Top

The journal of nutrition, health & aging

Published in:

01-01-2018

Dysphagia in Hospitalized Older Patients: Associated Factors and Nutritional Interventions

Authors: Doris Eglseer, R. J. G. Halfens, J. M. G. A. Schols, C. Lohrmann

Published in: The journal of nutrition, health & aging | Issue 1/2018

Abstract

Objectives

To (1) assess the association between dysphagia and malnutrition as well as other related factors and (2) investigate the nutritional interventions that are initiated in dysphagic older patients.

Design

Cross-sectional, multi-center point prevalence measurement.

Setting

53 Austrian hospitals.

Participants

3174 hospitalized patients, 65 years or older.

Measurements

A standardized and tested questionnaire was used for the data collection, which was based on both inspections of the patients and information documented in the patient chart. Medical diagnoses were assessed by referring to the International Classification of Diseases. Dysphagia was measured by asking the patient a dichotomous question. Several other data points were collected including: gender, age, number of diseases, malnutrition, care dependency scale (CDS) score and dependency during activities of daily living (ADL). To investigate the associations between dysphagia and malnutrition and other associated factors, cross tabulation, chi-squared test, t-test and Mann-Whitney U test were used.

Results

The prevalence of dysphagia among these patients was 7.6%. Dysphagia and malnutrition were significantly associated (< 0.001). Patients with dysphagia had statistically significant lower BMI values (p = 0.01), more medical diagnoses (p = 0.003) and were more care dependent (p < 0.001) than patients who did not suffer from dysphagia. The frequency of underlying respiratory diseases, dementia, nervous system disorders and cerebrovascular accidents also differed significantly between dysphagic and non-dysphagic patients. The following nutritional interventions were most frequently initiated in patients with dysphagia: provision of texturemodified food/fluid (32.2%), referral to a dietitian (31.4%), provision of an energy- and/or protein-enriched diet (27.3%), monitoring of nutritional intake (21.5%), enteral nutrition (19.4%) and provision of energy-enriched snacks (15.7%). 24% of patients received no nutritional interventions.

Conclusion

This study demonstrates that a very strong association exists between dysphagia and malnutrition as well as high levels of care dependency and dependency in activities of daily living. Nearly one-quarter of the patients did not receive any nutritional intervention. Therefore, a potential for the improvement of nutritional therapy in older dysphagic hospitalized patients still exists.

World Health Organisation (WHO), 2016. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) http://apps.who.int/ classifications/icd10/browse/2016/en#/R13. Accessed 13 January 2016

Takizawa C, Gemmell E, Kenworthy J et al. A Systematic Review of the Prevalence of Oropharyngeal Dysphagia in Stroke, Parkinson’s Disease, Alzheimer’s Disease, Head Injury, and Pneumonia. Dysphagia 2016;31:434–441CrossRefPubMed

Hiramatsu T, Kataoka H, Osaki M et al. Effect of aging on oral and swallowing function after meal consumption. Clin Interv Aging 2015;10:229–235PubMedPubMedCentral

Wirth R, Dziewas R, Beck AM et al. Oropharyngeal dysphagia in older persons-from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clinical Interv Aging 2016;11:189–208CrossRef

Clave P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol 2015;12:259–270CrossRefPubMed

Chen PH, Golub JS, Hapner ER et al. Prevalence of perceived dysphagia and qualityof-life impairment in a geriatric population. Dysphagia 2009;24:1–6CrossRefPubMed

Elia M, Lungqvist O, Stratton R et al. Principles of Clinical Nutrition. 3rd edn. Wiley-Blackwell, New York, 2015.CrossRef

Allard JP, Keller H, Jeejeebhoy KN et al. Malnutrition at Hospital Admission-Contributors and Effect on Length of Stay: A Prospective Cohort Study From the Canadian Malnutrition Task Force. JPEN J Parenter Enteral Nutr 2015;40:487–497CrossRefPubMed

Roller RE, Eglseer D, Eisenberger A et al. The Graz Malnutrition Screening (GMS): a new hospital screening tool for malnutrition. Br J Nutr 2016;115:650–657CrossRefPubMed

10.

Norman K, Pichard C, Lochs H et al. Prognostic impact of disease-related malnutrition. Clin Nutr 2008;27:5–15CrossRefPubMed

11.

