Signs of dysphagia and associated outcomes regarding mortality, length of hospital stay and readmissions in acute geriatric patients: Observational prospective study.

BACKGROUND AND AIMS: Dysphagia is a prevalent disorder in acute geriatric patients. This observational prospective study aimed at investigating adverse clinical outcomes linked to signs of dysphagia, including mortality, length of hospital stay (LOS), readmissions, among patients aged ≥ 65 years at a Danish acute medical unit (AMU). METHODS: Signs of dysphagia were assessed using bedside screening tools including the Eating Assessment Tool (EAT-10), a 30 mL Water Swallowing Test (WST) and the Gugging Swallowing Screen tool (GUSS), as described in the preceding cross-sectional study. Data for the follow-up was twice retrieved from electronic medical charts 30 days and 90 days after the patients' primary admission to the hospital. Statistical analysis included non-parametric tests of independence and proportional hazards modelling. RESULTS: 444 patients were recruited, 334 of whom completed the dysphagia screening with 144 (43.1 %) showing signs of dysphagia. Patients with signs of dysphagia, compared to those without, experienced higher mortality after 30 days (12.5 % vs. 1.6 %, p < 0.001) and 90 days (21.5 % vs. 5.8 %, p < 0.001), longer LOS (median [Q1; Q3]: 4 [2; 8] vs. 3 [1; 6] days, p = 0.004), more total hospital days (THD) during both the 30-day and 90-day follow-up (for 90d: median [Q1; Q3]: 6 [2.25; 12] vs. 4 [2; 9] days, p = 0.007), but no significant difference in frequency of readmissions. Multivariate proportional hazards modelling revealed signs of dysphagia, low performance status and high comorbidity to be independent risk factors for mortality. High comorbidity and low hemoglobin, but not signs of dysphagia, were revealed as independent risk factors for readmission. CONCLUSION: Dysphagia is a notable risk factor linked to increased mortality and length of hospital stay (LOS) for acute geriatric patients in general, not just those suffering from stroke, head and neck cancer or neurodegenerative diseases. Further research is needed to investigate the effectiveness and feasibility of systematic dysphagia screening within this population.

Prevalence of signs of dysphagia and associated risk factors in geriatric patients admitted to an acute medical unit.

BACKGROUND AND AIMS: Dysphagia is a prevalent disorder among the older persons. Despite this, signs of dysphagia often go unnoticed in hospital settings. This cross-sectional study aimed at investigating the prevalence of signs of dysphagia among patients aged 65 or older in a Danish acute care setting. METHODS: We studied 334 patients aged 65 years or older admitted to the acute medical unit (AMU) at Aalborg University Hospital, Denmark. Signs of dysphagia were assessed using bedside screening tools including the Eating Assessment Tool (EAT-10), a 30 mL Water Swallowing Test (WST) and the Gugging Swallowing Screen tool (GUSS). Other risk factors were assessed using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS), the Nutritional Risk Screening 2002 (NRS), and the Charlson's Comorbidity Index (CCI). RESULTS: Signs of dysphagia were identified in 144 of 334 (43.1%) patients. Geriatric patients with signs of dysphagia were significantly older (79.5 years [74; 85] vs. 77 years [72; 84], p = 0.025) and had higher CCI scores (3 points [2; 4] vs. 2 points [1; 4], p = 0.001) than those with normal swallowing capacity. Furthermore, a multivariate logistic regression model found signs of dysphagia to be independently associated with nutritional risk (OR = 2.169, 95% CI 1.313-3.582, p = 0.002), cerebrovascular disease (OR = 2.209, 95% CI 1.235-3.953, p = 0.008), chronic pulmonary disease (OR = 2.276, 95% CI 1.338-3.871, p = 0.002) and rheumatic disease (OR = 2.268, 95% CI 1.099-4.683, p = 0.027). Age was not independently associated with signs of dysphagia among the geriatric patients. CONCLUSION: Signs of dysphagia were common among patients aged 65 or older in the acute care setting. Signs of dysphagia were associated with nutritional risk, higher CCI scores and specific comorbidities. These findings could indicate a need for systematic screening for dysphagia in acute geriatric patients, yet further investigation is needed to assess clinical outcomes associated with dysphagia within this population.