title: Caregiver-reported swallowing difficulties, malnutrition, and mortality among older people in assisted living facilities.
abstract: OBJECTIVE
  The aim of this study is to explore the prevalence of swallowing difficulties (SWD) and their associations with nutritional status, eating habits, nutritional care, and mortality among older people in assisted living.
  
  
  METHODS
  A cross-sectional study with interviews and nutritional assessments at baseline and 3-year follow-up for mortality.
  
  
  METHODS
  Assisted living facilities in the Helsinki metropolitan area, Finland.
  
  
  METHODS
  All residents (N=1466) in assisted living facilities.
  
  
  METHODS
  Personal interviews yielded information on demographics, medical history, functional status, SWDs and eating habits. Residents' nutritional status was assessed with the Mini Nutritional Assessment (MNA). Three-year mortality data were retrieved from central registers.
  
  
  RESULTS
  SWDs were common; 11.8% of subjects suffered from them. Those with SWDs were older, more often female, and more frequently had Parkinson's disease, chronic obstructive pulmonary disease (COPD), and chronic/ recurrent infections than those without SWDs. No differences were present between the groups in prevalence of stroke or dementia, but more severe cognitive decline occurred among those with SWDs. According to the MNA, 30.6% of those with SWDs were malnourished (<17 points), whereas the respective figure for those without SWDs was 11.0% (p < .001). Those with SWDs ate more often fluid or puréed food (27.8% vs. 3.8%, p < .001), ate more often little or quite little of their food portion (32.6% vs. 23.5%, p < .010), and consumed less fluids (< 5 cups/day 51.7% vs. 35.6%, p< .001) than those without SWDs. Of those with SWDs, 55.0% died by the end of follow-up, whereas the respective figure for those without SWDs was 41.5%. In logistic regression analysis using age, sex, comorbidities, and MNA as covariates, SWDs continued to predict mortality (OR=1.49, 95% CI=1.04 -2.12).
  
  
  CONCLUSIONS
  SWDs are common and associated with poor nutrition and risk of death of patients in assisted living facilities. Nurses should be trained to assess SWDs and nutritional problems in order to take optimal care of these residents.
authors.affiliation: Eeva Lindroos, M.Sc, Helsinki Metropolia, University of Applied Sciences, Finland, Mannerheimintie 172, FIN-00300 Helsinki, Finland, tel. +358-50-5695677, E-mail address:eeva.lindroos@metropolia.fi.
authors.forename: E
authors.initials: E
authors.lastname: Lindroos
authors.forename: R K T
authors.initials: RK
authors.lastname: Saarela
authors.forename: H
authors.initials: H
authors.lastname: Soini
authors.forename: S
authors.initials: S
authors.lastname: Muurinen
authors.forename: M H
authors.initials: MH
authors.lastname: Suominen
authors.forename: K H
authors.initials: KH
authors.lastname: Pitkälä
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D017028:Caregivers; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000453:epidemiology*; D003704:Dementia / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D009735:Nursing Homes; D015596:Nutrition Assessment; D009752:Nutritional Status; D010300:Parkinson Disease / Q000453:epidemiology; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology