Identifying and predicting dysphagia in older adults : associated factors and risk factors

Abstract

Background Dysphagia, the medical term for difficulties with swallowing, is a condition typically experienced by individuals who suffer from diseases and/or disorders that affect the neurological and/or physiology systems that control and modulate swallowing. Examples of diseases well known to cause dysphagia are stroke, progressive neurological diseases like amyotrophic lateral sclerosis, and head-and-neck cancer. Dysphagia has been gaining attention as a geriatric syndrome in the current population trends of rapid ageing. This phenomenon has a two-fold explanation: one, as people live longer, they experience more diseases that would otherwise have gone unnoticed and are likely to cause dysphagia; and two, even in the absence of morbidity, ageing is a degenerative process that leads to suboptimal performance of all functions, including swallowing. The impacts and burden of dysphagia are extremely detrimental to the physical and psychological wellbeing of older adults. Disordered swallowing function can lead to malnutrition, dehydration, aspiration pneumonia, impaired quality of life, and even death. Understanding the factors that are indicative of dysphagia and have prognostic potential would vastly lighten the burden of health professionals and carers of older adults who are at risk for the disorder. Current knowledge of risk factors related to dysphagia are limited due to the complexity of the condition in the ageing population, as well as limitations in the designs of epidemiological studies. Objective This thesis aimed to investigate the factors associated with geriatric dysphagia and identify those that can help to predict the likelihood of developing dysphagia in older adults. Method A cross-sectional study that examined 878 adults from aged care facilities was first conducted. Speech-language pathologists clinically assessed all participants for dysphagia. Information regarding demographics and medical background were analysed for possible association with dysphagia. The second study used a prospective cohort design and employed a validated dysphagia screening tool to assess participants. This study included a group of 70 adults over the age of 60 years old from aged care facilities and the community. They were assessed and followed up at 6 to 12 months after the initial assessment. Factors relevant to dysphagia from the initial study were analysed for their predictive value of disordered swallowing. Results The cross-sectional study found two distinct profiles of dysphagia based on the overall responsiveness of participants. For those who were more frail and unable to cooperate in clinical assessments: being male, dependency for activities of daily living, and a history of pneumonia were indicative of dysphagia. In those who were more robust: cognitive decline, edentulousness, and overall poor oromotor performance were indicative of dysphagia. In the prospective cohort study, the risk factors found to be predictive of dysphagia were taking asymmetry of the jaw, frequent dysphonia, and taking more than five medications concurrently. Conclusion There are distinct profiles of dysphagia in older adults based on their functional status, with different factors associated with frail and robust individuals. Risk factors of dysphagia in this population are marked by variables that indicate frailty and sarcopenia. These findings demonstrate the close ties of dysphagia to functional impairments and frailty in ageing. They also highlight the importance of assessing the overall function and wellbeing of the individual when assessing for dysphagia, and indicate a need for transdisciplinary intervention to effectively target geriatric dysphagia.