Key summary points
Our aim was to investigate which swallowing difficulty of food consistency in older people who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD) risk.
AbstractSection FindingsWe have found that the eating/drinking difficulty of thick liquids was the highest predictive value with respect to OD risk and the eating difficulty of mixed content food had the highest diagnostic ratio.
AbstractSection MessageThe present study reports that even in older person who do not go to the hospital with the complaints of swallowing difficulty, the difficulty of swallowing thick liquids and especially the mixed content food should be questioned.
Abstract
Purpose
The present study aimed to investigate which swallowing difficulty of food consistency in participants over 65 years of age who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD).
Methods
The cross-sectional and multicenter study was conducted at 12 hospitals including 883 participants aged ≥65 years who were fed orally and who were admitted to the physical medicine and rehabilitation outpatient clinics between September 2017 and December 2018. Demographic characteristics were recorded. Katz Daily Living Activities Index (KDLAI), swallowing-related quality of life scale (Swal-QoL) and 10-item Eating Assessment Tool (EAT-10) were used. The participants were asked the “yes” or “no” questions including swallowing difficulty of various types of food consistency with the face-to-face interview.
Results
Participants were divided into two groups as normal swallowing (EAT-10 < 3 group) (n = 639) and OD risk groups (EAT-10 ≥ 3 group) (n = 244) according to the EAT-10 scores. While there was no difference related to number of teeth and KDLAI scores between groups (p = 0.327 and p = 0.221, respectively), the significant difference was found between groups in terms of yes/no questions and Swal-QoL scores (p < 0.05). Receiver operating characteristic analysis revealed that eating difficulty of mixed content food provided maximum sensitivity (99%) and eating/drinking difficulty of thick liquid had maximum specificity (77%). The higher area under curve was in eating/drinking difficulty of thick liquid (0.891), and higher positive likelihood ratio (LR) was eating/drinking difficulty of thick liquid (4.26) as well as lower negative LR was eating difficulty of mixed content food (0.01). The higher diagnostic odds ratio was eating difficulty of mixed content food (367.0), and the higher posttest probability was eating/drinking difficulty of thick liquid (0.211).
Conclusion
While eating difficulty of hard solid food is the most common symptom in healthy participants over 65 years of age, the eating difficulty of thick liquids is the highest predictive value related to oropharyngeal dysphagia risk. Also, the eating difficulty of mixed content food had the highest diagnostic ratio.
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References
Wakabayashi H (2014) Presbyphagia and sarcopenic dysphagia: association between aging, sarcopenia, and deglutition disorders. J Frailty Aging 3:97–103
Ebihara S, Sekiya H, Miyagi M, Ebihara T, Okazaki T (2016) Dysphagia, dystussia, and aspiration pneumonia in elderly people. J Thorac Dis. 8(3):632–639
Namasivayam AM, Steele CM (2015) Malnutrition and dysphagia in long-term care: a systematic review. J Nutr Gerontol Geriatr. 34(1):1–21
Khan A, Carmona R, Traube M (2014) Dysphagia in the elderly. Clin Geriatr Med 30(1):43–53
Foley N, Teasell R, Salter K, Kruger E, Martino R (2008) Dysphagia treatment post stroke: a systematic review of randomised controlled trials. Age Ageing 37(3):258–264
Newman R, Vilardell N, Clavé P, Speyer R (2016) Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: white paper by the european society for swallowing disorders. Dysphagia 31:232–249
Teramoto S, Yoshida K, Hizawa N (2015) Update on the pathogenesis and management of pneumonia in the elderly-roles of aspiration pneumonia. Respir Investig 53(5):178–184
Serra-Prat M, Hinojosa G, López D et al (2011) Prevalence of oropharyngeal dysphagia and impaired safety and efficacy of swallow in independently living older persons. J Am Geriatr Soc 59(1):186–187
Serra-Prat M, Palomera M, Gomez C et al (2012) Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: a population-based prospective study. Age Ageing 41(3):376–381
Baijens LW, Clavé P, Cras P et al (2016) European Society for Swallowing Disorders—European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 11:1403–1428
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919
McHorney CA, Martin-Harris B, Robbins J, Rosenbek J (2006) Clinical validity of the SWAL-QOL and SWAL-CARE outcome tools with respect to bolus flow measures. Dysphagia 21:141–148
