Dysphagia and geriatric syndromes in older patients admitted to an intermediate care unit: prospective observational study

Abstract

Background: Dysphagia is a geriatric syndrome often unrecognized or underestimated, and there is a lack of studies in a heterogeneous population in intermediate care (IC) services. This study aims to describe the prevalence of dysphagia and its association with geriatric syndromes in older patients in IC. Methods: Prospective cohort study of patients 70 years and older admitted to an IC unit. At admission, the severity of the clinical conditions, comorbidity, delirium, frailty, sarcopenia, nutritional status, and medications were assessed. Each patient was evaluated with the 3-OZ test, and dysphagia was confirmed by a speech therapy consultation. Two multivariable logistic regression models were used to evaluate the association of dysphagia at admission with geriatric syndromes (model 1), along with the severity of illness and admission diagnosis (model 2). Results: A total of 455 patients were included. The prevalence of dysphagia was 10% and there was a high prevalence of mild-moderate dysphagia in patients with cognitive impairment and moderate risk of malnutrition. In the univariate analysis, an association was found between dysphagia and sarcopenia, malnutrition, and use of antipsychotics. In Model 1, higher odds of dysphagia were associated with the severity of comorbidity (Odds Ratio 6.49, 95% Confidence Interval: 2.02-20.78), and cognitive impairment (OR 0.91, 95% CI: 0.88-10.62); in Model 2, the severity of clinical conditions-NEWS2 (OR 1.61, 95% CI: 1.23-2.13) was associated with dysphagia, besides the severity of comorbidity and cognitive impairment. In a subset of 300 patients, delirium was also associated with dysphagia. Conclusions: The study provides novel information on dysphagia prevalence in patients admitted to an IC unit and its association with geriatric syndromes. Additional research is needed to further define the relationship between geriatric syndromes and dysphagia, and to adequately standardize speech therapist treatments.