J, Andersen AL. 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. Geriatrics. 2021;6:46. https://doi.org/10.3390/geriatrics6020046.CrossRefPubMedPubMedCentral Hansen T, Nielsen RL, Houlind MB, Tavenier J, Rassmussen LJH, Jørgensen LM, Treldal C, Beck AM, Pedersen MM, Andersen O, Petersen J, Andersen AL. 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. Geriatrics. 2021;6:46. https://​doi.​org/​10.​3390/​geriatrics602004​6.CrossRefPubMedPubMedCentral
51.
go back to reference Baijens LWJ, Clave P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, et al. European society for swallowing disorders—European Union Geriatric Medicine Societywhite paper: oropharyngeal dysphagia as a geriatric syndrome. CIA. 2016;11:1403–28.CrossRef Baijens LWJ, Clave P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, et al. European society for swallowing disorders—European Union Geriatric Medicine Societywhite paper: oropharyngeal dysphagia as a geriatric syndrome. CIA. 2016;11:1403–28.CrossRef
52.
go back to reference Smithard DG. Swallowing and eating difficulties in institutionalised patients. Clin Rehabil. 1996;2:153–4.CrossRef Smithard DG. Swallowing and eating difficulties in institutionalised patients. Clin Rehabil. 1996;2:153–4.CrossRef
53.
go back to reference Takizawa C, Gemmell E, Kenworthy J, Speyer R. A systematic review of the prevalence of oropharyngeal dysphagia in stroke, Parkinson’s disease, Alzheimer’s disease, head injury and pneumonia. Dysphagia. 2016;31:434–41.PubMedCrossRef Takizawa C, Gemmell E, Kenworthy J, Speyer R. A systematic review of the prevalence of oropharyngeal dysphagia in stroke, Parkinson’s disease, Alzheimer’s disease, head injury and pneumonia. Dysphagia. 2016;31:434–41.PubMedCrossRef
54.
55.
go back to reference Smithard D, Westmark S, Melgaard D. Evaluation of the prevalence of screening for dysphagia among older people admitted to medical services—an international survey. Geriatrics. 2019;3:1–8.CrossRef Smithard D, Westmark S, Melgaard D. Evaluation of the prevalence of screening for dysphagia among older people admitted to medical services—an international survey. Geriatrics. 2019;3:1–8.CrossRef
56.
go back to reference Gallegos C, Brito-de la Fueente E, Clave P, Costa A, Assegehegen G. Nutritional aspects of dysphagia management. Adv Food Nutr Res. 2017;81:271–318.PubMedCrossRef Gallegos C, Brito-de la Fueente E, Clave P, Costa A, Assegehegen G. Nutritional aspects of dysphagia management. Adv Food Nutr Res. 2017;81:271–318.PubMedCrossRef
57.
go back to reference Wirth R, Pourhassan M, Streicher M, Hiesmayr M, Schindler K, Sieber C, Volkert D. The impact of dysphagia on mortality of nursing home residents: results from the nutrition day project. JAMDA. 2018;19:775–8.PubMed Wirth R, Pourhassan M, Streicher M, Hiesmayr M, Schindler K, Sieber C, Volkert D. The impact of dysphagia on mortality of nursing home residents: results from the nutrition day project. JAMDA. 2018;19:775–8.PubMed
58.
go back to reference Casey JA, Schwartz BS, Stewart WF, Adler NE. Using electronic health records for population health research: a review of methods and applications. Ann Rev Public Health. 2016;37:61–81.CrossRef Casey JA, Schwartz BS, Stewart WF, Adler NE. Using electronic health records for population health research: a review of methods and applications. Ann Rev Public Health. 2016;37:61–81.CrossRef
59.
go back to reference Todd OM, Burton JK, Dodds RM, Hollinghurst J, Lyons RA, Quinn TJ, Schneider A, Walesby KE, Wilkinson C, Conroy S, Gale C, Hall M, Walters K, Clegg AP. New Horizons in the use of routine data for ageing research. Age Ageing. 2020;49:716–22.PubMedPubMedCentralCrossRef Todd OM, Burton JK, Dodds RM, Hollinghurst J, Lyons RA, Quinn TJ, Schneider A, Walesby KE, Wilkinson C, Conroy S, Gale C, Hall M, Walters K, Clegg AP. New Horizons in the use of routine data for ageing research. Age Ageing. 2020;49:716–22.PubMedPubMedCentralCrossRef
62.
