The journal of nutrition, health & aging

, Volume 20, Issue 8, pp 806–815 | Cite as

Prevalence of and risk factors for dysphagia in the community dwelling elderly: A systematic review

  • Aarthi MadhavanEmail author
  • L. A. Lagorio
  • M. A. Crary
  • W. J. Dahl
  • G. D. Carnaby



This review clarifies current information regarding the prevalence of and risk factors associated with dysphagia (swallowing disorders) in the community dwelling elderly (CDE). A better understanding of prevalence and characteristics of dysphagia in the CDE will help to determine the scope of this problem. Understanding the scope of dysphagia is a critical first step towards early identification, management, and prevention of dysphagia related morbidities in the CDE.


Studies identified from multiple electronic databases (MEDLINE (Pubmed), PsychInfo, Google Scholar, EBSCO, PROQUEST, Web of Science and WorldCat dissertations and theses) evaluating prevalence and risk factors for dysphagia in the CDE were reviewed. Data from all eligible studies were abstracted by the first author and independently reviewed by two raters, using the Newcastle-Ottawa scale (NOS).


15 studies (n = 9947 participants) were eligible for inclusion. Studies included were all observational: 14 cross-sectional and 1 prospective cohort. Significant heterogeneity was observed in methodology among studies of dysphagia in the CDE. The average NOS study quality rating was 4.54 points (SD: 0.9), with a mode of 4 points (range 3-6). Only 6 of the 15 studies were identified as high quality research studies, with a mean of 5.33 points (SD: 0.47). Among reviewed studies, the prevalence of swallowing difficulty in the CDE ranged from 5% to 72%. However, the average prevalence of dysphagia estimated from the 6 high quality studies was 15%. Reported risk factors associated with dysphagia include advancing age; history of clinical disease; and physical frailty, including reduced ability to carry out activities of daily living.


Research on dysphagia in CDE is modest and consists mostly of observational studies with diverse methodology. However, prevalence rate of 15% from the high quality research suggests a significant public health impact of this impairment. Identification of specific risk factors that cause dysphagia in the CDE is premature, given the rigor of published studies. Future research efforts should focus on developing a valid definition and assessment of dysphagia in this population before clarifying causative risk factors.

