Relationship between Oral Health Status and Oropharyngeal Dysphagia in Older People: A Systematic Review

de Sire A., Ferrillo M., Lippi L., Agostini F., de Sire R., Ferrara P.E., Raguso G., Riso S., Roccuzzo A., Ronconi G., Invernizzi M., Migliario M.

Frailty is a highly prevalent condition in the elderly that has been increasingly considered as a crucial public health issue, due to the strict correlation with a higher risk of fragility fractures, hospitalization, and mortality. Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist leading to dehydration and malnutrition in these subjects. “Sarcopenic dysphagia” is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might be also related to poor oral health status. Moreover, the aging process is strictly related to poor oral health status due to direct impairment of the immune system and wound healing and physical and cognitive impairment might indirectly influence older people’s ability to carry out adequate oral hygiene. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, to frailty. In this scenario, sarcopenia, dysphagia, and oral health are closely linked sharing common pathophysiological pathways, disabling sequelae, and frailty. Thus, the aim of the present comprehensive review is to describe the correlation among sarcopenic dysphagia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features, to propose a comprehensive and effective management of elderly frail subjects.

Page M.J., McKenzie J.E., Bossuyt P.M., Boutron I., Hoffmann T.C., Mulrow C.D., Shamseer L., Tetzlaff J.M., Akl E.A., Brennan S.E., Chou R., Glanville J., Grimshaw J.M., Hróbjartsson A., Lalu M.M., et. al.

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.

Bourdiol P., Hennequin M., Peyron M., Woda A.

Before dealing with the role of occlusion in human mastication, this article presents mastication in healthy oral conditions considering two points of view: four-step food transport through the bucco-pharyngeal cavity, and food control at three checkpoints. Several methods to evaluate mastication are presented: number of posterior functional units, self-administered questionnaires, granulometry of the food bolus, physiologic methods, routine clinical evaluations. Evaluation of mastication evidences the wide and frequent variability of masticatory outcome and allows defining the concepts of capacity, incapacity and successful compensative adaptation. Evolving dental wear is an example of a change in occlusion with masticatory consequences even when dental wear occurs as a normal phenomenon. Several features of dental wear are reviewed such as the concomitant tooth displacements, the dental wear origin, its possible abnormalities and their repercussion on masticatory capacity / efficiency. Then, the question to be asked is to what extent malocclusion impacts chewing. The trivial claim that malocclusion has little impact on chewing is based on casual clinical situations. This statement does not take into account the broad variety of situations covered by the ill-defined term malocclusion. There is nothing in common between morphological malocclusions such as a limited anterior dental crowding and major malocclusions resulting, for example, from maxillofacial oncological surgery, aging related tooth loss, advanced carious disease, sudden severe cerebral palsy or chronic neuromuscular deficiencies. All shades are possible between these conditions. The description of how masticatory function adapts must also encompass the occlusal rehabilitation and the chosen therapeutic method. Finally, the impact of mastication on nutrition is examined.

Nishida T., Yamabe K., Honda S.

To investigate which domains of frailty are associated with dysphagia in community-dwelling elderly persons.Dysphagia is a common cause of aspiration pneumonia in frail elderly persons in Japan. Although frailty is considered to be multidimensional, it is unclear which domains of frailty affect dysphagia.The participants were 3475 independent Japanese elderly persons (≥65 years; 1555 men and 1920 women). A self-report questionnaire with a frailty checklist consisting of several domains (lifestyle, physical function, nutrition, oral function, homebound status, cognitive function and depressive mood) was used to determine the participants' characteristics. Dysphagia was defined as impaired swallowing in the oral function domain. To determine the associations between dysphagia and age, sex and the other domains on the frailty checklist, adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were calculated using multiple logistic regression analysis.The multiple logistic regression analysis showed that dysphagia was independently associated with female sex (AOR = 1.35; 95% CI = 1.08-1.68), chewing ability (AOR = 1.70; 95% CI = 1.32-2.18), oral dryness (AOR = 1.94; 95% CI = 1.48-2.54), physical function (AOR = 2.19; 95% CI = 1.66-2.90), cognitive function (AOR = 1.68; 95% CI = 1.34-2.12) and depressive mood (AOR = 1.82; 95% CI = 1.41-2.35).Dysphagia was independently associated with oral, physical, cognitive and psychological frailty. These results suggest that frailty prevention strategy including swallowing training might be useful for community-dwelling independent elderly persons aged ≥65 years.

