Abstract
Objectives
Dysphagia is a major healthcare problem as it increases the risk of malnutrition,
dehydration, aspiration pneumonia, and death. The aims of this analysis of data from
nursing homes (NHs) worldwide were to examine prevalence rates of dysphagia, to identify
characteristics of residents with dysphagia, and to describe which type of nutrition
residents with dysphagia receive.
Design
One-day cross-sectional study, repeated in yearly intervals since 2007.
Setting
926 NH units from 19 countries.
Participants
NH residents participating in the nutritionDay between 2007 and 2014, aged 65 years
or older, from Europe and North America, and with available information on dysphagia.
Measurements
Data on resident and unit level were collected on nutritionDay by local nursing staff
using standardized questionnaires. Residents' nutritional status, nutritional intake,
general residents’ characteristics, and unit characteristics were of interest as potential
predictors of dysphagia (no vs yes). Univariable generalized estimating equations
were performed for all variables, and significant predictors (P < .01) included in a multivariable analysis. Nutritional strategies (type of diet,
use of oral nutritional supplements, tube feeding, and parenteral nutrition) are described
for residents with and without dysphagia.
Results
Dysphagia was reported in 13.4% of the 23,549 residents included, with great variation
in the prevalence rates between participating countries. Twelve variables of 23 remained
in the multivariable model [area under the receiver operating curve = 0.898; 95% confidence
interval (CI) 0.892–0.904; P < .001]. Residents who were not able to eat lunch orally on nutritionDay were 14.90
[odds ratio (OR); 95% CI 9.61–23.11] times more likely to have dysphagia compared
with residents who ate everything. ORs of dysphagia were higher for residents with
chewing problems (OR 10.48; 95% CI 8.98–12.23), immobile (OR 5.10, 95% CI 4.25–6.11)
and partially mobile residents (OR 1.94; 95% CI 1.64–2.29) compared to mobile residents,
and residents with severe cognitive impairment (OR 1.99; 95% CI 1.64–2.42). Poor nutritional
status, digestive diseases, neurologic diseases, dehydration, and use of antibiotics
were also related to a higher risk of dysphagia. The most common nutritional strategy
for residents with dysphagia was providing texture-modified diet (42.5%) followed
by normal diet (28.2%). One-quarter of residents with dysphagia received oral nutritional
supplements additionally, 7.4% of residents with dysphagia received tube feeding exclusively,
and 8.0% in combination with oral nutrition.
Conclusions
This analysis of NHs participating in the nutritionDay provides important insight
into the current awareness of dysphagia, associated factors, and nutritional strategies.
Residents who were unable to eat orally, malnourished, or dehydrated suffered more
often from dysphagia, which substantiates the challenges of providing safe and adequate
nutrition for residents with dysphagia. Adequacy and efficiency of different nutritional
strategies need to be clarified in future studies.
Keywords
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Article info
Publication history
Published online: October 10, 2017
Footnotes
The nutritionDay project is funded by the Medical University of Vienna, the Austrian Society for Clinical Nutrition (AKE), and the European Society for Clinical Nutrition and Metabolism (ESPEN).
MS was financially supported by the Medical Nutrition International Industry (MNI). MNI was not involved in study concept, data analysis and interpretation.
The authors declare no conflicts of interest.
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© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