go back to reference Jones KH, Ford DV, Jones C, Dsilva R, Thompson S, Brooks CJ, Heaven ML, Thayer DS, McNerney CL, Lyons RA. A case study of the secire anonymous information linkage (SAIL) gateway: a privacy-protecting remote access system for health–related research and evaluation. J Biomed Inform. 2014;50:196–204.PubMedPubMedCentralCrossRef Jones KH, Ford DV, Jones C, Dsilva R, Thompson S, Brooks CJ, Heaven ML, Thayer DS, McNerney CL, Lyons RA. A case study of the secire anonymous information linkage (SAIL) gateway: a privacy-protecting remote access system for health–related research and evaluation. J Biomed Inform. 2014;50:196–204.PubMedPubMedCentralCrossRef
63.
go back to reference Rodgers SE, Lyons RA, Dsilva R, Jones KH, Brooks CJ, Ford DV, John G, Verplancke JP. Residential anonymous linking fields (RALFs): a novel information infrastructure to study the interaction between the environment and individuals health. J Pub Health. 2009;31:582–8. https://doi.org/10.1093/pubmed/fdp041.CrossRef Rodgers SE, Lyons RA, Dsilva R, Jones KH, Brooks CJ, Ford DV, John G, Verplancke JP. Residential anonymous linking fields (RALFs): a novel information infrastructure to study the interaction between the environment and individuals health. J Pub Health. 2009;31:582–8. https://​doi.​org/​10.​1093/​pubmed/​fdp041.CrossRef
65.
go back to reference Clegg A, Bates C, Young J, Ryan R, Nichols L, Teale EA, Mohammed MA, Parry J, Marshall T. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing. 2016;45:353–60.PubMedPubMedCentralCrossRef Clegg A, Bates C, Young J, Ryan R, Nichols L, Teale EA, Mohammed MA, Parry J, Marshall T. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing. 2016;45:353–60.PubMedPubMedCentralCrossRef
67.
go back to reference R Core Team. R: a language and environment for statistical computing. Vienna: R Core Team; 2020. R Core Team. R: a language and environment for statistical computing. Vienna: R Core Team; 2020.
68.
go back to reference Zhang Z, Parker RMA, Charlton CMJ, Leckie G, Browne WJ. R2MLwiN}: a package to run {MLwiN from within {R}. J Stat Softw. 2016;72:1–43.CrossRef Zhang Z, Parker RMA, Charlton CMJ, Leckie G, Browne WJ. R2MLwiN}: a package to run {MLwiN from within {R}. J Stat Softw. 2016;72:1–43.CrossRef
69.
go back to reference Clave P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015;12:259–70.PubMedCrossRef Clave P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015;12:259–70.PubMedCrossRef
75.
go back to reference Chen PH, Golub JS, Hapner ER, Johns IIIM. Prevalence of perceived dysphagia and quality of life impairment in a geriatric population. Dysphagia. 2009;24:1–6.PubMedCrossRef Chen PH, Golub JS, Hapner ER, Johns IIIM. Prevalence of perceived dysphagia and quality of life impairment in a geriatric population. Dysphagia. 2009;24:1–6.PubMedCrossRef
76.
go back to reference Ganassali S. The influence of the design of web survey questionnaires on the quality of responses. Surv Res Method. 2008;2:21–32. Ganassali S. The influence of the design of web survey questionnaires on the quality of responses. Surv Res Method. 2008;2:21–32.
78.
go back to reference Olsen K, Peytchev A. Effect of interviewer experience on interview pace and interviewer attitudes. Public Opin Q. 2007;71:273–86.CrossRef Olsen K, Peytchev A. Effect of interviewer experience on interview pace and interviewer attitudes. Public Opin Q. 2007;71:273–86.CrossRef
79.
go back to reference Holbrook AL, Green MC, Krosnick JA. Telephone versus face-to-face interviewinig of national probability samples with long questionnaires. Public Opin Q. 2003;67:79–125.CrossRef Holbrook AL, Green MC, Krosnick JA. Telephone versus face-to-face interviewinig of national probability samples with long questionnaires. Public Opin Q. 2003;67:79–125.CrossRef
Metadata
Title
Identifying Dysphagia and Demographic Associations in Older Adults Using Electronic Health Records: A National Longitudinal Observational Study in Wales (United Kingdom) 2008–2018
Authors
Joe Hollinghurst
David G. Smithard
Publication date
25-02-2022
Publisher
Springer US
Published in
Dysphagia / Issue 6/2022
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI
https://doi.org/10.1007/s00455-022-10425-5

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