Christmas C., Rogus‐Pulia N.

Swallowing problems, or dysphagia, are common as people age, and are associated with significant negative outcomes, including weight loss, pneumonia, dehydration, shortened life expectancy, reduced quality of life, and increased caregiver burden. In this article, we will discuss the complex process of swallowing in normal circumstances and with healthy aging, then review etiologies that contribute to dysphagia. We will discuss approaches to evaluating and treating dysphagia, providing relevant data where they are available. We highlight the desperate need for high-quality research to guide best practices in treating dysphagia in older adults. J Am Geriatr Soc 67:2643-2649, 2019.

Levenson S.A., Walker V.L.

Cuschieri S.

An observational study is a type of epidemiological study design, which can take the form of a cohort, a case–control, or a cross-sectional study. When presenting observational studies in manuscripts, an author needs to ascertain a clear presentation of the work and provide the reader with appropriate information to enable critical appraisal of the research. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines were created to aid the author in ensuring high-quality presentation of the conducted observational study. The original articles publishing the STROBE guidelines together with their bibliographies were identified and thoroughly reviewed. These guidelines consist of 22 checklist items that the author needs to fulfil before submitting the manuscript to a journal. The STROBE guidelines were created to aid the authors in presenting their work and not to act as a validation tool for the conducted study or as a framework to conduct an observational study on. The authors complying with these guidelines are more likely to succeed in publishing their observational study work in a journal.

Cichero J.

Reductions in muscle mass and strength are well known complications of advancing age. All muscles of the body are affected, including those critical to chewing and swallowing. A diagnosis of frailty and its features of weakness and unintentional weight loss are particularly relevant to the aging swallowing system. Age related changes to eating and swallowing function means that there is a natural tendency for elders to self-select ‘soft’ foods due to loss of dentition and fatigue on chewing. However, it is not well known that tooth loss and poor dental status is associated with increased choking risk, especially as people age. In fact, people over 65 years of age have seven times higher risk for choking on food than children aged 1–4 years of age. Texture modified foods are provided clinically to reduce choking risk and manage dysphagia. Although certain food textures offer greater swallowing safety, they significantly restrict food choice. This commentary paper will highlight age-related changes to the eating and swallowing system, noting especially those that are relevant for frail elders. Swallowing impairments also affect the ability to manage liquids, and aspiration risk in healthy and frail elders is also discussed. Modified food textures that are most often recommended by clinicians to maintain sufficient oral intake and reduce choking risk will be described, while also highlighting the nutritional challenges associated with these foods and offering some solutions. The ethical challenges associated with balancing the autonomy of choice of food textures with swallowing safety will be addressed.

Brochier C.W., Hugo F.N., Rech R.S., Baumgarten A., Hilgert J.B.

The study evaluated the association of the sociodemographic, behavioural variables and the oral conditions with the presence of oropharyngeal dysphagia in long-term care older persons.Due to the influence of ageing, swallowing may be altered both in people with natural teeth and in those who have dentures or tooth loss.This cross-sectional study evaluated 115 individuals older than 60 years, living in long-term care institutions of the State of Rio Grande do Sul in 2016. The diagnosis of dysphagia happen using a clinical speech evaluation, based on the research of signals and symptoms of alterations during deglutition, and on an oral sensory-motor evaluation. The dental clinical evaluation examined the oral cavity, teeth and dental prostheses, including a Xerostomia assessment. Poisson Regressions with robust variance was calculated were used to estimate crude and adjusted Prevalence Ratios(PR) and their IC95%.The sample was mostly comprised of older women (67.0%), with more than 81 years of age (44.3%) and edentulous (54.3%). Diagnosis of oropharyngeal dysphagia was verified in 60.9% of the participants. In the final model, older persons who presented no pair (PR=1.52(CI95%=1.02-2.40)) had a highest prevalence of oropharyngeal dysphagia, when compared to older persons who presented 8 to 14 mixed pairs, as well as those older persons who had more complaints related to symptoms of Xerostomia (PR=2.86(CI95% 1.58-5.18)).Institutionalised older persons with a poor oral health condition are associated with a higher prevalence of oropharyngeal dysphagia, as well as with the presence of Xerostomia.

