European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome

Survey of dysphagia and related medications in nursing home residents using the Eating Assessment Tool (EAT-10) applied by community pharmacists: A single-center retrospective study

BACKGROUND

This study aimed to assess the prevalence of dysphagia among nursing home residents and to examine the association between medication use and impaired swallowing function.

METHODS

Between January and December 2023, we conducted a retrospective survey across 14 nursing homes visited by community pharmacists. Swallowing function was evaluated using the Eating Assessment Tool-10 (EAT-10) questionnaire. Residents were categorized into two groups: those with reduced swallowing function (EAT-10 score ≥ 3) and those with normal swallowing function (EAT-10 score < 3). The association between medication use and swallowing function was analyzed using univariate and multivariate logistic regression models.

RESULTS

Significant differences were observed between the reduced (n = 101, 36.9%) and normal swallowing function (n = 173, 63.1%) groups in terms of age (P = 0.022), body mass index (BMI) (P < 0.001), and nursing care level (P < 0.001). Propensity score matching was performed to adjust for confounding factors, yielding 72 matched pairs. Analysis of the matched cohort revealed a significant association between antipsychotic use and reduced swallowing function (odds ratio [OR], 2.600; 95% confidence interval [CI], 1.210-5.560; P = 0.014).

CONCLUSIONS

This study identified a significant association between antipsychotic drug use and reduced swallowing function. Medication reviews incorporating assessments of swallowing function may help mitigate the risk of aspiration. Further prospective studies are warranted to validate these findings and to clarify causal relationship between medication use and swallowing dysfunction.

Current Technological Advances in Dysphagia Screening: Systematic Scoping Review

BACKGROUND

Dysphagia affects more than half of older adults with dementia and is associated with a 10-fold increase in mortality. The development of accessible, objective, and reliable screening tools is crucial for early detection and management.

OBJECTIVE

This systematic scoping review aimed to (1) examine the current state of the art in artificial intelligence (AI) and sensor-based technologies for dysphagia screening, (2) evaluate the performance of these AI-based screening tools, and (3) assess the methodological quality and rigor of studies on AI-based dysphagia screening tools.

METHODS

We conducted a systematic literature search across CINAHL, Embase, PubMed, and Web of Science from inception to July 4, 2024, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework. In total, 2 independent researchers conducted the search, screening, and data extraction. Eligibility criteria included original studies using sensor-based instruments with AI to identify individuals with dysphagia or unsafe swallow events. We excluded studies on pediatric, infant, or postextubation dysphagia, as well as those using non-sensor-based assessments or diagnostic tools. We used a modified Quality Assessment of Diagnostic Accuracy Studies-2 tool to assess methodological quality, adding a "model" domain for AI-specific evaluation. Data were synthesized narratively.

RESULTS

This review included 24 studies involving 2979 participants (1717 with dysphagia and 1262 controls). In total, 75% (18/24) of the studies focused solely on per-individual classification rather than per-swallow event classification. Acoustic (13/24, 54%) and vibratory (9/24, 38%) signals were the primary modality sources. In total, 25% (6/24) of the studies used multimodal approaches, whereas 75% (18/24) used a single modality. Support vector machine was the most common AI model (15/24, 62%), with deep learning approaches emerging in recent years (3/24, 12%). Performance varied widely-accuracy ranged from 71.2% to 99%, area under the receiver operating characteristic curve ranged from 0.77 to 0.977, and sensitivity ranged from 63.6% to 100%. Multimodal systems generally outperformed unimodal systems. The methodological quality assessment revealed a risk of bias, particularly in patient selection (unclear in 18/24, 75% of the studies), index test (unclear in 23/24, 96% of the studies), and modeling (high risk in 13/24, 54% of the studies). Notably, no studies conducted external validation or domain adaptation testing, raising concerns about real-world applicability.

CONCLUSIONS

This review provides a comprehensive overview of technological advancements in AI and sensor-based dysphagia screening. While these developments show promise for continuous long-term tele-swallowing assessments, significant methodological limitations were identified. Future studies can explore how each modality can target specific anatomical regions and manifestations of dysphagia. This detailed understanding of how different modalities address various aspects of dysphagia can significantly benefit multimodal systems, enabling them to better handle the multifaceted nature of dysphagia conditions.

Anticholinergic drug exposure is associated with prevalence, worsening and incidence of dysphagia among hospitalized older adults

OBJECTIVES

In this study, we aimed at evaluating the association between anticholinergic drug exposure and prevalence, worsening, and incidence of dysphagia among hospitalized older individuals.

DESIGN AND SETTING

We used data from the REPORT-Age project, a multicenter cohort study including patients aged 65 years or more, admitted to acute care hospitals of the Italian National Institute for Health and Sciences on Aging (INRCA-IRCCS) between 2011 and 2019.

PARTICIPANTS

4,005 older patients aged 84.7 (SD = 6.6) years underwent comprehensive geriatric examination according to the interRAI minimum dataset for acute care (MDS-AC), at both hospital admission and discharge.

MEASUREMENTS

Both prevalence and severity of dysphagia were assessed through items of subjective evaluation included in the section K3 of MDS-AC questionnaire; the anticholinergic drug exposure was measured by means of CRIDECO Anticholinergic Load Scale (CALS) and Anticholinergic Cognitive Burden (ACB) scales. Next, we used logistic regression models to evaluate the association between anticholinergic burden and prevalence of dysphagia at hospital admission; Kaplan Meier cumulative probability curves and cox proportional hazard models were used to analyze the association between anticholinergic burden at hospital admission and worsening or incidence of dysphagia during hospital stay.

RESULTS

Out of 4,005 patients included, 1,070 (30%) presented dysphagia at hospital admission. High anticholinergic burden was associated with increased prevalence of dysphagia at hospital admission (p < 0.001). Moreover, patients with high anticholinergic burden (ACB and CALS ≥ 2) were at increased risk of dysphagia worsening during hospital stay (HR, 95%CI: 1.14, 1.06-1.22 and 1.12, 1.03-1.23 for ACB and CALS respectively). Among the 2,935 patients with normal swallowing function at hospital admission, high anticholinergic burden was associated with the incidence of dysphagia at hospital discharge (HR, 95% CI: 1.89, 1.21-2.96 and 1.86, 1.14-3.06 for ACB and CALS respectively). Development of dysphagia during hospital stay was associated with a reduced prescription of anticholinergic medications (ORs, 95% CI 1.13 (1.07-1.20) and 1.08 (1.01-1.15) for ACB and CALS, respectively).

CONCLUSIONS

Increased anticholinergic burden was associated with the prevalence, worsening, and incidence of dysphagia among older hospitalized patients.

The effect of breathing training on swallowing function in patients with neurogenic dysphagia: a systematic review and meta-analysis

PURPOSE

This study aimed to systematically review various breathing training methods for patients with neurogenic dysphagia, and assess their clinical efficacy to improve swallowing function in individuals with neurological disorders such as stroke.

METHODS

Relevant studies were retrieved from nine databases (PubMed, Embase, Web of Science, The Cochrane Library, CINAHL, CNKI, Wanfang, China Science and Technology Journal Database, and China Biomedical Literature Database). Articles included in the review were published from the date of establishment of each database up to January 2024. Eleven randomized control trials (RCTs) and five quasi-experimental studies that met the inclusion criteria were included in this systematic review. Data and information were extracted independently by two reviewers, with disagreements resolved through consensus with a third coauthor. The primary outcome assessed was swallow function occurrence. The quality of the included studies was evaluated using the Cochrane risk of bias assessment tool and the JBI quality assessment tool.

RESULTS

The meta-analysis results showed that expiratory muscle strength training can improve swallowing function (standard mean deviation = -0.89, 95% confidence interval [-1.23, -0.55], Z = 5.11, P < 0.01).

CONCLUSION

This paper categorized and summarized specific respiratory muscle groups targeted in different breathing training methods, providing guidance for clinicians in designing personalized regimens. The study showed that expiratory muscles strength training is the main method for improving respiratory strength and coordination between swallowing and breathing, reducing the risk of aspiration. More research is needed to assess the effectiveness of independent breathing training.

Validation and Reliability of the Polish Version of the Eating Assessment Tool-10 Questionnaire

Introduction: Early identification of patients at risk of dysphagia is of paramount importance. To date, no dysphagia screening questionnaire has been validated and translated into Polish that can be widely used in a multidisciplinary setting. Our study aimed to validate and adapt the Polish version of the Eating Assessment Tool-10 questionnaire (EAT-10). Materials and Methods: The EAT-10 questionnaire was translated into Polish using a formal forward-backward translation method. The Polish EAT-10 was administered to 109 patients with different dysphagia etiologies and 24 control subjects. Internal consistency, unidimensionality, test-retest reliability and external validity against the Visual Analog Scale (VAS), and Flexible Endoscopic Evaluation of Swallowing (FEES) were performed. Results: The EAT-10PL demonstrated excellent internal consistency (Cronbach's α = 0.958) and confirmed unidimensionality. We found a strong correlation between EAT-10PL with the Visual Analog Scale (VAS) (rs = 0.94, p < 0.001) and a weaker correlation with the PAS (rs = 0.55, p < 0.001). We reported a sensitivity of 79.5% and specificity at the level of 60.0%, using ≥3 as a cut-off point. The statistically chosen cutoff point for PAS ≥ 2 and EAT-10 ≥ 6 indicated optimal specificity (70.0%) and sensitivity (79.5%) of measurements performed using EAT-10PL. The EAT-10PL questionnaire demonstrates high discriminatory ability relative to the control group (F(4, 104) = 16.219, p < 0.001, η2 = 0.38 [95%CI: 0.22-0.48]). Conclusions: The Polish EAT-10 is a valid and reliable, self-administered questionnaire for dysphagic patient identification. The Polish EAT-10 ≥ 3 can be considered abnormal; however, it seems that EAT-10PL is not appropriate for patients with dysphagia and a chronic cough background, and further research is required.

