Study: Dysphagia Independent Risk Factor for Mortality
Dysphagia, marked by impaired swallowing, is a common problem in nursing homes, and typical signs of aging such as sarcopenia contribute to this condition. A new study in the September issue of JAMDA identified dysphagia as an independent risk factor for mortality. The authors further observed that residents with dysphagia who also suffered weight loss are at a particularly high risk of mortality and should get special attention.
In “The Impact of Dysphagia on Mortality of Nursing Home Residents: Results from the nutritionDay Project,” researchers calculated the mortality risk for 10,185 residents of 191 nursing homes in 14 countries. Dysphagia was reported in 15% of residents, and the 6-month mortality for these individuals was significantly higher than those without this condition.
Residents who had dysphagia accompanied by previous weight loss had a nearly 40% mortality rate. There was no significant difference in mortality for those residents with feeding tubes. The same was true for the possible effect of oral nutritional supplements (ONS). However, the authors noted, “This does not imply that taking ONS may not be advantageous in older persons. The positive effect of ONS in older persons with malnutrition has been proven by many randomized prospective trials.”
The authors indicated that while the prevalence of dysphagia in nursing homes is high, reported rates greatly vary because of different definitions of the condition and varying diagnostic methods. They said that the 15% dysphagia rate reported in this study suggests the most obvious, symptomatic cases of dysphagia, rather than true prevalence. They observed, “The prevalence rate reported here could be described as the ‘tip of the iceberg.’” The study also had some limitations, the authors suggested, including the fact that dysphagia prevalence and other variables such as cognitive impairment were obtained by asking the nursing staff rather than using objective measures.
Despite the limitations, this study does offer some useful insights into a serious and common condition that is associated with multiple negative health outcomes and can contribute to increased mortality.
This study was conducted by researchers at Department of Geriatric Medicine at the Marien Hospital Herne, Ruhr-Universität Bochum in Herne, Germany; Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nurnberg, Germany; and Medical University Vienna in Austria.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About the Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.