Rech R., Baumgarten A., Colvara B., Brochier C., de Goulart B., Hugo F., Hilgert J.

To evaluate whether the oral functionality and the oral sensorimotor alterations are associated with oropharyngeal dysphagia in community-dwelling older persons and long-term care older residents.An exploratory study with 265 independent older persons of the southern state of Brazil. The diagnosis of dysphagia, as well as the condition of the oral sensorimotor system, was assessed by a speech-language therapist and the oral health status by a dentist. Poisson Regression with robust variance was used to calculate the crude and adjusted Prevalence Ratios (PR) and their respective confidence intervals of 95%.The mean age was 73.5 (±8.9) years, women represented 59.2% of the sample. The frequency of dysphagia in the studied population was 45.3% (n = 120), being more frequent in the long-term care older residents (62.5%; n = 75) than in the community-dwelling older persons (37.5%; n = 45). Individuals with four or more oral sensorimotor alterations (PR = 2.01; 95% CI 1.27-3.18), as well as those who presented a non-functional oral status (PR = 1.61; 95% CI 1.02-2.54) presented a higher frequency of dysphagia. Subgroup analysis indicates the same trend of results, when stratified by community-dwelling older persons and long-term older residents.A non-functional oral health status and oral sensorimotor alterations are associated with a higher prevalence of oropharyngeal dysphagia.

Wakabayashi H., Matsushima M., Ichikawa H., Murayama S., Yoshida S., Kaneko M., Mutai R.

This study aimed to examine the interrelationships among occlusal support, dysphagia, malnutrition, and activities of daily living in aged individuals needing long-term care. Cross-sectional study and path analysis. Long-term health care facilities, acute care hospitals, and the community. Three hundred and fifty-four individuals aged ≥ 65 years with dysphagia or potential dysphagia in need of long-term care. The modified Eichner Index, Dysphagia Severity Scale, Mini Nutritional Assessment Short Form, and Barthel index. The participants included 118 males and 236 females with a mean (standard deviation) age of 83 (8) years. A total of 216 participants had functional occlusal support with or without dentures. Of the total participants, 73 were within normal limits regarding the severity of dysphagia, 119 exhibited dysphagia without aspiration, and 162 exhibited dysphagia with aspiration. Only 34 had a normal nutritional status, while 166 participants were malnourished, and 154 were at risk of malnutrition. The median Barthel index score was 30. Path analysis indicated two important findings: occlusal support had a direct effect on dysphagia (standard coefficient = 0.33), and dysphagia was associated directly with malnutrition (standard coefficient = 0.50). Dysphagia and malnutrition were associated directly with impaired activities of daily living (standard coefficient = 0.57, 0.22). In aged individuals needing long-term care, occlusal support is associated directly with dysphagia and indirectly with malnutrition and activities of daily living via dysphagia.

Namasivayam-MacDonald A.M., Morrison J.M., Steele C.M., Keller H.

