Swallowing disorders in nursing home residents: how can the problem be explained?

Dália Nogueira, Elizabeth Reis, Dália Nogueira, Elizabeth Reis

Abstract

Background: The swallowing mechanism changes significantly as people age, even in the absence of chronic diseases. Presbyphagia, a term that refers to aging-related changes in the swallowing mechanism, may be linked to many health conditions and presents itself in distinct ways. Swallowing disorders are also identified as a major problem amongst the elderly population living in nursing homes.

Methods: The study sought to determine the prevalence of swallowing disorders in nursing home residents, to identify the relationship between self-perceived swallowing disorders, cognitive functions, autonomy, and depression, and also to analyze which variables explain the score of the Dysphagia Self-Test (DST). For this purpose, the researchers chose to apply a survey conveying questions on demographic aspects, general health, eating and feeding, as well as instruments to assess functional performance and the 3 ounce Water Swallow Test.

Results: The sample consisted of 272 elderly people living in eight nursing homes in Portugal. Six did not sign the informed consent form. Of the total, 29% were totally dependent, 33% were depressed, 45% had cognitive impairment, and 38% needed help with feeding. About 43% of the individuals reported having problems related to eating. Regarding the DST, 40% showed signs of dysphagia. With respect to the 3 ounce Water Swallow Test, 38% revealed at least one of the symptoms, wet voice being the most prevalent. Correlation measures showed that age had no linear association with the DST score although correlation with the Barthel Index and Mini Mental State Examination was found to be significant. A linear regression model was estimated with the DST score as the dependent variable and the MMSE and BI scores, gender, age, education, the Geriatric Depression Scale score, 3 ounce Water Swallow Test, and diagnosed conditions (such as neurological disorder, dementia, and cardiorespiratory problems) as explaining variables.

Conclusion: Results showed a high prevalence of dysphagia signs amongst a nursing home population. For the purpose of the present study, both a subjective and an objective assessment were applied. Results pointed to a significant statistical relation between objective and subjective measures, thus indicating that a self-perception test should be included in the assessment of swallowing disorders in a nursing home population. Notwithstanding, it should not be used as a single or principal measure as it is influenced by the individuals' cognitive condition.

Keywords: deglutition; deglutition disorders; elderly.

References

    1. Nilsson H, Ekberg O, Olsson R, Hindfelt B. Quantitative aspects of swallowing in an elderly nondysphagic population. Dysphagia. 1996;11(3):180–184.
    1. Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287–298.
    1. Malandraki GA, Perlman AL, Karampinos DC, Sutton BP. Reduced somatosensory activations in swallowing with age. Hum Brain Mapp. 2011;32(5):730–743.
    1. McKee GJ, Johnston BT, McBride GB, Primrose WJ. Does age or sex affect pharyngeal swallowing? Clin Otolaryngol Allied Sci. 1998;23(2):100–106.
    1. Nicosia MA, Hind JA, Roecker EB, et al. Age effects on the temporal evolution of isometric and swallowing pressure. J Gerontol A Biol Sci Med Sci. 2000;55(11):M634–M640.
    1. Steele CM, Van Lieshout P. Tongue movements during water swallowing in healthy young and older adults. J Speech Lang Hear Res. 2009;52(5):1255–1267.
    1. Bennett JW, van Lieshout PH, Steele CM. Tongue control for speech and swallowing in healthy younger and older subjects. Int J Orofacial Myology. 2007;33:5–18.
    1. Higashijima M. Influence of age and bolus size on swallowing function: basic data and assessment method for care and preventive rehabilitation. Am J Occup Ther. 2010;64(1):88–94.
    1. Humbert IA, Robbins J. Dysphagia in the elderly. Phys Med Rehabil Clin N Am. 2008;19(4):853–866.
    1. Allepaerts S, Delcourt S, Petermans J. Swallowing disorders in the elderly: an underestimated problem. Rev Med Liege. 2008;63(12):715–721. French.
    1. Hudson HM, Daubert CR, Mills RH. The interdependency of protein-energy malnutrition, aging, and dysphagia. Dysphagia. 2000;15(1):31–38.
    1. Rofes L, Arreola V, Romea M, et al. Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol Motil. 2010;22(8):851–858.
    1. Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clavé P. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing. 2010;39(1):39–45.
    1. Elliott JL. Swallowing disorders in the elderly: a guide to diagnosis and treatment. Geriatrics. 1988;43104(1):95–100. 113.
    1. Feinberg MJ. Swallowing versus eating impairment in nursing home residents. Dysphagia. 1997;12(1):51.
    1. Holland G, Jayasekeran 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(7):476–480.
    1. Chen PH, Golub JS, Hapner ER, Johns MM., 3rd Prevalence of perceived dysphagia and quality-of-life impairment in a geriatric population. Dysphagia. 2009;24(1):1–6.
    1. O’Loughlin G, Shanley C. Swallowing problems in the nursing home: a novel training response. Dysphagia. 1998;13(3):172–183.
    1. Wilkinson T, de Picciotto J. Swallowing problems in the normal ageing population. S Afr J Commun Disord. 1999;46:55–64.
    1. Rumeau P, Vellas B. Dysphagia, a geriatric point of view. Rev Laryngol Otol Rhinol (Bord) 2003;124(5):331–333. French.
    1. Kyle G. Managing dysphagia in older people with dementia. Br J Community Nurs. 2011;16(1):6–10.
    1. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003;124(1):328–336.
    1. Logemann JA. Effects of aging on the swallowing mechanism. Otolaryngol Clin North Am. 1990;23(6):1045–1056.
    1. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61–65.
    1. Guerreiro M, Silva A, Botelho M. Adaptação à população portuguesa na tradução do Mini Mental State Examination (MMSE) [Translation and adaptation of the MMSE to the Portuguese population]. Revista Portuguesa de Neurologia. 1994;1:9–10. Portuguese.
    1. Yesavage JA. Geriatric Depression Scale. Psychopharmacol Bull. 1988;24(4):709–711.
    1. Logemann JA, Stewart C, Hurd J, et al. Dysphagia Care Among Seniors in Los Angeles County: Planning and Pilot Study. Presented at the California Speech-Hearing-Language Association Convention; Monterey, Calfornia. 2008 April.
    1. Baker BM, Fraser AM, Baker CD. Long-term postoperative dysphagia in oral/pharyngeal surgery patients: subjects’ perceptions vs videofluoroscopic observations. Dysphagia. 1991;6(1):11–16.
    1. DePippo KL, Holas MA, Reding MJ. Validation of the 3-oz water swallow test for aspiration following stroke. Arch Neurol. 1992;49(12):1259–1261.

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