Subjective dysphagia in older care home residents: a cross-sectional, multi-centre point prevalence measurement.
BACKGROUND
Dysphagia has been found to be strongly associated with aspiration pneumonia in frail older people. Aspiration pneumonia is causing high hospitalization rates, morbidity, and often death. Better insight in the prevalence of (subjective) dysphagia in frail older people may improve its early recognition and treatment.


OBJECTIVE
First, to assess the prevalence of subjective dysphagia in care home residents in the Netherlands. Second, to assess the associations of subjective dysphagia with potential risk factors of dysphagia.


METHODS
Retrospective data-analysis of a cross-sectional, multi-centre point prevalence measurement.


METHODS
119 care homes in the Netherlands.


METHODS
Data of 8119 care home residents aged 65 years or older were included and analyzed.


METHODS
Subjective dysphagia was assessed by a resident's response to a dichotomous question with regard to experiencing swallowing problems. If a resident was not able to respond (e.g. residents with dementia or aphasia), the question was answered by the ward care provider, or the resident's file was consulted for registered swallowing complaints and/or dysphagia. Several residents' data were collected: gender, age, (number of) diseases, the presence of malnutrition, the Care Dependency Scale score, and the body mass index.


RESULTS
Subjective dysphagia was found in 751 (9%) residents. A final model for subjective dysphagia after multivariate backward stepwise regression analysis revealed eight significant variables: age (B -0.022), Care Dependency Scale score (B -0.985), 'malnutrition' (OR 1.58; 95% CI 1.31-1.90), 'comorbidity' (OR 1.07; 95% CI 1.01-1.14), and the disease clusters 'dementia' (OR 0.55; 95% CI 0.45-0.66), 'nervous system disorder' (OR 1.55; 95% CI 1.20-1.99), 'cardiovascular disease' (OR 0.81; 95% CI 0.67-0.99) and 'cerebrovascular disease/hemiparesis' (OR 1.74; 95% CI 1.45-2.10).


CONCLUSIONS
It seems justified to conclude that subjective dysphagia is a relevant care problem in older care home residents in the Netherlands. Care Dependency Scale score, 'malnutrition', and the disease clusters 'dementia', 'nervous system disorder', and 'cerebrovascular disease/hemiparesis' were associated with the presence of subjective dysphagia in this study. Age, 'comorbidity' and 'cardiovascular disease' showed very small influence.
BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, The Netherlands; Department of Oral Function and Prosthetic Dentistry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Electronic address: claarwierink@yahoo.com.
Claar D
CD
van der Maarel-Wierink
Department of Health Services Research, Focusing on Chronic Care and Ageing, Maastricht University, The Netherlands.
Judith M M
JM
Meijers
BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, The Netherlands; Department of Community Dentistry and Oral Public Health, Ghent University, Ghent, Belgium.
Luc M J
LM
De Visschere
BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, The Netherlands; Department of Oral Function and Prosthetic Dentistry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Cees
C
de Baat
Department of Health Services Research, Focusing on Chronic Care and Ageing, Maastricht University, The Netherlands.
Ruud J G
RJ
Halfens
BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, The Netherlands; Department of Health Services Research, Focusing on Chronic Care and Ageing, Maastricht University, The Netherlands; Caphri, Department of General Practice, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
Jos M G A
JM
Schols
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology
Cerebrovascular accident; Comorbidity; Dysphagia; Malnutrition; Nursing home; Swallowing disorders