Malnutrition is a major cause of hospitalization for residents of long-term care facilities (LTC). Dysphagia is thought to contribute to malnutrition. Tongue weakness is suggested to predict poor food intake, longer meals, and dysphagia. We explored the relationships between tongue strength, dysphagia, malnutrition and mealtime outcomes in LTC residents. Data were collected from 639 LTC residents (199 male), aged 62–102 (mean 87). Maximum isometric tongue pressures (MIPs) and saliva swallow pressures (MSPs) were measured using the Iowa Oral Performance Instrument. Participants also completed the Screening Tool for Acute Neuro Dysphagia. Nutrition status was assessed using the Patient-Generated Subjective Global Assessment. A series of repeated meal observations provided measures of meal duration and calories consumed. Mean MIPs were 33 kPa (95% CI 29–37) and MSPs were 26 kPa (95% CI 23–29). The odds of showing signs of dysphagia were 3.7 times greater in those with MSPs less than 26 kPa (p < 0.05). The odds of being malnourished were almost double in those showing signs of dysphagia. Co-occurrence of dysphagia and malnutrition was seen in 29%. Residents with low MSPs also had significantly longer mealtime durations (MTD) (p < 0.05). Moreover, those with both low swallowing pressures and suspected dysphagia consumed fewer calories/minute (p < 0.05) and had significantly longer MTDs (p < 0.05). This study confirms associations between tongue weakness, signs of dysphagia, mealtime outcomes and malnutrition among LTC residents. These findings suggest that saliva swallow pressure measures may be helpful for early identification of dysphagia and nutritional risk in this population.

Ortega O., Martín A., Clavé P.

Oropharyngeal dysphagia (OD) is a condition recognized by the World Health Organization and defined as the difficulty or inability to move a bolus safely and effectively from the oral cavity to the esophagus, and can include aspirations, choking, and residue. OD is pandemic among different phenotypes of older people, affecting between 27% and 91% of the population 70 years or older. Although OD can be diagnosed by well-defined clinical methods and complementary explorations, in the clinical setting OD is seldom systematically screened and treated, and awareness among the medical/geriatric community is scarce. The etiology of OD in this population includes many concomitant risk factors with neurogenic and neurodegenerative processes, muscular weakness, and sarcopenia. The pathophysiology includes mechanical deficits in the swallow response (mainly delayed laryngeal vestibule closure time and weak tongue thrust), reduced pharyngeal sensitivity, and sensory/motor central nervous system impairments. Recently, OD has been recognized as a geriatric syndrome due to its high prevalence and its relationship with many comorbidities and their poor outcomes, including malnutrition, respiratory infections and aspiration pneumonia, functional disability and frailty, institutionalization and increased readmissions, and mortality. There is an evidence-based and effective treatment for OD in the elderly mainly oriented to compensating swallow impairments through adaptation of fluid viscosity and solid food textures to avoid aspiration and choking, and improving nutritional status and oral health to avoid respiratory infections. This has been defined as the minimal effective treatment to be provided to this population. New treatments aiming at recovering the swallowing function are under research with promising results, and the near future will provide us with methods to stimulate the swallow response with pharmacological or physical stimuli.

Inui A., Takahashi I., Kurauchi S., Soma Y., Oyama T., Tamura Y., Noguchi T., Murashita K., Nakaji S., Kobayashi W.

Peyron M.A., Woda A., Bourdiol P., Hennequin M.

The paper reviews human mastication, focusing on its age-related changes. The first part describes mastication adaptation in young healthy individuals. Adaptation to obtain a food bolus ready to be swallowed relies on variations in number of cycles, muscle strength and volume of emitted saliva. As a result, the food bolus displays granulometric and rheological properties, the values of which are maintained within the adaptive range of deglutition. The second part concerns healthy ageing. Some mastication parameters are slightly modified by age, but ageing itself does not impair mastication, as the adaptation possibilities remain operant. The third part reports on very aged subjects, who display frequent systemic or local diseases. Local and/or general diseases such as tooth loss, salivary defect, or motor impairment are then indistinguishably superimposed on the effects of very old age. The resulting impaired function increases the risk of aspiration and choking. Lastly, the consequences for eating behaviour and nutrition are evoked.

Ye C., Zhao L., He X., Huang Q., Li J., Wang W., Yang K., Su J., Chen Y., Lin Y., Qiu Y., Wang B., Tang M., Zhang H.

Rech R.S., Hugo F.N., Rech G.S., Hilgert J.B.

Venkatraman A., Davis R., Tseng W., Thibeault S.L.

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.

Aquino M.D., Rech R.S., Baumgarten A., Goulart B.N.

ABSTRACT Purpose To investigate the association between the number of permanent teeth and the use of removable dental prostheses with self-reported dysphagia occurrence in individuals aged 60 years or older. Methods A population-based cross-sectional study was conducted with 5,432 old individuals who participated in the baseline of the Brazilian Longitudinal Study of Elderly Health (ELSI-Brazil). The outcome "dysphagia" was associated with the number of permanent teeth and the use of removable dental prostheses. Sociodemographic independent variables (age, sex, and race/ethnicity) and clinical history variables (no morbidity, one morbidity, or more than two morbidities) were analyzed using Poisson Regression with robust variance and their respective 95% confidence intervals (CI). Results The prevalence of self-reported dysphagia in non-institutionalized old individuals was 30%. The group of old individuals with 10 – 19 natural teeth showed a 52% increased risk of self-reported dysphagia complaint (PRadj 1,565 IC95% 1,34;1,826) compared to their counterparts with more teeth. Conclusion An association was found between a lower number of teeth and removable prostheses with the occurrence of dysphagia.

Aquino M.D., Rech R.S., Baumgarten A., Goulart B.N.

RESUMO Objetivo Verificar a associação entre o número de dentes e uso de prótese dentária removível e a ocorrência de disfagia autorreferida em idosos de 60 anos ou mais. Método Estudo transversal de base populacional com 5.432 idosos, que participaram da linha de base do Estudo Longitudinal da Saúde do Idoso (ELSI-Brasil). O desfecho “disfagia” foi associado ao número de dentes permanentes e ao uso de prótese dentária removível. As variáveis independentes sociodemográficas (idade, sexo e cor/raça) e de histórico clínico (nenhuma morbidade, uma morbidade ou mais de duas morbidades) utilizando Regressão de Poisson com variância robusta e seus respectivos intervalos de confiança (IC) de 95% foram analisados. Resultados A prevalência de disfagia autorreferida nos idosos não institucionalizados foi de 30%. O grupo de idosos com 10 – 19 dentes permanentes apresentou um risco de 52% de queixa de disfagia autorreferida (RPaj 1,565 IC95% 1,34;1,826) se comparado com seus pares com mais dentes. Conclusão foi encontrada associação entre o menor número de dentes e próteses removíveis com a ocorrência de disfagia.

Beltrán V., Muñoz-Sepúlveda F., Acevedo C., Navarro P., Venegas B., Salgado C., Uribe P., Engelke W.

BackgroundLimited attention has been given to oral health challenges faced by older Indigenous populations, especially in rural settings, where disparities exist. This study aims to assess oral health in a rural Mapuche community in southern Chile, utilizing geriatric technology support, and exploring the connection between geriatric health and oral well-being to fill a gap in this context.MethodsA cross-sectional study was conducted involving 76 independent older adults from a rural Mapuche community who required dental care. Assessments were in a remote care setting gathering extensive data including comprehensive geriatric assessments, medical and dental conditions using a geriatric teledentistry platform (TEGO®). Statistical analysis involved descriptive analysis, logistic regression, and both multiple correspondence analysis and k-means cluster analysis.ResultsThe sample comprised individuals with limited formal education and a high degree of vulnerability. Geriatric assessments unveiled cognitive deterioration, frailty, depression risk, and multimorbidity. A distribution of the DMFT index, number of remaining teeth, number of occluding pairs, number of teeth with restorative needs and other relevant clinical findings was conducted based on sociodemographic, and medical-geriatric-dental characteristics, and additionally, a Multinomial Logistic Regression Analysis of Dentition Variables in Relation to Geriatric Assessments was performed. The dental burden was substantial, with an average DMFT index of 25.96 (SD 4.38), high prevalence of non-functional dentition (89.3%), periodontal disease (83%), xerostomia (63.2%) and oral mucosal lesions (31.5%). Age, lower education, depression, daily medication number and sugary consumption frequency were associated with a decreased average number of teeth (p &lt; 0.05). Multiple correspondence analysis and k-means cluster analysis identified 4 clusters, with the edentulous and functional dentition groups being the most distinct.ConclusionThis study uncovers a substantial dental burden and intricate medical-geriatric conditions interlinked among Indigenous older adults in a rural Chilean Mapuche community. The implementation of a geriatric technological ecosystem in the community enabled the resolution of less complex oral health issues and facilitated remote consultations with specialists, reducing the necessity for travel to health centers. This underscores the need for innovative dental public health initiatives to address health disparities and improve the overall well-being of older Indigenous adults.

Belmonte M.S., Pedreira L.C., Gomes N.P., Oliveira D.V., Souza A.C., Pinto I.S.

RESUMO Objetivo: Apreender as estratégias de cuidadores para oferta do alimento à pessoa idosa com disfagia orofaríngea após desospitalização. Método: Pesquisa qualitativa, realizada com cuidadores de pessoas idosas com disfagia orofaríngea, que tiveram alta após internamento em um hospital universitário na Bahia. A coleta de dados foi realizada entre janeiro e fevereiro de 2023, por meio de uma entrevista semiestruturada, cujo dados foram organizados com base na análise de conteúdo e analisados com auxílio do software IRaMuTeQ. Resultados: Emergiram três categorias: Estratégias dos cuidadores para oferta segura do alimento à pessoa idosa com disfagia; Estratégias de cuidadores para higiene oral da pessoa idosa; Reconhecimento da continuidade do acompanhamento fonoaudiológico após desospitalização. Conclusão: As estratégias dos cuidadores para a oferta do alimento a pessoas idosas com disfagia orofaríngea foram sustentadas pelo conhecimento tácito e por um cuidado efetivo na transição hospital-domicílio.

Belmonte M.S., Pedreira L.C., Gomes N.P., Oliveira D.V., Souza A.C., Pinto I.S.

ABSTRACT Objective: To understand caregivers’ strategies for offering food to older adults with oropharyngeal dysphagia after dehospitalization. Method: Qualitative research carried out with caregivers of older adults with oropharyngeal dysphagia, who were discharged after hospitalization at a university hospital in Bahia. Data collection was carried out between January and February 2023 through a semi-structured interview, whose data were organized based on content analysis and analyzed with the help of IRaMuTeQ software. Results: Three categories emerged: Caregivers’ strategies for safely offering food to older adults with dysphagia; Caregiver strategies for oral hygiene for older adults; Recognition of continuity of speech therapy after dehospitalization. Conclusion: Caregivers’ strategies for offering food to older adults with oropharyngeal dysphagia were supported by tacit knowledge and effective care in the hospital-home transition.

Hennequin M., Osta N.E., Munoz-Sanchez M., Vandenberghe Descamps M., Andreeva V.A., Feron G., Nicolas E., Pereira B., Peyron M., Cousson P., Sulmont-Rosse C., Faulks D.

Epidemiological data regarding the evolution of problems related to mastication and swallowing with age are lacking. This study aims to (i) describe changes in oral function with age, using data from a large French population, (ii) validate online, self-report uses of an ICF questionnaire in older persons, and (iii) assess whether impairment is related to avoidance of certain foods, xerostomia, body mass index (BMI) and oral health related quality of life (OHRQoL). Volunteers aged ≥18 years with internet access completed a series of questionnaires on sociodemographic, anthropometric and oral health characteristics (oral function, Xerostomia Index (XI), OHRQoL, reasons for avoidance of certain food). Oral function was assessed using items derived from the International Classification of Functioning (ICF). Five ICF items related to ingestion function and six items related to activities and participation were used. A validation study was undertaken to identify those with poor chewing ability and low salivary flow amongst older participants reporting impairment. 39 597 individuals were included. The prevalence of individuals with impairment for ICF items related to ingestion function and oral activity (eating, drinking and speaking), and the percentage of participants with poor OHRQoL increased significantly with age (p < 0.001). Each ICF item was significantly associated with OHRQoL (p < 0.001), XI (p < 0.001), BMI (p < 0.001) and avoidance of certain food due to chewing or swallowing difficulties. Overall, 21.5% and 13.5% of the study population had chewing and/or biting impairments respectively, which might affect food selection and consumption. These findings raise individual and population-based issues. Further studies are needed to assess whether impairment in oral function might increase frailty in older individuals, and also to compare data with those from other countries.

