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Self-Reported Dysphagia and Psychosocial Health Among Community-Dwelling Older Adults: Results of a National Study

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Abstract

Background

The risk of dysphagia increases with age, affecting up to 33% of adults over the age of 65. Older adults with dysphagia are at increased risk for negative physical health outcomes such as aspiration pneumonia and death. However, the relationship between dysphagia and psychosocial health is uncertain in this population.

Objective

We aimed to assess the associations between dysphagia and psychosocial health among older adults (≥ 65) with self-reported dysphagia.

Design

We performed a cross-sectional assessment of the National Health and Aging Trends Study (NHATS) conducted in 2019.

Main Measures

Weighted logistic and linear regression models were used to assess the relationship between self-reported dysphagia and psychosocial health using established patient-reported outcome measures including those for depression, anxiety, and social isolation previously used in NHATS analyses, while adjusting for demographics, comorbid conditions, and risk factors for dysphagia identified by purposeful selection.

Key Results

Among the 4041 adults in this cohort, almost half (40%) were between 70 and 74 years old, more than half were female (55%), and a significantly higher proportion were White, non-Hispanic respondents (78.1%, p < 0.01) compared with other races and ethnicities. There were 428 (10.5%) respondents reporting dysphagia symptoms within the previous month. In the multivariable model, dysphagia was associated with significantly increased odds of anxiety (OR 1.33 [1.06, 1.67]) and a significantly decreased sense of well-being (coefficient − 1.10 [− 1.66, − 0.54]), but no association was detected for social isolation.

Conclusions

When accounting for factors associated with underlying physical health status, self-reported dysphagia is independently associated with negative psychosocial health and warrants attention by healthcare providers. Future studies should aim to identify causal factors and the extent to which interventions may mitigate these factors.

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Data Availability

All NHATS data are publicly available.

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Funding

Duke Pepper Older Americans Independence Center (NIA P30AG028716) and US Department of Veterans Affairs Rehabilitation Research and Development Service Program (Grant IK2RX002348).

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Authors and Affiliations

  1. Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA

    David A. Leiman MD, MSPH

  2. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA

    David A. Leiman MD, MSPH

  3. Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA

    Harrison N. Jones PhD & Seth M. Cohen MD, MPH

  4. Center for the Study of Aging, Duke University School of Medicine, Durham, NC, USA

    Rebecca North PhD, Kathryn N. Porter Starr PhD, RD & Carl F. Pieper PhD

  5. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA

    Rebecca North PhD & Carl F. Pieper PhD

  6. Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA

    Kathryn N. Porter Starr PhD, RD

  7. Geriatrics Research, Education, and Clinical Center, Durham VA Health Care Center, Durham, NC, USA

    Kathryn N. Porter Starr PhD, RD

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Contributions

D.A.L.: project concept/design; data interpretation; drafting of the manuscript; critical revision for important intellectual content; approval of the final draft.

H.N.J.: project concept/design; data interpretation; critical revision for important intellectual content; approved final draft.

R.N.: project concept/design; data analysis and interpretation; critical revision for important intellectual content; approved final draft.

K.N.P.S.: project concept/design; critical revision for important intellectual content; approved final draft.

C.F.P.: project concept/design; data analysis and interpretation; critical revision for important intellectual content; approved final draft.

S.M.C.: Project concept/design; data interpretation; critical revision for important intellectual content; approved final draft.

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Correspondence to David A. Leiman MD, MSPH.

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Conflict of Interest:

D.A.L. (none), H.N.J. (none), R.N. (none), K.N.P.S. (Abbott Nutrition Health Institute, Speakers Bureau), C.F.P. (none), S.M.C. (none).

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Leiman, D.A., Jones, H.N., North, R. et al. Self-Reported Dysphagia and Psychosocial Health Among Community-Dwelling Older Adults: Results of a National Study. J GEN INTERN MED 38, 3329–3338 (2023). https://doi.org/10.1007/s11606-023-08232-1

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