Steele CM, Alsanei WA, Ayanikalath S et al (2015) The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia 30(1):2–26
Cichero JA, Lam P, Steele CM et al (2017) Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia 32(2):293–314
Akobeng AK (2007) Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr 96(5):644–647
Eusebi P (2013) Diagnostic accuracy measures. Cerebrovasc Dis. 36:267–272
Etges CL, Scheeren B, Gomes E, Barbosa Lde R (2014) Screening tools for dysphagia: a systematic review. Codas 26(5):343–349
Speyer R (2013) Oropharyngeal dysphagia screening and assessment. Otolaryngol Clin North Am 46(6):989–1008
Uhm KE, Kim M, Lee YM et al (2019) The Easy Dysphagia Symptom Questionnaire (EDSQ): a new dysphagia screening questionnaire for the older adults. Eur Geriatr Med. 10(1):47–52
Molina L, Santos-Ruiz S, Clavé P, González-de Paz L, Cabrera E (2018) Nursing Interventions in adult patients with oropharyngeal dysphagia: a systematic review. Eur Geriatr Med 9(1):5–21
Khader FA, Gangadhara SKS (2018) Swallowing difficulties among healthy elderly: prevalence and aetiology. Int J Otorhinolaryngol Head Neck Surg 4:494–498
Wirth R, Dziewas R, Beck AM et al (2016) Oropharyngeal dysphagia in older persons—from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging 23(11):189–208
Muhle P, Wirth R, Glahn J, Dziewas R (2015) Age-related changes in swallowing. Physiology and pathophysiology. Nervenarzt 86(4):440–451
Rofes L, Arreola V, Romea M et al (2010) Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol Motil 22(8):851–858
Baumgarten A, Schmidt JG, Rech RS, Hilgert JB, Goulart BNG (2017) Dental status, oral prosthesis and chewing ability in an adult and elderly population in southern Brazil. Clinics (Sao Paulo). 72(11):681–685
Sierpińska T, Gołebiewska M, Długosz JW (2006) The relationship between masticatory efficiency and the state of dentition at patients with non rehabilitated partial lost of teeth. Adv Med Sci. 51(1):196–199
Kumar Y, Chand P, Arora V, Singh SV, Mishra N, Alvi HA, Verma UP (2017) Comparison of rehabilitating missing mandibular first molars with implant- or tooth-supported prostheses using masticatory efficiency and patient satisfaction outcomes. J Prosthodont 26(5):376–380
Kaneoka A, Pisegna JM, Saito H et al (2017) A systematic review and meta-analysis of pneumonia associated with thin liquid vs thickened liquid intake in patients who aspirate. Clin Rehabil 31(8):1116–1125
Logemann JA, Gensler G, Robbins J et al (2008) A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s disease. J Speech Lang Hear Res. 51:173–183
Niezgoda H, Miville A, Chambers LW, Keller HH (2012) Issues and challenges of modified-texture foods in long-term care: a workshop report. Ann Long Term Care. 20(7):22–27
Groher ME, McKaig TN (1995) Dysphagia and dietary levels in skilled nursing facilities. J Am Geriatr Soc 43:528–532
O’Keeffe ST (2018) Use of modified diets to prevent aspiration in oropharyngeal dysphagia: Is current practice justified? BMC Geriatr 18(1):167. https://doi.org/10.1186/s12877-018-0839-7
Hayashi H, Hori K, Taniguchi H, Nakamura Y, Tsujimura T, Ono T, Inoue M (2013) Biomechanics of human tongue movement during bolus compression and swallowing. J Oral Sci 55(3):191–198
Tamine K, Ono T, Hori K, Kondoh J, Hamanaka S, Maeda Y (2010) Age-related changes in tongue pressure during swallowing. J Dent Res 89:1097–1101
Shiozawa M, Taniguchi H, Hayashi H et al (2012) Differences in chewing behavior during mastication of foods with different textures. J Texture Stud 44:45–55
Aguayo-Mendoza MG, Ketel EC, van der Linden E, Forde CG, Piqueras-Fiszman B, Stiege M (2019) Oral processing behavior of drinkable, spoonable and chewable foods is primarily determined by rheological and mechanical food properties. Food Qual Prefer 71:87–95
van Eck A, Hardeman N, Karatza N, Fogliano V, Scholten E, Stieger M (2019) Oral processing behavior and dynamic sensory perception of composite foods: toppings assist saliva in bolus formation. Food Qual Prefer 71:497–509
Okada A, Honma M, Nomura S, Yamada Y (2007) Oral behavior from food intake until terminal swallow. Physiol Behav 90:172–179
Stokes JR, Boehm MW, Baier SK (2013) Oral processing, texture and mouthfeel: from rheology to tribology and beyond. Curr Opin Colloid Interface Sci 18(4):349–359
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards (Ethics committee of University of Health Sciences, Ankara Diskapi Training and Research Hospital).
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Umay, E., Eyigor, S., Karahan, A.Y. et al. Which swallowing difficulty of food consistency is best predictor for oropharyngeal dysphagia risk in older person?. Eur Geriatr Med 10, 609–617 (2019). https://doi.org/10.1007/s41999-019-00206-z
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DOI: https://doi.org/10.1007/s41999-019-00206-z