Age-defying swallowing

Swallowing disorders, which are generally underdiagnosed, affect the elderly, leading to a decreased quality of life and complications, including aspiration pneumonia and death. Understanding the neurophysiology of swallowing and the causes of its dysfunction is a fundamental tool for the prevention, early diagnosis, and treatment of dysphagia. New technologies open a wide range of possibilities for the implementation of new care protocols for this disorder.

The Impact of Bolus Rheology on Physiological Swallowing Parameters Derived by Pharyngeal High-Resolution Manometry Impedance

BACKGROUND

The shear rheology of ingested fluids influences their pharyngo-esophageal transit during deglutition. Thus, swallowed fluids elicit differing physiological responses due to their shear-thinning profile.

METHODS

Two hydrocolloid fluids, xanthan gum (XG) and sodium carboxymethylcellulose gum (CMC), were compared in 10 healthy adults (mean age 39 years). Manometry swallowing assessments were performed using an 8-French catheter. Swallows were analyzed using the Swallow Gateway web application (www.swallowgateway.com). Grouped data were analyzed by a mixed statistical model. The coefficient of determination (r2) assessed the relationship between measures and bolus viscosity (SI units, mPa.s) at shear rates of 1-1000 s-1.

KEY RESULTS

Rheology confirmed that the thickened fluids had similar viscosities at 50 s-1 shear rate (XG IDDSI Level-1, 2, and 3 respectively, 74.3, 161.2, and 399.6 mPa.s vs. CMC Level-1, 2, and 3 respectively 78.0, 176.5, and 429.2 mPa.s). However, at 300 s-1 shear, CMC-thickened fluids exhibited approximately double the viscosity (XG Level-1, 2, and 3 respectively 19.5, 34.4, and 84.8 mPa.s vs. CMC Level-1, 2, and 3 respectively, 41.3, 80.8, and 160.2 mPa.s). In vivo swallows of CMC, when compared to XG, showed evidence of greater flow resistance, such as increased intrabolus pressure (p < 0.01) and UES Integrated Relaxation Pressure (UESIRP, p < 0.01) and shorter UES Relaxation Time (p < 0.05) and Bolus Presence Time (p < 0.001). The apparent fluid viscosity (mPa.s) correlated most significantly with increasing UESIRP (r2 0.69 at 50 s-1 and r2 0.97 at 300 s-1, p < 0.05).

CONCLUSION

Fluids with divergent shear viscosities demonstrated differences in pharyngeal function. These physiological responses were linked to the shear viscosity and not the IDDSI level.

Development and Validation of a Prediction Model for Dysphagia in Community-Dwelling Older Adults

Objectives. Dysphagia is a geriatric syndrome, which may lead to complications such as dehydration, malnutrition, aspiration, pneumonia, and a significant reduction in quality of life. The purpose of this study was to construct and validate a prediction model for dysphagia in community-dwelling older adults and provide an assessment tool for the prevention and control of dysphagia. Design. Cross-sectional study. Setting. The community-dwelling Chinese older adults. Participants. 3655 participants aged 65 years and older were involved, who were randomly divided into the training set and the validation set. Methods. Data were collected and analyzed from June 2022 to September 2022. Univariate and multivariate logistic regression analysis were used to identify independent risk factors for dysphagia. We applied R software to develop a nomogram model to predict dysphagia in community-dwelling older adults. The predictive value of the model was assessed by the area under the ROC curve (AUC), the calibration curve was used to evaluate the reliability of the nomogram model for predicting dysphagia in community-dwelling older adults. The model's clinical utility was further evaluated using a Decision Curve Analysis (DCA). Results. The incidence of dysphagia was 11.8% (320/3655). Maximum tongue pressure, number of molars, pneumonia, ADL, sarcopenia, age, neurological diseases, and rheumatic immune diseases were selected as risk predictors for dysphagia. The prediction model demonstrated fair discriminative ability with the AUC was 0.709 (95%CI: 0.679-0.739) in the training set and 0.693 (95%Cl: 0.640-0.747) in the validation set, the calibration is adequate, and the Hosmer and Lemeshow test showed p values of 0.163 and 0.415, respectively. The DCA curve of our model shows a positive clinical net benefit. Conclusions. The prediction model established in this study was of a certain predictive value for the risk of dysphagia in community-dwelling older adults. By estimating the likelihood of future outcomes or the onset of certain diseases, it can assist medical personnel in formulating preventive strategies, lessening the workload of nurses, and also diminishing the financial burden on patients, thereby enhancing their overall quality of life.

Prevalence of dehydration in older hospitalized patients with oropharyngeal dysphagia

The diagnosis of dehydration among older patients with oropharyngeal dysphagia (OD) remains a clinical challenge. We aimed to assess the prevalence of dehydration in hospitalized older adults with OD and its relationship with other comorbidities. This is a cross-sectional study involving hospitalized older patients (≥ 70 years) with OD, assessed for OD using the Volume-Viscosity Swallowing Test. Treatment for impaired safety of swallow was based on xanthan gum thickened fluids with appropriate bolus viscosity (250 mPa·s or 800 mPa·s). Hydration status was evaluated using three different methodologies: (a) osmolarity equation (> 295 mmol/L), (b) blood urea nitrogen to creatinine ratio (BUN/Cr > 20 and (c) bioimpedance analysis (BIA): phase angle (PA) < 4.5. Nutritional status (Mini Nutritional Assessment-short form), functionality (Barthel Index), frailty (Fried Index), and sarcopenia (European Working Group on Sarcopenia in Older People) were also assessed. We included 218 hospitalized (9.1 ± 7.2 days) patients with OD (87.4 ± 5.5 years), 85.3% with safety impairments. On admission, (a) up to 58.3% needed fluid thickening for safe swallowing (90.6% of them at 250 mPa·s) and 93.6% textured modified diets, (b) According to BUN/Cr ratio, 78.9% were dehydrated and to osmolarity, 81.2% and (c) 61.1% of participants had values of PA < 4.5, and (d) hydration status was significantly worse in patients with lower functional status, frailty, malnutrition, and sarcopenia. Dehydration is a highly prevalent condition among hospitalized older patients with OD. Assessment of hydration status, and promotion and monitoring of safe fluid intake with multimodal hydration interventions, is mandatory in patients with OD.

Validity and Reliability of Dysphagia Outcome Severity Scale (DOSS) When Used to Rate Flexible Endoscopic Evaluations of Swallowing (FEES)

The Dysphagia Outcome and Severity Scale is used both clinically and within dysphagia research, internationally. Although it was developed using videofluoroscopic swallowing studies, it is frequently used to rate Flexible Endoscopic Evaluations of Swallowing. The validity and reliability of DOSS-use with FEES, however, has not previously been evaluated. This study investigated the validity and rater reliability of clinicians using DOSS to rate FEES. Eleven Speech-Language Pathologists (SLPs) with varied dysphagia experience were recruited to review and DOSS-rate 17 soundless FEES (198 bolus swallows) recorded from 11 heterogenic dysphagic patients (2 cases with repeat FEES) and 4 healthy adults. The SLPs DOSS-ratings were compared against the initial comprehensive dysphagia evaluation (including patient diagnosis, interview, cranial nerve and complete FEES assessment) with Functional Oral Intake Scale (FOIS) and DOSS outcome measures. The SLPs were blinded to patient details and comprehensive dysphagia examination. Re-randomised rating of FEES cases occurred two weeks later (intra rater reliability). Criterion validity for DOSS-ratings (compared against comprehensive dysphagia evaluation with FOIS and DOSS) were strong-very strong (rs = 0.858 and 0.936 respectively; p < 0.001). Inter rater reliability demonstrated high agreement (α = 0.891), also intra rater reliability demonstrated almost perfect agreement (Kw = 0.945). This study's results, with strong-very strong criterion validity and high rater reliability by SLPs, adds to the evidence for DOSS-use with FEES. Future validity research comparing DOSS with both FEES and VFSS simultaneously is recommended.

Pathway analysis of the impact of dysphagia on the prognosis of patients with stroke: Based on structural equation modeling

BACKGROUND AND AIMS

Dysphagia is significantly correlated with prognostic outcomes in patients with stroke; however, the intrinsic mechanism of action between the two remains unclear. This study aimed to model the intrinsic mechanism of action between dysphagia and prognostic outcomes in patients with stroke based on structural equation modeling.

METHODS

A retrospective analysis of 900 inpatients with stroke from three large hospitals was performed. AMOS software (version 23.0) was used to construct the structural equation modeling.