Thomas MN, Kufeldt J, Kisser U et al. Effects of malnutrition on complication rates, length of hospital stay, and revenue in elective surgical patients in the G-DRGsystem. Nutrition 2016;32:249–254CrossRefPubMed

12.

Elia M, Normand C, Norman K, Laviano A. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr 2016;35:370–380CrossRefPubMed

13.

Felder S, Lechtenboehmer C, Bally M et al. Association of nutritional risk and adverse medical outcomes across different medical inpatient populations. Nutrition 2015;31:1385–1393CrossRefPubMed

14.

Carrion S, Cabre M, Monteis R et al. Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of older patients admitted with an acute disease to a general hospital. Clin Nutr 2015;34:436–442CrossRefPubMed

15.

Andersen UT, Beck AM, Kjaersgaard A. Systematic review and evidence based recommendations on texture modified foods and thickened fluids for adults (≥18 years) with oropharyngeal dysphagia. e-SPEN Journal 2013;8:e127–e134CrossRef

16.

Volkert D, Berner YN, Berry E et al. ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clin Nutr 2006;25:330–360CrossRefPubMed

17.

Wirth R, Smoliner C, Jager M et al. Guideline clinical nutrition in patients with stroke. Exp Transl Stroke Med 2013;5:14CrossRefPubMedPubMedCentral

18.

Intercollegiate Stroke Working Party, 2012. National clinical guideline for stroke. London. https://www.nottingham.ac.uk/emahsn/documents/stroke-idocumentroyalcol legeofphysiciansnationalclinicalguidelineforstroke.pdf. Accessed 13 January 2017

19.

Arnold M, Liesirova K, Broeg-Morvay A et al. Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome. PLoS One 2016;11:e0148424

20.

Falsetti P, Acciai C, Palilla R et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis 2009;18:329–335CrossRefPubMed

21.

Cabre M, Serra-Prat M, Palomera E et al. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing 2010;39:39–45CrossRefPubMed

22.

Leder SB, Suiter DM. An epidemiologic study on aging and dysphagia in the acute care hospitalized population: 2000-2007. Gerontology 2009;55:714–718CrossRefPubMed

23.

van Nie-Visser NC, Schols JM, Meesterberends E et al. An international prevalence measurement of care problems: study protocol. J Adv Nurs 2013;69:e18–29CrossRef

24.

Bundesministerium für Frauen und Gesundheit, 2016. Krankenanstalten in Österreich. http://www.bmgf.gv.at/home/Gesundheit/Krankenanstalten/Krankenanstalten_und_selbststaendige_Ambulatorien_in_Oesterreich/ Krankenanstalten_in_Oesterreich. Accessed 13. January 2017

25.

Lohrmann C, Dijkstra A, Dassen T. The Care Dependency Scale: an assessment instrument for elderly patients in German hospitals. Geriatr Nursing 2003;24:40–3CrossRef

26.

Lohrmann C. Pflegequalitätserhebung 14. April 2015. Research Report. Graz: Medical University Graz

27.

IBM Statistics. SPSS Software for Windows. Armonk, NY: IBM Cor, 2015.

28.

van der Maarel-Wierink CD, Meijers JM, De Visschere LM et al. Subjective dysphagia in older care home residents: a cross-sectional, multi-centre point prevalence measurement. Int J Nurs Stud 2014;51:875–881CrossRefPubMed

29.

Parker C, Power M, Hamdy S et al. Awareness of dysphagia by patients following stroke predicts swallowing performance. Dysphagia 2004;19:28–35CrossRefPubMed

30.

Bours GJ, Speyer R, Lemmens J et al. Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review. J Adv Nurs 2009;65:477–493CrossRefPubMed

31.

Rofes L, Arreola V, Almirall J et al. 2011. Diagnosis and management of oropharyngeal Dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterol Res Pract doi: 10.1144/2011/818979

32.

Schepp SK, Tirschwell DL, Miller RM et al. Swallowing screens after acute stroke: a systematic review. Stroke 2012;43:869–871CrossRefPubMed

33.

Turner-Lawrence DE, Peebles M, Price MF. A feasibility study of the sensitivity of emergency physician Dysphagia screening in acute stroke patients. Ann Emerg Med 2009;54:344–348CrossRefPubMed

34.