Roberts H., Lambert K., Walton K.

Dysphagia commonly affects older adults, making them nutritionally vulnerable. There is significant variation in the reported prevalence of dysphagia in aged care. The aim of this systematic review and meta-analysis was to determine the prevalence of dysphagia in individuals living in residential aged care facilities using appropriate assessment methods, and in four subgroups at higher risk: individuals with nervous system diseases, dementia, malnutrition, and poor dentition. Scopus, Web of Science, Medline, and CINAHL Plus were searched, and study selection was conducted in Covidence. Meta-analysis using a random effects model was used to obtain the pooled prevalence of dysphagia. Seven studies were eligible for inclusion. Dysphagia prevalence ranged from 16 to 69.6%. The pooled prevalence of dysphagia was 56.11% (95% CI 39.363–72.172, p < 0.0001, I2 = 98.61%). Sensitivity analysis examining the prevalence of dysphagia using only the CSE indicated a pooled prevalence of 60.90% (95% CI 57.557–64.211, p = 0.9994, I2 = 0%). Only one study each reported on dysphagia prevalence in individuals with nervous system diseases (31%), poor dentition (92%), and dementia (68.4%), meaning that meta-analysis could not be completed. No studies reported on the prevalence of dysphagia in individuals with malnutrition. The prevalence of dysphagia is high amongst residents of aged care facilities. This evidence should be used to guide improvements in the health outcomes and quality of life of aged care residents. Future research should explore the prevalence in the subgroups at higher risk.

Lee D., Kim H., Choi J.

Most previous studies addressing dysphagia examined individuals who already had diseases causing dysphagia and did not pay much attention to oral health conditions as a risk factor. This pilot study investigated 62 healthy adults aged 65 years or older who were living independently in the community, performed basic activities of daily living independently, and had no history of a causative disease of dysphagia to identify the factors associated with dysphagia risk, especially oral health. The Dysphagia Risk Assessment Scale was used to screen the patients for dysphagia. Hyposalivation was diagnosed by evaluating the unstimulated salivary flow rate, and orofacial muscle strength (anterior tongue elevation, buccinator muscle, and lip strength) was quantitatively measured using the Iowa Oral Performance Instrument. To analyze the factors associated with dysphagia risk, the Mann–Whitney test, Kruskal–Wallis test, and multiple logistic regression analyses were conducted. In the final regression model adjusted for sociodemographic characteristics, the oral health-related factors independently associated with dysphagia risk were buccinator muscle strength, hyposalivation, and subjective masticatory discomfort (p < 0.05). Therefore, our findings suggest that weak buccinator muscle strength, hyposalivation, and subjective masticatory discomfort are valuable indicators for the early detection of dysphagia in older, healthy, independent, community-dwelling adults.

Ferreira R.P., Alves L.M., Mangilli L.D.

Abstract Objective to investigate and demonstrate the association between the self-perceived swallowing assessment carried out by nurses and the dysphagia risk classification carried out by speech therapists in hospitalized elderly patients. Method an analytical cross-sectional study using the Eating Assessment Tool and the Speech and Hearing Therapy Protocol for Dysphagia Risk Assessment in 52 elderly patients in a medical clinic, as well as collecting sociodemographic data and health conditions. Fisher's exact test and logistic regression for odds ratios were used for statistical analysis. Results there was an association (p=0.01) between the nurse's assessment and that of the speech therapist, with an odds ratio of a hospitalized elderly person exposed to the risk of dysphagia by the Eating Assessment Tool presenting a change in the Speech Therapy Protocol for Dysphagia Risk Assessment (OR 3.89 95% CI: 1.10-13.68). Conclusion and implications for practice the findings indicate that there is an association between the nurse's assessment and that of the speech therapist in swallowing disorders and that Nursing can act to identify risks, prevent and rehabilitate dysphagia.