RESULTS

The overall model showed a good fit (chi-square = 27.3, root mean square error of approximation = 0.01, standardized root mean square residual = 0.032, comparative fit index = 0.98, and adjusted goodness of fit = 0.94). Structural equation modeling showed that the total effect of dysphagia on the prognosis of patients with stroke was 0.694, with a direct effect of 0.599, accounting for 86.31 % of the total effect. The total indirect effect was 0.095, with the mediating effects of serum albumin level and pneumonia accounting for 6.48 % and 7.35 % of the total effect, respectively. The moderating effects of sex on dysphagia and the relationship between activities of daily living, modified Rankin scale score, and length of hospital stay were insignificant (ΔR2 = 0.063, P = 0.145; ΔR2 = 0.002, P = 0.620; ΔR2 = 0.001, P = 0.307).

CONCLUSIONS

Dysphagia can directly affect the prognostic outcomes of patients with stroke and indirectly affect prognosis by triggering pneumonia and lowering albumin levels. Sex was not found to play a moderating role in the relationship between dysphagia and prognosis.

Adaptation and Validation of the Sydney Swallow Questionnaire into Kannada (KSSQ)

Self-rating questionnaires are necessary to quantify the impairment and the impact of impairment on the quality of life, provided that these questionnaires are delivered in the patient's native language. There are no questionnaires to assess the symptom severity of oropharyngeal dysphagia in Kannada-speaking individuals. The Sydney Swallow Questionnaire (SSQ) is one such explicit tool to assess the symptoms of dysphagia, especially among patients with oropharyngeal dysphagia. The SSQ is a simple and easy-to-understand questionnaire. Therefore, the present study aimed to adapt and validate the SSQ in Kannada. English version of the SSQ was translated to Kannada and was administered to two groups of native Kannada-speaking participants - Group 1 included 53 participants (66.49 + 12.65 years) diagnosed with oropharyngeal dysphagia, and Group 2 included 53 age and gender-matched native Kannada speakers with normal swallowing ability with no history and symptoms of swallowing disorders. Cronbach's alpha was used to assess the test-retest reliability. Internal consistency was assessed using the split-half correlation. The concurrent validity of the Kannada version of SSQ (KSSQ) was measured by determining the correlation between the total scores of KSSQ and the Kannada version of Dysphagia Handicap Index (DHI). The discriminant validity was assessed by comparing the KSSQ scores between the participants of both groups. The results indicated that the KSSQ had excellent test-retest reliability, strong internal consistency, and good concurrent and discriminant validity. Therefore, it was inferred that the KSSQ is a valid and reliable tool for assessing the symptoms of dysphagia, especially among Kannada-speaking patients with oropharyngeal dysphagia.

Narrative review: nutritional strategies for ageing populations - focusing on dysphagia and geriatric nutritional needs

The increase in elderly populations worldwide highlights the urgency of addressing age-related problems through effective nutritional management to enhance the well-being of the elderly and for the prevention and treatment of various diseases. The trend towards an increasing elderly population brings with it an increase in conditions such as sarcopenia, osteosarcopenia and frailty, emphasising the importance of regular checks for malnutrition in the elderly and the implementation of personalised nutritional therapies. The importance of nutrition in addressing geriatric syndromes such as frailty, sarcopenia, osteosarcopenia, obesity and metabolic syndrome is highlighted. Dysphagia, frequent in the elderly, requires special attention to prevent malnutrition and complications. It is essential to maintain muscle mass and bone health in old age. In this review we investigate the fundamental role of nutrition in geriatrics, focusing on promoting healthy ageing and managing problems such as malnutrition and overeating. The importance of protein intake and healthy dietary patterns such as the Mediterranean diet are then discussed. Finally, the challenges of personalised nutritional care, including the need for artificial nutrition or oral supplements, to improve quality of life and health care in an ageing society are addressed.

Do Orally Disintegrating Tablets Facilitate Medical Adherence and Clinical Outcomes in Patients with Post-stroke Dysphagia?

Orally disintegrating tablets (ODTs) dissolve rapidly in contact with saliva and have been reported to facilitate oral administration of medications in swallowing difficulties. However, their clinical benefits remain unclear because no previous studies have examined whether ODTs facilitate medication adherence and clinical outcomes in patients with post-stroke dysphagia. This study evaluated the association between ODT prescriptions and clinical benefits using high-dimensional propensity score (hd-PS) matching to adjust for confounding factors. Using a large Japanese commercial medical and dental claims database, we identified patients aged ≥ 65 years with post-stroke dysphagia between April 2014 and March 2021. To compare 1-year outcomes of medication adherence, cardiovascular events, and aspiration pneumonia between patients taking ODTs and non-ODTs, we performed hd-PS matching. We identified 11,813 patients without ODTs and 3178 patients with ODTs. After hd-PS matching, 2246 pairs were generated. Medication adherence for 1 year, based on the proportion of days covered, was not significantly different between the non-ODT and ODT groups before (0.887 vs. 0.900, P = 0.999) and after hd-PS matching (0.889 vs. 0.902, P = 0.977). The proportion of cardiovascular events (0.898 vs. 0.893, P = 0.591) and aspiration pneumonia (0.380 vs. 0.372, P = 0.558) were also not significantly different between the groups. This study found no significant differences in medication adherence, cardiovascular diseases, or aspiration pneumonia between the non-ODT and ODT groups in patients with post-stroke dysphagia. Both groups achieved a proportion of days covered exceeding 80%. Clinicians may consider prescribing ODTs or non-ODTs based on patient preferences rather than solely on post-stroke conditions.

Analysis of Patients' Dietary Status/Restrictions Following Instrumental Swallow Evaluations in Skilled Nursing Facilities

Many residents in Skilled Nursing Facilities (SNFs) present with dysphagia and receive altered diets or liquids to minimize the risk of complications. Limited access to timely instrumental evaluations of swallow may impede the best management of these dysphagic residents. De-identified FEES reports completed by a mobile FEES company during a single month, January 2019, were reviewed. Descriptive statistics were used to summarize the pre-study diet/liquid levels and the post-study diet/liquid recommendations. FEES reports (n = 952) were reviewed. Before the FEES evaluation, 209 residents were receiving only non-oral nutrition. After the FEES evaluation, 76% of these residents were recommended to receive oral nutrition. Before the FEES evaluation, 442 (46%) residents were receiving thickened liquids, after the FEES evaluation, 244 (26%) were recommended to have a less restrictive liquid level. Before the FEES evaluation, 576 (60%) residents were receiving altered food texture, after the FEES evaluation, 413 (43%) were recommended to have a less restrictive food texture. The percentage of residents recommended to receive thin liquids increased from 32 to 68% and those recommended to receive a regular diet increased from 18 to 34%. These data indicate that access to instrumental swallow evaluations in the SNF setting generally resulted in lifting liquid and diet restrictions for many residents in the cohort reviewed and potentially improved their quality of life.

Effect of Thickened Fluids on Swallowing Function in Oropharyngeal Dysphagia: Impact of Shear Rheology and Disorder Subtype

INTRODUCTION

Fluid thickeners used in the management of oropharyngeal dysphagia exhibit non-Newtonian shear-thinning rheology, impacting their viscosity during deglutition. This study investigated how the rheological properties of thickened fluids affect pharyngeal swallowing parameters in patients with oropharyngeal motor disorders diagnosed by pharyngeal high-resolution manometry impedance (P-HRM-I).

METHODS

Seventy-two patients (18-89 years) referred for P-HRM-I were diagnostically assessed with a 10 mL thin bolus. In 57 of the patients, 10 mL swallows of two moderately thick formulations-xanthan gum (XG) and sodium carboxymethylcellulose gum (CMC)-were also tested. The XG and CMC fluids had equivalent empirical thickness but different viscosity at pharyngeal phase shear rates: XG 87 mPa.s (83-91) versus CMC mean 157 mPa.s (148-164) at 300 s-1. Standard metrics of pharyngeal and upper esophageal sphincter (UES) function were derived from P-HRM-I recordings and analyzed to characterize patients into one of four disorder subtypes: (i) No Disorder, (ii) UES Disorder, (iii) Pharyngeal Disorder, and (iv) Combination UES/Pharyngeal Disorder. Impedance recordings also assessed pharyngeal bolus transit.

RESULTS

Patients with a Combination UES/Pharyngeal Disorder were most likely to have abnormal bolus transit (82%, p < 0.001). Increasing bolus viscosity significantly influenced UES residual pressure, UES opening area, and post-swallow residue. Patients with UES Disorder exhibited pronounced increases in UES residual pressure with CMC compared to XG. Pharyngeal contractility was unaffected by viscosity changes. Post-swallow residue increased with CMC, particularly in patients with a Combination Disorder. Case-by-case analysis revealed individual variability in response to the different viscosities.

CONCLUSION

The rheological properties of thickened fluids significantly affect swallowing function, with these effects dependent upon the disorder subtype.

Association between the Hospital Anxiety and Depression Scale and Swallowing Function in Dysphagic Patients in Japan

OBJECTIVE

Dysphagia affects 2.3 %-16 % of the general population and increases with age. It can lead to malnutrition, weight loss, aspiration pneumonia, and emotional symptoms such as anxiety and depression. Mental health disorders impact appetite and muscle mass, further worsening dysphagia. Additionally, cultural and economic factors influence anxiety and depression, which can either result from or contribute to dysphagia. Studies on the relationship between anxiety, depression, and swallowing function using FEES are limited in Asian populations. The Hospital Anxiety and Depression Scale (HADS) is a useful tool for assessing mood disorders. Therefore, in this study, we aimed to investigate the associations among anxiety, depression, and swallowing function in Japanese patients with dysphagia using HADS.