Poisson P, Laffond T, Campos S et al. Relationships between oral health, dysphagia and undernutrition in hospitalised elderly patients. Gerodontology 2016;33:161–168CrossRefPubMed

35.

Eglseer D, Halfens R, Lohrmann C. Is the presence of a validated malnutrition screening tool associated with better nutritional care in hospitalized patients? Nutrition 2017;37:104–111CrossRefPubMed

36.

van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM et al. Meta-analysis of dysphagia and aspiration pneumonia in frail elders. J Dent Res 2011;90:1398–1404CrossRefPubMed

37.

Sarabia-Cobo CM, Perez V, de Lorena P et al. The incidence and prognostic implications of dysphagia in elderly patients institutionalized: A multicenter study in Spain. Appl Nurs Res 2016;30:e6–9CrossRef

38.

Madhavan A, LaGorio LA, Crary MA et al. Prevalence of and Risk Factors for Dysphagia in the Community Dwelling Elderly: A Systematic Review. JNHA 2016;20:806–15

39.

Baroni AF, Fabio SR, Dantas RO. Risk factors for swallowing dysfunction in stroke patients. Arq Gastroenterol 2012;49:118–124CrossRefPubMed

40.

Charlesworth CJ, Smit E, Lee DS. Polypharmacy Among Adults Aged 65 Years and Older in the United States: 1988-2010. J Gerontol A Biol Sci Med Sci 2015;70:989–995CrossRefPubMedPubMedCentral

41.

Guthrie B, Makubate B, Hernandez-Santiago V. The rising tide of polypharmacy and drug-drug interactions: population database analysis. BMC Med 2015;13:74CrossRefPubMedPubMedCentral

42.

Wirth R, Dziewas R, Jäger M et al. Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE, der DGN und der DGG. Aktuel Ernahrungsmed 2013;38:e49–e89CrossRef

43.

Keller H, Chambers L, Niezgoda H et al. Issues associated with the use of modified texture foods. JNHA 2012;16:195–200

44.

Vivanti AP, Campbell KL, Suter MS et al. Contribution of thickened drinks, food and enteral and parenteral fluids to fluid intake in hospitalised patients with dysphagia. J Hum Nutr Diet 2009;22:148–155CrossRefPubMed

45.

Wright L, Cotter D, Hickson M et al. Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet. J Hum Nutr Diet 2005;18:213–219CrossRefPubMed

46.

Carnaby G, Hankey GJ, Pizzi J. Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial. Lancet Neurol 2006;5:31–37CrossRefPubMed

47.

Sura L, Madhavan A, Carnaby G et al. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging 2012;7:287–298PubMedPubMedCentral

Title: Dysphagia in Hospitalized Older Patients: Associated Factors and Nutritional Interventions
Authors: Doris Eglseer
R. J. G. Halfens
J. M. G. A. Schols
C. Lohrmann
Publication date: 01-01-2018
Publisher: Springer Paris
Published in: The journal of nutrition, health & aging / Issue 1/2018
Print ISSN: 1279-7707
Electronic ISSN: 1760-4788
DOI: https://doi.org/10.1007/s12603-017-0928-x

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Dysphagia in Hospitalized Older Patients: Associated Factors and Nutritional Interventions

Abstract

Objectives

Design

Setting

Participants

Measurements

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Design

Setting

Participants

Measurements

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

Lower 25-Hydroxyvitamin D is Associated with Higher Relapse Risk in Patients with Relapsing-Remitting Multiple Sclerosis

Why is the Skeleton Still in the Hospital Closet? A Look at the Complex Aetiology of Protein-Energy Malnutrition and its Implications for the Nutrition Care Team

The My Meal Intake Tool (M-MIT): Validity of a Patient Self-Assessment for Food and Fluid Intake at a Single Meal

Feasibility, Acceptability and Effects of a Home-Based Exercise Program Using a Gerontechnology on Physical Capacities After a Minor Injury in Community-Living Older Adults: A Pilot Study

Real-Life Peak and Trough Dabigatran Plasma Measurements Over Time in Hospitalized Geriatric Patients with Atrial Fibrillation

Dynapenic Abdominal Obesity Increases Mortality Risk Among English and Brazilian Older Adults: A 10-Year Follow-Up of the ELSA and SABE Studies

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page