Accuracy of tongue strength, endurance, and pressure using Iowa oral performance instrument and predictors of dysphagia in community-dwelling older adults: a cross-sectional study
Background
Decreased tongue strength, pressure, and endurance are key indicators in determining oropharyngeal dysphagia (OD). This study aimed to examine the accuracy of the Iowa Oral Performance Instrument (IOPI) in assessing tongue strength, endurance, and pressure, and to identify predictors of OD.
Methods
In this study, we analyzed data of community-dwelling older adults (age ≥ 65 years) collected between March to December 2022. The accuracy for IOPI was examined with Receiver operating characteristic curve using area under the ROC curve (AUC), sensitivity (Se) and specificity (Sp) and optimal cutoff with Youden index (J). Bivariate and multivariate logistic regression analysis for predictors of OD were performed presenting odds ratio (OR) with 95% confidence interval (CI).
Results
The cohort consisted of 85 older adults with mean age of 83.25 years (SD 6.76), of which 64 (75.3%) were female. The prevalence of OD using EAT-10 was 8.3%. Tongue strength demonstrated better diagnostic accuracy using anterior tongue strength (ATS): cut-off: 37.5 kPa (AUC: 0.79, Se: 0.86, and Sp: 0.65) and posterior tongue strength: cut-off: 31.5 kPa (AUC: 0.73, Se: 0.71, and Sp: 0.79). Tongue endurance demonstrated better diagnostic accuracy using anterior endurance target second (ATE-Target Sec): cut-off: 2.4 (AUC: 0.96, Se: 0.86, and Sp: 0.90), PTE-Target Sec: cut-off: 1.7 (AUC: 0.93, Se: 0.86, and Sp: 0.83), ATE-Target Max with cut-off: 34.4 kPa (AUC 0.81, Se = 0.86, and Sp = 0.64), and PTE-Target Max with cut-off: 29.5 kPa (AUC: 0.77, Se = 0.86, and Sp = 0.69). Tongue pressure revealed limited diagnostic accuracy using saliva swallowing pressure with cut-off: 23.3 kPa (AUC: 0.60) and effortful swallowing pressure with cut-off: 28.5 kPa (AUC: 0.62). Significant predictors for OD were frailty (3.02, 95%CI: 1.56–5.88), age (1.17, 95%CI: 1.01–1.35), nutritional status (0.72, 95%CI: 0.57–0.92), ATS (0.86, 95%CI: 0.77–0.97), ATE-Target Max (0.90, 95%CI: 0.84–0.97), PTE-Target Max (0.92, 95%CI: 0.86–0.99), ADL (0.91), IADL (0.67), and depression (1.32).
Conclusions
The findings suggest that tongue strength and endurance, measured by IOPI, are more effective parameters than tongue pressure, with frailty, age, nutritional status, ATS, ATE-Target Max, PTE-Target Max, ADL, IADL, and depression being essential for early screening of OD in community-dwelling older adults.
Clinical trial number
Not applicable.