METHODS

Data on age; sex; HADS; Eating Assessment Tool-10 (EAT-10); Functional Oral Intake Scale (FOIS); tongue pressure; Hyodo score, a scoring system for evaluating the swallowing function determined by flexible endoscopic evaluation of swallowing (FEES); and videofluoroscopic dysphagia scale (VDS), assessed by videofluoroscopic swallowing study, were collected and analyzed from medical records. Hyodo score consists of four parameters: (1) salivary pooling in the vallecula and piriform sinuses; (2) glottal closure reflex or cough reflex induced by touching the epiglottis or arytenoid; (3) swallowing reflex induced by colored water; and (4) extent of pharyngeal clearance after colored water is swallowed. The Mann-Whitney U test, Fisher's exact test, and multiple logistic regression analyses were used to estimate associations between HADS and swallowing function.

RESULTS

No significant relationships were observed between the EAT-10, FOIS, and VDS with HADS scores. Patients with depression were associated with a significantly higher percentage of anorexia complaints (p = 0.047). Lower tongue pressure was observed in patients with depression than in patients without depression (p = 0.002). Patients with anxiety had better swallowing function, as assessed by the Hyodo score (p = 0.047). Fluid clearance, a component of the Hyodo score, was significantly better in patients with anxiety (p = 0.03) even after propensity score matching adjusted for the effects of age, sex, and fluid clearance.

CONCLUSION

In patients with anxiety, swallowing function assessed by FEES was favorable, whereas a higher proportion of patients with depression reported decreased appetite, and lower tongue pressure. This discrepancy between subjective dysphagia and FEES findings suggests that patients with anxiety may underestimate their swallowing function.

Dysphagia and geriatric syndromes in older patients admitted to an intermediate care unit: prospective observational study

BACKGROUND

Dysphagia is a geriatric syndrome often unrecognized or underestimated, and there is a lack of studies in a heterogeneous population in intermediate care (IC) services. This study aims to describe the prevalence of dysphagia and its association with geriatric syndromes in older patients in IC.

METHODS

Prospective cohort study of patients 70 years and older admitted to an IC unit. At admission, the severity of the clinical conditions, comorbidity, delirium, frailty, sarcopenia, nutritional status, and medications were assessed. Each patient was evaluated with the 3-OZ test, and dysphagia was confirmed by a speech therapy consultation. Two multivariable logistic regression models were used to evaluate the association of dysphagia at admission with geriatric syndromes (model 1), along with the severity of illness and admission diagnosis (model 2).

RESULTS

A total of 455 patients were included. The prevalence of dysphagia was 10% and there was a high prevalence of mild-moderate dysphagia in patients with cognitive impairment and moderate risk of malnutrition. In the univariate analysis, an association was found between dysphagia and sarcopenia, malnutrition, and use of antipsychotics. In Model 1, higher odds of dysphagia were associated with the severity of comorbidity (Odds Ratio 6.49, 95% Confidence Interval: 2.02-20.78), and cognitive impairment (OR 0.91, 95% CI: 0.88-10.62); in Model 2, the severity of clinical conditions-NEWS2 (OR 1.61, 95% CI: 1.23-2.13) was associated with dysphagia, besides the severity of comorbidity and cognitive impairment. In a subset of 300 patients, delirium was also associated with dysphagia.

CONCLUSIONS

The study provides novel information on dysphagia prevalence in patients admitted to an IC unit and its association with geriatric syndromes. Additional research is needed to further define the relationship between geriatric syndromes and dysphagia, and to adequately standardize speech therapist treatments.

Association between oral dryness and dysphagia in community-dwelling older population

OBJECTIVE

There remains inconsistent recognition of the relationship between oral dryness and dysphagia. This study aimed to investigate whether the degree of oral dryness was related to the prevalence of dysphagia in community-dwelling older adults.

DESIGN

A cross-sectional study.

SETTING

A survey was conducted from March 9 to June 19, 2023, in the Futian community, Yiwu, China.

PARTICIPANTS

3325 older adults aged 65 and above were enrolled.

MEASUREMENTS

Oral dryness was evaluated by self-reported oral dryness and oral moisture instrument. Swallowing problems were screened using the Eating Assessment Tool-10 questionnaire (EAT-10) and 30-ml water swallowing test (WST). T-tests, Chi-square tests, and logistic regression were employed to measure the associations.

RESULTS

The prevalence of subjective oral dryness was 53.7%, with an average oral moisture level of 29.6 ± 2.0. Dysphagia was determined to have a prevalence of 7.7% and 9.5% according to EAT-10 and WST, respectively. Participants with dysphagia exhibited a heightened experience of dry mouth and lower oral moisture (P < .001). The adjusted logistic regression model further suggested that both subjective (adjusted OR = 1.99, 95% CI: 1.46-2.72 for EAT-10) and objective (adjusted OR = 0.92, 95% CI: 0.87-0.97 for EAT-10; adjusted OR = 0.89, 95% CI: 0.84-0.93 for WST) measures of oral dryness were risk factors for dysphagia.

CONCLUSIONS

The presence of oral dryness emerged as a significant risk factor for dysphagia, and the assessment of oral moisture proved to be more sensitive in identifying swallowing problems among older adults.

The basic theory and application of the mirror neuron system in dysphagia after stroke

The discovery of the brain's mirror neuron system enables researchers to gain a deeper understanding of social cognitive activities from the level of neural mechanisms. Mirror neurons are situated in bilateral brain regions, overlapping with the swallowing neural network, and there are complex network pathways connecting the two. Repeatedly inducing the activation of mirror neurons in stroke patients can enhance the brain's ability to relearn its original swallowing function, and then restore the swallowing neural network. With the deepening of related studies, rehabilitation therapies based on the mirror neuron system have been discussed and explored by numerous scholars and applied to the rehabilitation of dysphagia after stroke. In this paper, we review the basic theory of mirror neuron system, its mechanism, its relevance to the swallowing neural network, and the clinical application and research progress of related rehabilitation therapies in stroke dysphagia, with a view to triggering relevant researchers to comprehend and innovate the rehabilitation of dysphagia after stroke.

Post-stroke dysphagia: Neurological regulation and recovery strategies

Swallowing is a complex process requiring precise coordination of numerous muscles in the head and neck to smoothly guide ingested material from the mouth to the stomach. Animal and human studies have revealed a complex network of neurons in the brainstem, cortex, and cerebellum that coordinate normal swallowing. The interactions between these regions ensure smooth and efficient swallowing. However, the current understanding of the neurophysiological mechanisms involved in post-stroke dysphagia (PSD) is incomplete, and complete functional connectivity for swallowing recovery remains understudied and requires further exploration. In this review, we discussed the neuroanatomy of swallowing and the pathogenesis of PSD and summarized the factors affecting PSD recovery. We also described the plasticity of neural networks affecting PSD, including enhancing activation of neural pathways, cortical reorganization, regulation of extracellular matrix dynamics and its components, modulation of neurotransmitter delivery, and identification of potential therapeutic targets for functional recovery in PSD. Finally, we discussed the therapeutic strategies based on functional compensation and motor learning. This review aimed to provide a reference for clinicians and researchers to promote the optimization of PSD treatments and explore future research directions.

Self-perception and clinical presentation of eating and swallowing difficulties within elderly care

BACKGROUND

 The growing ageing population requires effective management of complex medical diagnoses and healthy ageing support within residential care facilities. However, limited access to guidelines on monitoring residents' eating and swallowing abilities has been reported. Recent research is critical for future policy development.

OBJECTIVES

 This study aimed to compare self-perceived and clinical presentation of eating and swallowing abilities among a portion of elderly residents to enhance management of the residential care population within the South African context.

METHOD

 This comparative, within-subject research study assessed 44 participants using an oropharyngeal dysphagia protocol including a medical history review, the Eating Assessment Tool - 10 (EAT-10), the Mann Assessment of Swallowing Abilities (MASA), and the three-ounce water test of the Yale Swallow Protocol (YSP). A brief cognitive screener was used when cognitive impairment was unknown.

RESULTS

 Of the participants, 21 out of 44 (48%) self-reported concerns for oropharyngeal dysphagia. Evidence of compensatory eating behaviours, without therapeutic intervention, was found. A negative, low correlation was present between the EAT-10 and the MASA (r = -0.306, p  0.05) scores.

CONCLUSION

 Individuals who self-reported eating and swallowing difficulties demonstrated fewer clinical symptoms, potentially due to compensatory techniques. The disparity between patient-reported outcome measures and clinical assessment tools highlights the need for robust screening and assessment policies within this context.Contribution: This study highlights the importance of holistic assessment practices by integrating self-perception with clinical findings to address oropharyngeal dysphagia incidence within this complex population.

Dysphagia Rehabilitation Using Digital Technology: A Scoping Review

AIM

Digital health technology in swallowing rehabilitation offers personalized exercises, remote monitoring, and real-time feedback, enhancing accessibility and effectiveness of therapy. This scoping review was conducted to summarize what types and features of digital technology-based dysphagia rehabilitation interventions exist, how they are applied in patients with dysphagia, and what the effectiveness and facilitators and barriers to intervention application are.