Ferreira R.P., Alves L.M., Mangilli L.D.

Resumo Objetivo investigar e demonstrar a associação entre a avaliação de autopercepção da deglutição realizada pelo enfermeiro e a classificação de risco de disfagia realizada pelo fonoaudiólogo em idosos hospitalizados. Método estudo transversal analítico realizado com a aplicação dos instrumentos Eating Assessment Tool e do Protocolo Fonoaudiológico de Avaliação de Risco para Disfagia em 52 idosos em clínica médica, além da coleta de dados sociodemográficos e de condições de saúde. Para a análise estatística foi utilizado o teste exato de Fisher e a regressão logística para a razão de chances. Resultados houve a associação (p=0,01) entre a avaliação do enfermeiro e a do fonoaudiólogo, com razão de chances de um idoso hospitalizado exposto ao risco de disfagia pelo Eating Assessment Tool apresentar a alteração no Protocolo Fonoaudiológico de Avaliação do Risco para Disfagia (OR 3,89 IC 95%: 1,10-13,68). Conclusão e implicações para a prática os achados apontam que há uma associação entre a avaliação do enfermeiro e a do fonoaudiólogo nas alterações da deglutição e que a Enfermagem poderá atuar na identificação de riscos, prevenção e reabilitação em disfagia.

Leonard R.

Purpose of review Dementia and its variants, including Alzheimer's disease, become more prevalent with age. Dysphagia, that is, difficulty swallowing, also occurs with aging, and is often associated with dementia. Currently, there is no cure for dementia, and dysphagia, unrecognized or untreated, can have life-altering, even fatal consequences. Prolonged ability to eat safely and effectively could contribute to improved quality of life in a fragile population. In this review, difficulties associated with the management of dysphagia in individuals with dementia, as well as promising possibilities for continued investigation, will be discussed. Recent findings Recent reports point to unique problems related to understanding the comorbidities of dysphagia and dementia. These include delays in identifying dysphagia in affected individuals, as well as a lack of prevalence data for dysphagia in types and stages of dementia, or according to setting, for example, residential center, hospital. Emphasis on new tools, and new applications of existing tools, are needed. Summary New evidence not only underscores complexities and shortcomings of our understanding of dysphagia in dementia but also points to existing applications with potential for improving the situation, and new investigational directions that may elaborate our further understanding of these comorbidities.

Leira J., Maseda A., Lorenzo-López L., Cibeira N., López-López R., Lodeiro L., Millán-Calenti J.C.

Dysphagia is considered a geriatric syndrome that is characterized by inability to or difficulty in safely and effectively forming or moving the food bolus toward the esophagus. This pathology is very common and affects approximately 50% of institutionalized older people. Dysphagia is often accompanied by high nutritional, functional, social, and emotional risks. This relationship implies a higher rate of morbidity, disability, dependence, and mortality in this population. This review is aimed at studying the relationship between dysphagia and different health-related risk factors in institutionalized older people.We conducted a systematic review. The bibliographic search was performed in the Web of Science, Medline, and Scopus databases. Data extraction and methodological quality were evaluated by two independent researchers.Twenty-nine studies met the inclusion and exclusion criteria. A clear relationship between the development and progression of dysphagia and a high nutritional, cognitive, functional, social, and emotional risk in institutionalized older adults was found.There is an important relationship between these health conditions that shows the need for research and new approaches to considerations such as their prevention and treatment as well as the design of protocols and procedures that will help reduce the percentage of morbidity, disability, dependence, and mortality in older people.