Predicting dysphagia in the frail elderly: risk factors and predictors in medical history and bedside examination

Abstract

Introduction Dysphagia and its related complications can wreak havoc in the frail elderly population. This is especially evident in aged care facilities, where the elderly require high levels of care. Identifying practical and reliable ways to identify those who are likely to have dysphagia or more likely to develop the condition in the future is invaluable to geriatric care, as cost incurred due to poorly managed dysphagia can be avoided. This study aimed to identify risk factors that can predict dysphagia both in medical history and during clinical bedside examinations. Methods Six nursing homes were recruited for this study. 164 elderly individuals were clinically examined using the 3 ounce water swallowing test, oro-motor examination, Eating Assessment Tool (EAT10), and Montreal Cognitive Assessment (MoCA). Nursing home medical records were inspected for diseases and current medications. Results Signs of dysphagia were correlated with impaired functional ability, use of polypharmacy, history of a range of conditions across multiple disease types; and oro-motor performance during bedside examination. Subsequent statistical modelling found that intelligibility rating in oro-motor examination and a combined history of both neurological and psychological disorders were highly predictive of failing the 3 ounce water swallowing test. Conclusions This study identified a number of factors associated with higher risks of dysphagia that can help clinicians working with the frail elderly population, the most predictive of which were history of multiple disease types and compromised motor speech performance. Further research is needed to pinpoint more reliable and objective predictors.