METHODS

We searched Medline Complete, Embase, CINAHL, Scopus, and gray literature for articles published between January 2000 and June 2023. We used subheadings and terms related to digital health, dysphagia, and rehabilitation to search for articles. The included studies were mapped according to the types and features, effectiveness, enablers, barriers, and future improvements of swallowing rehabilitation using digital technologies.

RESULTS

Twenty-five studies met the inclusion criteria. Three types of digital swallowing rehabilitation interventions were identified: home-based rehabilitation using the mHealth app, synchronous telepractice and monitoring, as well as game-based biofeedback and tracking. The included studies reported positive results regarding physiological changes in swallowing function, swallowing performance, and quality of life. Digital unfamiliarity, resources for digital access, and technical issues related to the failure of the mobile device operating system were identified as barriers to the use of digital swallowing rehabilitation technology and future improvements.

CONCLUSIONS

Digital technology has potential value in dysphagia rehabilitation. In the future, developing various interventions utilizing the advantages of digital technology and conducting additional research to validate their effectiveness is necessary. Additionally, improved digital familiarity, better accessibility, better technology, and management practices will be needed.

Oropharyngeal functions are related to physical activity level and quality of life in older adults

This study aimed to investigate the relationship between oropharyngeal functions and physical activity levels and quality of life in older adults. The Clinical Frailty Scale and Simple Questionnaire to Rapidly Diagnose Sarcopenia were used to assess frailty. Oropharyngeal functions were assessed using the Test of Masticating and Swallowing Solids (TOMASS) and Yale Swallowing Protocol (YSP). The Physical Activity Scale for the Elderly (PASE) was used to assess physical activity, and Short Form-36 (SF-36) to assess quality of life. There was a negative correlation between TOMASS and work-related activities (p = 0.024) and between YSP and total score and household activities (p < 0.05). There were negative correlations between role-physical and number of bites (p = 0.034) and total time of TOMASS (p < 0.001), and between role-emotional and number of bites, total time of TOMASS and YSP (p < 0.05). In conclusion, poor oropharyngeal function is associated with reduced physical activity and poorer quality of life in older adults.

The relationships between dysphagia risk, frailty, and depression in older adults living in nursing homes

OBJECTIVES

To examine the relationships between the risk of dysphagia, frailty, and depression in older adults living in nursing homes.

METHODS

This correlational study was conducted with 205 older adults living in a nursing home in Istanbul, Turkey. Data were collected using the Turkish Eating Assessment Tool (T-EAT-10), the Edmonton Frailty Scale (EFS), and the Geriatric Depression Scale-Short Form (GDS-15).

RESULTS

The prevalence of risk of dysphagia was 21.5 %, the prevalence of frailty was 69.3 %, and the prevalence of depression was 63 %. The risk of dysphagia alone, frailty alone, and dysphagia risk along with gender were significant predictors of depression. The risk of dysphagia alone, depression alone, and dysphagia risk along with age were significant predictors of frailty.

CONCLUSIONS

As the risk of dysphagia increases, so do frailty and depression. Depression is higher in women. Increased frailty is associated with increased depression. As age increases, frailty also increases.

Advances in wearable electronics for monitoring human organs: Bridging external and internal health assessments

Devices used for diagnosing disease are often large, expensive, and require operation by trained professionals, which can result in delayed diagnosis and missed opportunities for timely treatment. However, wearable devices are being recognized as a new approach to overcoming these difficulties, as they are small, affordable, and easy to use. Recent advancements in wearable technology have made monitoring information possible from the surface of organs like the skin and eyes, enabling accurate diagnosis of the user's internal status. In this review, we categorize the body's organs into external (e.g., eyes, oral cavity, neck, and skin) and internal (e.g., heart, brain, lung, stomach, and bladder) organ systems and introduce recent developments in the materials and designs of wearable electronics, including electrochemical and electrophysiological sensors applied to each organ system. Further, we explore recent innovations in wearable electronics for monitoring of deep internal organs, such as the heart, brain, and nervous system, using ultrasound, electrical impedance tomography, and temporal interference stimulation. The review also addresses the current challenges in wearable technology and explores future directions to enhance the effectiveness and applicability of these devices in medical diagnostics. This paper establishes a framework for correlating the design and functionality of wearable electronics with the physiological characteristics and requirements of various organ systems.

Psychometric Properties of Dysphagia Handicap Index Scale for Older Adults with Oropharyngeal Dysphagia in China

The impact of oropharyngeal dysphagia (OD) on older adults is recognized in Western countries but has not received sufficient attention in China. The dysphagia handicap index (DHI) scale is an OD quality-of-life evaluation instrument. This study evaluated the psychometric properties of the Chinese version of DHI scale in older Chinese adults. A total of 600 older adults were recruited from five nursing homes in one city to complete the 25-item scale. The reliability and validity of the scale were evaluated: internal consistency was investigated using Cronbach's alpha; test-retest reliability was evaluated using the intraclass correlation coefficient; the content validity of the scale was evaluated using content validity ratio; and the factor structure was examined using an exploratory factor analysis, principal component analysis, and confirmatory factor analysis. The scale was divided into three subscales: physical, functional, and emotional. Cronbach's alpha was 0.97 for the entire scale and between 0.89 and 0.94 for the three subscales. The item-to-total correlation coefficients for the three subscales were between 0.63 and 0.92, and the test-retest correlation coefficient was 0.87. The content validity was 0.93. In the factor analysis, these three factors accounted for 75.3% variance of 25 items. The confirmatory factor analysis was significant (p < 0.0001). The Chinese version of dysphagia index scale had good reliability and validity. Thus, it can provide a subjective evaluation of older adults with OD and can be used by clinicians to improve the outcomes of older adults with OD.

Objective dysphagia is very common after radiotherapy in oropharyngeal cancer patients

OBJECTIVE

Dysphagia is one of the most serious adverse events in the treatment of head and neck cancer. This cross-sectional study aimed to assess pharyngeal residue, and penetration/aspiration in oropharyngeal cancer patients (OPC) after radiotherapy using flexible endoscopic evaluation of swallowing (FEES).

METHODS

A total of 35 OPC patients who had received radio-(chemo) therapy (R(C)T), including 8 patients with primary R(C)T), were included and examined by FEES to determine the swallowing status and were asked to indicate their swallowing ability on a visual scale to reflect the problem perceived by the patient. During FEES the patients were given three standardized bolus consistencies and four test pills. Penetration, aspiration, and residue were evaluated and classified.

RESULT

Relevant dysphagia was present in 23/35 (66%) patients. Almost half of all patients (15/35) showed aspiration (53% (8/15) silent). Residue occurred in 91% but without correlation to aspiration. A significant association between dysphagia and impaired pill swallowing was found (P = .003) occurring in 20 of 35 patients. Even in patients with small tumors and without prior surgery severe dysphagia was found.

CONCLUSIONS

Severe dysphagia is frequent after R(C)T affecting more than half of the patients with OPC. The frequent impaired pill swallowing ability should be considered Therefore, regular dysphagia diagnostics in the follow-up setting are advisable to initiate appropriate treatment and raise patients' quality of life, prevent aspiration pneumonia, and improve overall outcomes after tumor therapy.

Validity and Reliability of the Swedish Version of the Gugging Swallowing Screen for use in Acute Stroke Care

The purpose of this study was to cross-culturally validate the Swedish version of the Gugging Swallowing Screen (GUSS-S) for use in the acute phase of stroke. Further, to evaluate the inter-rater reliability between different healthcare professionals. GUSS was translated into Swedish using a forward-backward method followed by expert rating to obtain content validity. For criterion validity, the GUSS-S score was compared with Flexible Endoscopic Evaluation of Swallowing (FEES) assessed with the Penetration-Aspiration Scale (PAS) in acute stroke patients (≤ 96 h after stroke onset). Convergent validity was calculated by comparison with the Functional Oral Intake Scale (FOIS) as per the comprehensive FEES assessment, the Standardized Swallowing Assessment (SSA), and the National Institutes of Health Stroke Scale (NIHSS). To evaluate inter-rater reliability, a nurse and a speech-language pathologist (SLP) independently assessed 30 patients. In total, 80 patients (32 women, median age 77 years (range 29-93) were included, mean 1.7 ± 0.9 days after admission. With a cut-off value of 14 points, the GUSS-S identified aspiration with a sensitivity of 100% and a specificity of 73% (area under the curve: 0.87, 95% CI 0.78-0.95). Spearman rank correlation showed very strong correlation between the GUSS-S and PAS (rs=-0.718, P = < 0.001) and FOIS (rs=0.720, P = 0.001) and strong correlation between the GUSS-S and SSA (rs=0.545, P = < 0.001) and NIHSS (rs=-0.447, P = 0.001). The inter-rater agreement for GUSS-S was substantial (Kw=0.67, P = < 0.001). The results indicate that the GUSS-S is a valid and reliable tool for the assessment of dysphagia in acute stroke patients by different healthcare professionals.

