News| Volume 19, ISSUE 5, P7, May 01, 2018

Nearly One in Seven Nursing Home Residents Experiences Dysphagia

      Among nursing home residents in Europe and North America, 13.4% experienced dysphagia, with the prevalence varying widely by region, according to results of the nutritionDay project.
      Despite the potential for severe symptoms with dysphagia, the condition is often undetected and untreated, wrote study author Melanie Streicher, MSc, of the Friedrich-Alexander-Universität Erlangen-Nürnberg in Nuremberg, Germany, and her colleagues. The team of researchers analyzed the data of nursing home residents participating in the nutritionDay project, a 1-day cross-sectional survey with an outcome evaluation after 6 months. The goal of their study was to assess the prevalence of dysphagia in nursing home residents, the characteristics of residents with dysphagia, and the nutritional strategies used for residents with the condition (J Am Med Dir Assoc 2018;19:141–147).
      The study included nursing home residents from Europe or North America who were 65 or older, had available information on dysphagia, and participated in the nutritionDay project between 2007 and 2014. In all, 23,549 residents from 926 nursing home units and 19 countries were featured in the analysis.
      The results revealed that 13.4% of residents had dysphagia. The rate of dysphagia differed widely by country, with the highest prevalence observed in Poland (48%) and the lowest in Turkey (4%) and Hungary (8%). Ten countries had a prevalence of dysphagia of 10% to 20%, and six countries, including the United States and Canada, had a rate between 21% and 25%.
      “A large variation in the number of participants, with only 59 participants in Poland and 185 in Turkey but several thousands in Austria (n = 8,038), Hungary (n = 6,344), and Germany (n = 3,544), might have biased these prevalence rates,” Streicher and colleagues wrote. “The huge disparity in prevalence rates might also be due to the different national health systems, which may vary in the assessment and diagnosis of dysphagia and availability of multidisciplinary teams to evaluate dysphagia.”
      The researchers added that in almost all (98.4%) North American nursing homes, a dietitian or person responsible for nutritional care was available, but the rate was 70% or less in nursing homes of the other country regions. “Possibly, the presence of nutritional experts increased the awareness and diagnosis of dysphagia,” they wrote. “Further, it is common that clinical signs of dysphagia, such as coughing or drooling, are lacking, and this is possibly the reason why dysphagia is not recognized in some cases. Thus, attentive observation of residents’ mealtime behavior helps to identify signs of dysphagia (e.g., coughing and choking during and after meal, pocketing or dropping of food, excessive drooling, or refusal to eat).”
      According to their multivariable analysis, 12 variables significantly predicted dysphagia, including the inability to eat orally at lunch, chewing problems, immobility, partial mobility, and severe cognitive impairment. When compared with residents from Western Europe, those from North America had a significantly higher odds ratio for dysphagia, whereas those from Eastern Europe had a significantly lower likelihood.
      For residents with dysphagia, 82.5% received oral nutrition exclusively, 42.5% received a texture-modified diet, 28.2% received a normal diet, and 25% received oral nutritional supplements. “The first choice for patients with dysphagia should be texture-modified foods (soft, gratin, or pureed diet) and thickened fluids to ease the swallowing process and to prevent aspiration,” Ms. Streicher and her colleagues wrote. “Required nutritional strategies for patients with dysphagia can, however, vary as the severity of dysphagia varies from mild to moderate difficulties in swallowing, up to complete inability to eat orally.”
      The researchers recommended regular clinical screenings for dysphagia to determine whether any nursing home residents have swallowing dysfunction so that appropriate nutritional strategies can be initiated. “Residents with dysphagia are at high risk of malnutrition, dehydration, and require monitoring of food and fluid intake,” they wrote. “Future studies should clarify if enrichment of texture-modified diets, attractive presentation, and provision of additional nutrients by [oral nutritional supplements] are effective to meet energy and nutrient requirements and to improve or maintain nutritional status and quality of life.”
      Brian Ellis is a freelance writer and editor based in NJ.