Key words

Dysphagia community dwelling elderly systematic review 

Supplementary material


  1. 1.
    Centers for Disease Control and Prevention. Older Person’s Health. Accessed 15th Jan 2015.Google Scholar
  2. 2.
    US Department of Health and Human Services, 1999: 1-6. Agency for Healthcare Research and Quality. Diagnosis and treatment of swallowing disorders (dysphagia) in acute-care stroke patients. Evidence report/technology assessment (Summary). Archived EPC Evidence Reports. Accessed 15th June 2015.Google Scholar
  3. 3.
    Barczi SR, Sullivan PA, Robbins J. How should dysphagia care of older adults differ? Establishing optimal practice patterns. Semin Speech Lang. 2000;21(4):347–61.CrossRefPubMedGoogle Scholar
  4. 4.
    Steele CM, Greenwood C, Ens I, Robertson C, Seidman-Carlson R. Mealtime difficulties in a home for the aged: not just dysphagia. Dysphagia. 1997;12(1):43–50; discussion 1.CrossRefPubMedGoogle Scholar
  5. 5.
    Lee A, Sitoh YY, Lieu PK, Phua SY, Chin JJ. Swallowing impairment and feeding dependency in the hospitalised elderly. Ann Acad Med Singapore. 1999;28(3):371–6.PubMedGoogle Scholar
  6. 6.
    Leder SB, Suiter DM. An epidemiologic study on aging and dysphagia in the acute care hospitalized population: 2000-2007. Gerontology. 2009;55(6):714–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Byles J. The epidemiology of communication and swallowing disorders. International Journal of Speech-Language Pathology. 2005;7(1):1–7.CrossRefGoogle Scholar
  8. 8.
    Prasse JE, Kikano GE. An overview of dysphagia in the elderly. Advanced studies in medicine. 2004;4(10):527–33.Google Scholar
  9. 9.
    Bloem BR, Lagaay AM, van Beek W, Haan J, Roos RA, Wintzen AR. Prevalence of subjective dysphagia in community residents aged over 87. BMJ. 1990;300(6726):721–2.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Chen MY, Lin LC. Nonimaging clinical assessment of impaired swallowing in community-dwelling older adults in Taiwan. J Nurs Res. 2012;20(4):272–80.CrossRefPubMedGoogle Scholar
  11. 11.
    Gonzalez-Fernandez M, Humbert I, Winegrad H, Cappola AR, Fried LP. Dysphagia in old-old women: prevalence as determined according to self-report and the 3-ounce water swallowing test. J Am Geriatr Soc. 2014;62(4):716–20.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Chen PH, Golub JS, Hapner ER, Johns MM, 3rd. Prevalence of perceived dysphagia and quality-of-life impairment in a geriatric population. Dysphagia. 2009;24(1):1–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Holland G, Jayasekeran V, Pendleton N, Horan M, Jones M, Hamdy S. Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus. 2011;24(7):476–80.CrossRefPubMedGoogle Scholar
  14. 14.
    Kawashima K, Motohashi Y, Fujishima I. Prevalence of dysphagia among community-dwelling elderly individuals as estimated using a questionnaire for dysphagia screening. Dysphagia. 2004;19(4):266–71.CrossRefPubMedGoogle Scholar
  15. 15.
    Lindgren S, Janzon L. Prevalence of swallowing complaints and clinical findings among 50-79-year-old men and women in an urban population. Dysphagia. 1991;6(4):187–92.CrossRefPubMedGoogle Scholar
  16. 16.
    Mann T, Heuberger R, Wong H. The association between chewing and swallowing difficulties and nutritional status in older adults. Aust Dent J. 2013;58(2):200–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Okamoto N, Tomioka K, Saeki K, Iwamoto J, Morikawa M, Harano A, et al. Relationship between swallowing problems and tooth loss in communitydwelling independent elderly adults: the Fujiwara-kyo study. J Am Geriatr Soc. 2012;60(5):849–53.CrossRefPubMedGoogle Scholar
  18. 18.
    Roy N, Stemple J, Merrill RM, Thomas L. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol. 2007;116(11):858–65.CrossRefPubMedGoogle Scholar
  19. 19.
    Takeuchi K, Aida J, Ito K, Furuta M, Yamashita Y, Osaka K. Nutritional status and dysphagia risk among community-dwelling frail older adults. J Nutr Health Aging. 2014;18(4):352–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Yang EJ, Kim MH, Lim JY, Paik NJ. Oropharyngeal Dysphagia in a communitybased elderly cohort: the korean longitudinal study on health and aging. J Korean Med Sci. 2013;28(10):1534–9.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Serra-Prat M, Palomera M, Gomez C, Sar-Shalom D, Saiz A, Montoya JG, et al. 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. 2012;41(3):376–81.CrossRefPubMedGoogle Scholar
  22. 22.
    Singer C, Keintz, C., Danesh, A., Engstrom, G., Ouslander, J., Tappen, R. Perceived swallowing disorders in healthy aging individuals: impact on quality of life American Speech, Language, and Hearing Association Annual Convention, 2014. Orlando, FL.Google Scholar
  23. 23.
    Butler SG, Stuart A, Leng X, Wilhelm E, Rees C, Williamson J, et al. The relationship of aspiration status with tongue and handgrip strength in healthy older adults. J Gerontol A Biol Sci Med Sci. 2011;66(4):452–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Miura H, Kariyasu M, Yamasaki K, Arai Y. Evaluation of chewing and swallowing disorders among frail community-dwelling elderly individuals. J Oral Rehabil. 2007;34(6):422–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Altman KW, Yu GP, Schaefer SD. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch Otolaryngol Head Neck Surg. 2010;136(8):784–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moer D. The PRISMA statement for reporting systematic reviews and meta- analyses of studies that evaluate health care intervetions: explanation and elaboration. PLoS Medicine. 2009;6(7).Google Scholar
  27. 27.
    Fritz CO, Morris PE, Richler JJ. Effect size estimates: current use, calculations, and interpretation. Journal of experimental psychology. 2012;14(1):2–18.CrossRefGoogle Scholar
  28. 28.
    Wells GA SC, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottowa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses 2014.Google Scholar
  29. 29.
    Herzog R, Alvarez-Pasquin MJ, Diaz C, Del Barrio JL, Estrada JM, Gil A. Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health. 2013;13:154.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefPubMedGoogle Scholar
  31. 31.
    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetrationaspiration scale. Dysphagia. 1996;11(2):93–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Perry L. Screening swallowing function of patients with acute stroke. Part one: Identification, implementation and initial evaluation of a screening tool for use by nurses. J Clin Nurs. 2001;10(4):463–73.CrossRefPubMedGoogle Scholar
  33. 33.
    Nathadwarawala KM, McGroary A, Wiles CM. Swallowing in neurological outpatients: use of a timed test. Dysphagia. 1994;9(2):120–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, et al.. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg. 2001;127(7):870–6.PubMedGoogle Scholar
  35. 35.
    McHorney CA, Robbins J, Lomax K, Rosenbek JC, Chignell K, Kramer AE, et al. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia inGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France 2016

Authors and Affiliations

  • Aarthi Madhavan
    • 1
    Email author
  • L. A. Lagorio
    • 2
  • M. A. Crary
    • 3
  • W. J. Dahl
    • 4
  • G. D. Carnaby
    • 3
  1. 1.Swallowing Research Laboratory, Department of Speech, Language, and Hearing SciencesUniversity of FloridaGainesvilleUSA
  2. 2.Department of Communication Disorders and SciencesRush UniversityChicagoUSA
  3. 3.Swallowing Research Laboratory, Department of Communication Sciences and DisordersUniversity of Central FloridaOrlandoUSA
  4. 4.Department of Food Science and Human NutritionUniversity of FloridaGainesvilleUSA

Personalised recommendations