An accelerometry and gyroscopy-based system for detecting swallowing and coughing events

Measuring spontaneous swallowing frequencies (SSF), coughing frequencies (CF), and the temporal relationships between swallowing and coughing in patients could provide valuable clinical insights into swallowing function, dysphagia, and the risk of pneumonia development. Medical technology with these capabilities has potential applications in hospital settings. In the management of intensive care unit (ICU) patients, monitoring SSF and CF could contribute to predictive models for successful weaning from ventilatory support, extubation, or tracheal decannulation. Furthermore, the early prediction of pneumonia in hospitalized patients or home care residents could offer additional diagnostic value over current practices. However, existing technologies for measuring SSF and CF, such as electromyography and acoustic sensors, are often complex and challenging to implement in real-world settings. Therefore, there is a need for a simple, flexible, and robust method for these measurements. The primary objective of this study was to develop a system that is both low in complexity and sufficiently flexible to allow for wide clinical applicability. To construct this model, we recruited forty healthy volunteers. Each participant was equipped with two medical-grade sensors (Movesense MD), one attached to the cricoid cartilage and the other positioned in the epigastric region. Both sensors recorded tri-axial accelerometry and gyroscopic movements. Participants were instructed to perform various conscious actions on cue, including swallowing, talking, throat clearing, and coughing. The recorded signals were then processed to create a model capable of accurately identifying conscious swallowing and coughing, while effectively discriminating against other confounding actions. Training of the algorithm resulted in a model with a sensitivity of 70% (14/20), a specificity of 71% (20/28), and a precision of 66.7% (14/21) for the detection of swallowing and, a sensitivity of 100% (20/20), a specificity of 83.3% (25/30), and a precision of 80% (20/25) for the detection of coughing. SSF, CF and the temporal relationship between swallowing and coughing are parameters that could have value as predictive tools for diagnosis and therapeutic guidance. Based on 2 tri-axial accelerometry and gyroscopic sensors, a model was developed with an acceptable sensitivity and precision for the detection of swallowing and coughing movements. Also due to simplicity and robustness of the set-up, the model is promising for further scientific research in a wide range of clinical indications.

Optimizing Tilapia-based surimi ink for 3D printing: Enhancing physicochemical properties and printability with Ulva powder

The elderly face malnutrition and dysphagia. 3D printing with high-protein surimi offers an innovative way to customize nutrition and texture of foods for the elderly. This study explored whether tilapia-based surimi ink (TBSI) with Ulva powder (UP, 0-3 %) could improve physicochemical properties and printability as an alternative to traditional pollock-based surimi ink (PBSI). TBSI showed a more uniform microstructure, greater water-holding capacity (WHC), and better printability with consistent extrusion than PBSI. Adding UP to TBSI promoted cross-linking and enhanced microstructure and WHC. Rheological analysis revealed that all inks exhibited shear-thinning behavior. UP increased complex viscosity, storage modulus, and loss modulus. Notably, UP above 2 % improved protein matrix uniformity, structural integrity, and printability, as confirmed by FT-IR and 3D printing tests. The hardness of steamed TBSI fish cake increased when infill density increased. This study highlights the potential of TBSI with UP for 3D printing to prepare personalized and elderly-friendly food.

The Impact of Home Enteral Tube-Feeding on the Intent and Experience of Going Out in Public: A Qualitative Study on Patients' and Caregivers' Perspectives

BACKGROUND

Individuals on tube-feeding experience significant lifestyle changes and social isolation, but the barriers and support for travelling out while on tube-feeding to reintegrate into the community have not been studied. This research explores the factors influencing the decisions of individuals on tube-feeding and their carers to travel outside of their homes, their experiences, and perceived barriers and support when performing tube-feeding in public settings.

METHODS

A qualitative design using purposive sampling explored the experiences of three individuals and five carers living at home on long-term tube-feeding. One-to-one semi-structured interviews were conducted and transcribed. Thematic analysis was conducted via open coding and merging of recurring codes to form themes.

RESULTS

Six themes emerged: (1) Motivators and deterrents to going out: Motivators include desire for social normalcy. Deterrents include physical health, logistics and psychosocial considerations, such as fear of negative public perception and the loss of travelling and dining as motivating social activities. (2) Going out requires meticulous preparation and planning. (3) Inadequate tube-feeding facilities in the community contribute to ambivalence and discomfort to tube-feeding outside. Participants must accept potential negative emotions when confronted with public reaction to tube-feeding. (4) Ideal tube-feeding facilities should be private and hygienic, in highly frequented locations. (5) Community support and awareness are needed to support tube-feeding. (6) Adaptability is crucial when satisfactory feeding locations are absent during local and overseas travel.

CONCLUSIONS

Carers and healthcare professionals are pivotal in encouraging patients to disregard public curiosity, planning tube-feeding logistics, and advocating for the right to tube feed in public spaces without shame. Public awareness, carer support, and availability of tube-feeding facilities should be improved for patients to live, work and engage meaningfully in the community.

Screening for dysphagia in older people: A validation study of the psychometric properties of the Danish 4 Question Test (4QT-DK)

AIM

The four-item questionnaire test (4QT) is a simple screening measure of dysphagia for older people. A positive answer to any item indicates the need for further assessment. The 4QT is fast, simple to apply and requires no training beforehand. However, it is not translated to Danish, and the psychometric properties in an older Danish population are unknown. The aim was to translate the 4QT to Danish, determine criterion validity according to the existing measures, the Minimal Eating Observation Form-II (MEOF-II) and Volume-Viscosity Swallow Test (V-VST), and determine construct and structural validity and reliability by exploring whether 4QT fits the assumptions of the Rasch model.

METHODS

The 4QT was translated and back-translated. A total of 73 participants aged ≥65 years were included and screened with the 4QT-DK, and assessed using the V-VST and MEOF-II. Criterion validity was assessed compared with the V-VST and MEOF-II according to sensitivity, specificity and predictive values. Construct and structural validity were examined using confirmatory factor analysis and Rasch model analysis investigating item and person fit, differential item functioning for sex, age, primary disease and local dependency. Reliability was assessed using Cronbach's coefficient alpha.

RESULTS

For criterion validity, the 4QT-DK showed high sensitivity (84% and 90% with the V-VST and MEOF-II, respectively). As expected, specificity was lower (36%, and 42%). Analyses confirmed the psychometric validity of the 4QT-DK. Reliability was low (Cronbach's alpha = 0.58) due to the number of items.

CONCLUSION

The 4QT-DK is a valid and sensitive measure for screening older people for dysphagia. Further studies are required to assess the psychometric properties and confirm findings in a larger Danish sample. Geriatr Gerontol Int 2025; 25: 294-299.

Incidence, Risk Factors, and Outcomes of Recurrent Laryngeal Nerve Injury and Dysphonia Following Anterior Cervical Spine Surgery: A Systematic Review and Meta-Analysis

Anterior cervical spine surgery (ACSS) is an effective treatment for various cervical spine conditions but carries a risk of recurrent laryngeal nerve (RLN) injury and dysphonia. This systematic review and meta-analysis aimed to evaluate the incidence of these complications and their associated risk factors. An analysis of 17 studies involving 5,706 patients revealed a pooled RLN injury incidence of 3.41% and a dysphonia incidence of 2.5%. Prolonged surgeries exceeding two hours and multilevel procedures were associated with higher risks, while implant material demonstrated minimal impact. These findings highlight the importance of surgical planning to mitigate RLN injury risk and improve patient outcomes in ACSS.

Development of a Screening Intervention for Dysphagia in Hospitalised Geriatric Patients

Prevalence of dysphagia is high in hospitalised geriatric patients, posing risks of complications including malnutrition, dehydration, aspiration, and pneumonia. These complications may lead to reduced daily functioning, frailty, prolonged hospital stays, readmissions, and mortality. Diagnosing dysphagia in geriatric patients is often challenging due to the complex health conditions of this patient group, and overall these patients are at risk of lack of continuity in patient pathways and unnecessary hospitalisations. Recognising the critical importance of prompt diagnosis and treatment of dysphagia, we developed a dysphagia screening intervention aligned with clinical guidelines and the political focus to improve patient pathways and reduce preventable hospitalisations. This article outlines the development process of a dysphagia screening intervention to geriatric patients (≥ 65 years) admitted to medical inpatient wards. We applied a theory-, evidence- and implementation-based approach combined with stakeholder involvement in adherence to the IdentifyiNg and assessing different approaches to DEveloping compleX intervention (INDEX) guidance, encompassing eleven actions. We developed a dysphagia screening intervention comprising a screening procedure (the 4 Questionnaire Test (4QT), the 30 ml water swallowing test, and an action algorithm) targeting the patient level. Moreover, we developed an implementation strategy (activities necessary for adequate delivery of the dysphagia screening procedure and activities supporting the delivery of the screening procedure) targeting health professionals and the organisational level. The dysphagia screening intervention is now ready for feasibility testing, promising improved health and healthcare services for hospitalised geriatric patients.

Perspectives of Hospital Medicine Providers on the Management of Oropharyngeal Dysphagia in Patients with Dementia

BACKGROUND

Oropharyngeal dysphagia (dysphagia) is a common (up to 86%) and devastating syndrome in hospitalized older adults with dementia.

OBJECTIVE

To describe the perspectives of dysphagia management in hospitalized patients with dementia among hospital medicine providers (i.e., hospitalists, internal medicine residents, and advanced practice providers, APPs).

DESIGN

An anonymous cross-sectional survey study across a large health system in the greater New York metropolitan area PARTICIPANTS: Surveys were distributed to hospitalists, internal medicine residents, and APPs via a multimodal approach. Survey questions were created by an interprofessional team consisting of hospitalists, a geriatrician, and a geriatrics-trained APP.

MAIN MEASURES

Survey questions assessed current practices and perceptions of dysphagia management in patients with dementia.

KEY RESULTS

Of 104 surveys completed, 62.1% were hospitalists, 24.3% were APPs, and 13.6% were residents. Nursing report (61.0%) was the most common way providers found out about suspected dysphagia. The vast majority (85.0%) always/often consulted a Speech-Language Pathologist (SLP) for suspected dysphagia evaluation. Over a third (39.8%) rarely/never discussed goals of care before consulting a SLP. Provider perceptions of the risks/benefits of dysphagia diets varied widely: dysphagia diets in patients with dementia improve quality of life (strongly disagree/disagree 33.0%, neither agree or disagree 31.1%, strongly agree/agree 35.9%); dysphagia diets in patients with dementia reduce the risk of mortality (strongly disagree/disagree 33.0%, neither agree or disagree 22.3%, strongly agree/agree 44.7%). Lastly, only 64% thought there was enough evidence to recommend against a PEG in patients with advanced dementia.

CONCLUSION

Our study highlights the need for standardizing dysphagia management best practices in hospitalized patients with dementia, the importance of addressing goals of care, and provider education on the risks and benefits of dysphagia diets and artificial nutrition via PEG tube.

Effects of Capsaicin on Masticatory and Swallowing Function

INTRODUCTION

Recent studies have shown that capsaicin improves the pharyngeal swallowing reflex. However, the mechanism by which capsaicin alters mastication and oesophageal function remains unclear. This study aimed to investigate the effects of capsaicin on masticatory and oesophageal function.

MATERIALS AND METHODS

Participants were 12 healthy individuals (7 men, 5 women: aged 31.5 ± 3.0 years). The participants ingested five rice cakes without capsaicin and then five rice cakes containing capsaicin. Total mastication frequency, total mastication time, and mastication rate were measured. Pharyngeal and upper oesophageal sphincter (UES) parameters were evaluated using high-resolution manometry (HRM). The masticatory and HRM parameters were compared between the ingestion of capsaicin-containing and non-capsaicin containing rice cakes.

RESULTS

The total mastication frequency and total mastication time(s) for capsaicin ingestion were significantly smaller (20.3 ± 9.4 vs. 22.4 ± 7.4; p = 0.011) and shorter (14.2 ± 7.0 vs. 15.4 ± 5.6; p = 0.038), respectively, than those for non-capsaicin ingestion. Comparison of the HRM parameters revealed significantly higher hypopharyngeal contractile integral (mmHg-s-cm) (56.6 ± 40.7 vs. 49.7 ± 43.6; p = 0.016) and proximal oesophageal contractile integral (mmHg-s-cm) (492.3 ± 292.64 vs. 381.2 ± 266; p < 0.001), significantly shorter UES basal pressure (mmHg) (93.6 ± 37.8 vs. 114.5 ± 43.4; p < 0.001), and significantly longer UES relaxation time (ms) (486.7 ± 90.7 vs. 431.2 ± 82.3; p < 0.001) for capsaicin ingestion than for non-capsaicin ingestion.

CONCLUSIONS

Decreased mastication frequency and time, increased hypopharyngeal and proximal oesophageal contractile integral, and prolonged UES opening time with capsaicin ingestion suggests that capsaicin improves oral, pharyngeal and oesophageal phases of swallowing.

Application of Orofacial Muscle Strength Measurement to Screen for Penetration/Aspiration Risk in Older Adults With Sarcopenia: A Diagnostic Accuracy Study

BACKGROUND

Early identification of penetration/aspiration (P/A) risk in older adults with sarcopenia is crucial to prevent complications and maintain quality of life.

PURPOSE

To evaluate the diagnostic utility of orofacial muscle strength measurements for predicting the risk of P/A in older adults with sarcopenia.

METHODS

In this observational and prospective study, we collated consecutive data from community-dwelling older adults diagnosed with sarcopenia at a musculoskeletal disorder clinic. Altogether, 54 participants underwent orofacial muscle strength measurements (the index test) using the Iowa Oral Performance Instrument and a videofluoroscopic swallowing study (VFSS) (the reference test) to evaluate for the presence of P/A. Receiver operating characteristic (ROC) curve analysis was performed to determine orofacial muscle strength based on P/A.

RESULTS

Overall, 34 patients showed penetration in the VFSS, although none of the patients showed signs of aspiration. The cut-off for tongue strength to identify the risk of P/A was ≤ 20.5 kPa, with a sensitivity and specificity of 0.75 and 0.74, respectively; the area under the curve (AUC) was 0.88. The cut-off for buccinator strength was ≤ 19.5 kPa, with a sensitivity and specificity of 0.65 and 0.68, respectively, with an AUC of 0.69. The cut-off for lip muscle strength was ≤ 18.5 kPa, with a sensitivity and specificity of 0.65 and 0.71, respectively, with an AUC of 0.69.

CONCLUSION

The evaluation of buccinator and lip muscle strength did not demonstrate sufficient diagnostic utility for detecting the risk of P/A in older patients with sarcopenia; however, tongue strength showed reliable diagnostic utility for identifying the risk of P/A.

Fish Protein Hydrolysate as Protein Enrichment in Texture-Modified Salmon Products

The aim of this study was to develop a chilled, texture-modified salmon product for dysphagia patients, enriched with dairy and fish hydrolysate proteins. The challenge was to create a product with appealing sensory qualities and texture that meets level 5 (minced & moist) of the IDDSI framework. Atlantic salmon (Salmo salar) was heat-treated (95 °C/15 min), blended, and reconstructed by adding texture modifiers, casein and whey protein, and enzymatically derived fish hydrolysate. The products were packaged in oxygen-free plastic trays, heat-treated to a core temperature of 95 °C for 15 min, chilled and stored at 4 °C for 29 days and analyzed for microbiology, instrumental texture, and sensory properties. The texture analyses showed that products with fish protein hydrolysate were softer than those only with casein and whey protein, a result also confirmed by the IDDSI fork pressure test. Quantitative descriptive analysis of salmon products revealed significant differences (p < 0.05) in sensory attributes within flavour (fish flavour), and texture (softness and adhesiveness) but there was no significant change in bitterness. The shelf-life study at 4 °C showed good microbiological quality of the product, and safety after 29 days with appealing sensory and textural properties, i.e., a product at IDDSI level 5 for age care facilities and commercial production was obtained.

Microbiome and Communication Disorders: A Tutorial for Clinicians

PURPOSE

Emerging research in the field of microbiology has indicated that host-microbiota interactions play a significant role in regulating health and disease. Whereas the gut microbiome has received the most attention, distinct microbiota in other organs (mouth, larynx, and trachea) may undergo microbial shifts that impact disease states. A comprehensive understanding of microbial mechanisms and their role in communication and swallowing deficits may have downstream diagnostic and therapeutic implications.

METHOD

A literature review was completed to provide a broad overview of the microbiome, including differentiation of commensal versus pathogenic bacteria; cellular mechanisms by which bacteria interact with human cells; site-specific microbial compositional shifts in certain organs; and available reports of oral, laryngeal, and tracheal microbial dysbiosis in conditions that are associated with communication and swallowing deficits.

RESULTS/CONCLUSIONS

This review article is a valuable tutorial for clinicians, specifically introducing them to the concept of dysbiosis, with potential contributions to communication and swallowing deficits. Future research should delineate the role of specific pathogenic bacteria in disease pathogenesis to identify therapeutic targets.

Oropharyngeal dysphagia impact of pneumonia risk in neurological patients receiving enteral tube feeding: Insights from a gastroenterologist

BACKGROUND

Oropharyngeal dysphagia is prevalent among neurological patients, often necessitating enteral tube feeding with a nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG). These patients are at significant risk of developing aspiration pneumonia. This study aimed to assess the impact of oropharyngeal dysphagia on pneumonia risk requiring hospitalization in neurological patients on long-term enteral tube feeding.

METHODS

This retrospective observational study was conducted between 2015 and 2022. It included neurological patients who underwent upper gastrointestinal endoscopy combined with a Modified Flexible Endoscopic Evaluation of Swallowing (mFEES) for suspect dysphagia, characterized by difficulty or discomfort in swallowing. Participants were either orally fed or had been on long-term enteral tube feeding via NGT or PEG. A 2-year follow-up was conducted to monitor pneumonia cases requiring hospitalization. Multivariate analyses were conducted to identify risk factors for pneumonia requiring hospitalization.

KEY RESULTS

A total of 226 orally fed and 152 enteral tube-fed patients were enrolled. Multivariate analyses showed a significantly increased risk of pneumonia in patients with a history of pneumonia and those receiving enteral tube feeding. Subgroup analysis indicated a significantly lower risk of pneumonia among enteral tube-fed patients with oropharyngeal dysphagia who PEG-fed patients compared to NGT-fed patients (adjusted HR: 0.21, 95% CI: 0.10-0.44, p < 0.001). The cumulative incidence of pneumonia requiring hospitalization was significantly lower in the PEG group than in the NGT group (p < 0.001).

CONCLUSION

mFEES could be a screening tool for oropharyngeal dysphagia. PEG is preferred over NGT for long-term enteral feeding, as it significantly reduces the risk of pneumonia requiring hospitalization, especially in patients with oropharyngeal dysphagia.

Preoperative dysphagia and adverse postoperative outcomes in middle aged and older adults

BACKGROUND

Dysphagia is a swallowing impairment with adverse health consequences. The impact of preoperative dysphagia on postoperative outcomes is not known. This study will examine the association between preoperative dysphagia and postoperative outcomes.

METHODS

This is a retrospective, observational study of patients ≥50 years of age undergoing surgery not directly involving the swallowing mechanism (i.e., oral cavity, larynx, pharynx, or esophagus). The National COVID Cohort Collaborative (N3C) database from January 1st, 2020 to August 31st, 2023 was used. The N3C database comprises electronic health record (EHR) data from more than 75 US health systems and harmonizes these data in a centralized resource. The main predictor was dysphagia with or without malnutrition in the 3 months prior to surgery. Logistic regression models assessed the association between our main predictor and outcomes of mortality, readmission, and medical/surgical complications adjusted for covariates. A negative binomial regression model was used for length of stay (LOS).

RESULTS

380,869 adults ≥50 years old were included, mean age 66.0 (SD = 9.2), 52.6 % male. 7.9 % had dysphagia and/or malnutrition 3 months preoperatively including 3.0 % preoperative dysphagia alone, 3.8 % preoperative malnutrition alone, and 1.1 % both. Adjusted models demonstrated higher odds of mortality (1-year mortality odds ratio (OR) 1.37, 95 % confidence interval (CI) 1.29 to 1.44), readmission (90-day readmission OR 1.19, 95 % CI 1.14 to 1.24), and medical/surgical complications (OR 1.35, 95 % CI 1.28 to 1.42) among patients with 3 months preoperative dysphagia with or without malnutrition compared to patients with neither condition.

CONCLUSION

Patients with 3 months preoperative dysphagia with and without malnutrition had poor postoperative outcomes. These findings highlight the rationale for integrating dysphagia screening and intervention into routine preoperative protocols to mitigate the risk of adverse postoperative outcomes.

Evaluation of the performance of screening tools for dysphagia in older adults: A diagnostic meta-analysis

This systematic review evaluated the diagnostic accuracy of multiple screening tools for dysphagia in older adults. The analysis covered 30 studies involving 13 tools and 2,697 participants. The results showed that the volume viscosity swallow test performed best in sensitivity, specificity, and area under the curve, making it a recommended screening tool. Other tools have low sensitivity, unstable results or insufficient research and need to be further validated. Overall, this study provides an important reference for the screening of dysphagia in older adults.

Transoral Laser Microsurgery and Transoral Robotic Surgery in Aging Patients: A State-of-The-Art Review

Purpose

In the present study, the findings related to the epidemiology, clinical presentation, and therapeutic outcomes of elderly patients treated with transoral laser microsurgery (TOLM) and transoral robotic surgery (TORS) for supraglottic laryngeal squamous cell carcinoma (LSCC) have been reviewed.

Methods

A PubMed, Cochrane Library, and Scopus literature search was conducted according to the PRISMA statements. Critical literature analysis was carried out considering the last advancement in TOLS and TORS, and their related surgical, functional, and survival outcomes.

Findings

The mean age of patients with supraglottic LSCCs has progressively increased in the past decades. The data on postoperative complications in elderly patients with LSCC are heterogeneous and contradictory. The thought of the age-related high risk of complications was based on open supraglottic laryngectomy (SGL), but not on TOLM and TORS findings, which do not support an age-related increase of most postoperative complications. The only complication that could be associated with age is aspiration. The adequate selection of patients undergoing TOLM or TORS, and the pre- to postoperative evaluation of swallowing function can prevent this risk. The OS of elderly patients treated with TOLM or TORS SGL could be lower compared to younger patients. However, the disease-free survival was not influenced by age, highlighting the role of comorbidities and intercurrent diseases in the presumed lower survival. The survival analysis could definitively consider the physiological age rather than the chronological age to investigate the impact of age on survival outcomes.

Conclusion

The current literature supports an important place of TOLM and TORS in managing cT1-T3 supraglottic LSCC. The preoperative geriatric, nutritional, and swallowing evaluations are important for ensuring an adequate selection of patients treated with TORS or TOLM SGL.

Prevalence of Self-Reported Swallowing Difficulties and Swallowing-Related Quality of Life Among Community-Dwelling Older Adults in India

Self-reported swallowing difficulties are highly prevalent but underreported among older adults. The aging population in India is increasing, yet there is a lack of empirical data on self-reported swallowing difficulties in older adults. In the present study, we aimed to estimate the prevalence of self-reported swallowing difficulties and assess the swallowing-related quality of life (QOL) among community-dwelling older adults in India. We recruited 361 older adults (60-91 years) from the community. Participants completed the Eating Assessment Tool-10 (EAT-10) to assess self-reported swallowing difficulties and the Dysphagia Handicap Index (DHI) to assess swallowing-related QOL. Participants rated the EAT-10 from 0 for 'no problem' to 4 for 'severe problem'. The DHI rating included 0 for 'never', 2 for 'sometimes', and 4 for 'always'. The total scores of EAT-10 and DHI were summarised using descriptive statistics. Statistically significant differences between pass-fail groups of EAT-10 and DHI were evaluated using an independent t-test and multivariate analysis of variance test, respectively. The overall mean score for EAT-10 was 3.34, and 7.56 for DHI, with higher scores observed among females. 36.6% of older adults self-reported experiencing swallowing difficulties, while 47.4% self-reported having poor swallowing-related QOL at p < 0.05. A strong positive correlation (r = 0.86) was found between EAT-10 and total DHI scores at p < 0.001. The present study sheds light on the widespread yet underreported issue of self-reported swallowing difficulties and the impact on swallowing-related QOL among older adults in India. These findings emphasize the urgent need for early swallowing screening programs among older adults.

The Chinese version of the Ohkuma questionnaire: reliability analysis and diagnostic value

BACKGROUND

While the Ohkuma questionnaire is a simple, reliable, and easy-to-use tool to assess dysphagia, none of its versions can be used by the Chinese population.

OBJECTIVE

The purpose of this study was to evaluate the internal consistency, reliability and clinical validity of a newly made Chinese version of the Ohkuma questionnaire, and to provide some objective basis for its application in screening dysphagia.

MATERIALS AND METHODS

From September 21 to June 2022, 96 patients with dysphagia and 89 asymptomatic subjects were recruited from three hospitals in China to form an observation and a control group, respectively. All subjects completed the Ohkuma questionnaire, Eating Assessment Tool-10, and a Video Fluoroscopy Study of Swallowing.

RESULTS

The Cronbach's α coefficient measured in the questionnaire was 0.867, indicating acceptable internal reliability. The analysis of variance generated four main factors to be assessed, showing a good aggregation effectiveness of the questionnaire. The AVE square root values of three factors were greater than the maximum absolute value of the correlation coefficients between factors, indicating good differentiation effectiveness. The sensitivity and specificity scores, together with the positive and negative likelihood as well as diagnostic odds ratios indicate a good reactivity of the questionnaire. Lastly, after adjusting for age and sex, the results of the stepwise linear regression analysis showed that there was a significant positive correlation between the Ohkuma questionnaire and the penetration aspiration scale.

CONCLUSIONS

The Chinese version of the Ohkuma questionnaire has good reliability and validity, and can be used as a rapid and effective screening tool for dysphagia.

Dysphagia Screening in Brazilian Older Adults with Dementia: Content Development and Validation of a Questionnaire for Caregivers - RaDID-QC

This study aims to develop and validate the content and response processes of a questionnaire intended for caregivers to screen for dysphagia in Brazilian older adults with dementia due to Alzheimer's disease and/or vascular dementia. The instrument items were developed in Brazilian Portuguese language based on the theoretical framework. A committee of speech-language-hearing therapists analyzed the relevance, objectivity, clarity, and understandability of the items with the Delphi method. The content validity index cutoff agreement score for experts' answers to validate each item in the questionnaire was 0.78; in the intraclass correlation coefficient, it was 0.75 for all items. For response process validity evidence, the questionnaire was applied to 30 caregivers of older adults with dementia, who judged the clarity and understandability of the items. Each item was validated when understood by at least 95% of participants. The first version of the instrument had 29 items. After two expert assessments, the last version had 24 items. The intraclass correlation coefficient was 0.85. Only one item needed semantic adjustments in the pre-test. The dysphagia screening instrument applied to caregivers of older adults with dementia was developed with adequate content and response process validity evidence, enabling adjustments in its construct. Future studies will analyze the remaining evidence of validity and reliability.

Prevention of Aspiration: Oral Care, Antibiotics, Others

Patients with aspiration pneumonia often develop this lung infection due to poor oral health or because the contents of the digestive tract or upper airway enter the lower airway traversing the larynx through different mechanisms. Prevention of this condition is directed at the mechanism by which it occurs. The elderly are the most likely to suffer from aspiration pneumonia, occasionally due to issues related to poor dental health, but more frequently due to abnormal swallowing, which may appear after a stroke, a functional impairment related to aging, or may be part of a specific disease such as Parkinson's disease or some other nervous system condition. People with dysphagia complicated by pneumonia have limited feeding and become debilitated, and aspiration pneumonia in these individuals has a high mortality rate at 90 days. Dietary modifications, assistance with feeding, use of postures that facilitate a normal deglutition, rehabilitation, and use of medications to improve swallowing defects are the tools of medicine to overcome the obstacles to swallowing normally and prevent the development of aspiration pneumonia and its consequences.