Dysphagia in frail elderly: self-reported mealtime symptoms and risk
DOI:
https://doi.org/10.11606/s1518-8787.2025059006440Palavras-chave:
Frail Elderly, Frailty, Deglutition Disorders, Speech-Language PathologyResumo
OBJECTIVE: This study aimed to characterize swallowing and investigate the association between self-reported coughing and/or choking during meals and the risk of dysphagia in frail elderly individuals receiving healthcare at a specialized center in São Paulo, Brazil.
METHODS: This cross-sectional observational study included elderly individuals attending an Elderly Health Reference Unit (URSI) from July 2017 to December 2023. Data from all patients referred to the URSI were collected, excluding only those with incomplete medical records. The study proceeded in two phases: the first phase involved physical, functional, and social assessments, while the second phase included speech and swallowing evaluations. Participants were categorized into groups based on self-reported mealtime symptoms. Descriptive and inferential analyses compared these groups using the Mann-Whitney U test for quantitative data and Pearson's χ2 test for qualitative data. Risk analysis employed multiple logistic regression with forward stepwise selection.
RESULTS: The study comprised 1,027 elderly individuals (mean age 78 years; 68.2% women; 64.2% self-identified as white). Approximately half reported frequent choking during meals. Sex, Multidimensional Assessment of the Elderly in Primary Care classification and score, polypharmacy, chronic diseases, falls, urinary incontinence, osteoporosis, cardiac disease, last dental visit, speech difficulty, change in food consistency, hearing loss, and hearing aid use were associated with mealtime symptoms. Speech alterations increased bronchoaspiration risk by 16%, memory complaints by 11%, and xerostomia and food consistency changes by 8%.
CONCLUSION: Speech alterations, changes in food consistency, memory complaints, and xerostomia were identified as factors increasing the risk of bronchoaspiration. Early identification and a multidisciplinary approach to swallowing disorders in frail elderly individuals are crucial for preventing aspiration pneumonia and maintaining quality of life. These findings underscore the significance of proactive management strategies in clinical practice.
Referências
United Nations. Department of Economic and Social Affairs, Population Division. World Population Ageing 2019. United Nations, Department of Economic and Social Affairs, Population Division; 2020.
Instituto Brasileiro de Geografia e Estatística (IBGE). Projeção da população do Brasil por sexo e idade: 2000–2060 [Internet]. IBGE; 2018 [accessed on March 13, 2024]. Available at: hftp://ftp.ibge.gov.br/Projecao_da_Populacao/Projecao_da_Populacao_2018/projecoes_2018_populacao_2010_2060_20200406.xls
Brasil. Ministério da Saúde. Portaria nº 2.528, de 19 de outubro de 2006. Aprova a Política Nacional de Saúde da Pessoa Idosa. Diário Oficial da União. Seção 1.
Prefeitura da Cidade de São Paulo. Secretaria Municipal de Saúde (SMS). Área Técnica de Saúde da Pessoa Idosa [Internet]. São Paulo: Prefeitura da Cidade de São Paulo [accessed on Oct 17, 2022]. Available at: https://www.prefeitura.sp.gov.br/cidade/secretarias/saude/atencao_basica/pessoa_idosa/?p=5432
Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487-92. https://doi.org/10.1111/j.1532-5415.2012.04054.x
Neri AL, Yassuda MS, Araújo LF de, Eulálio M do C, Cabral BE, Siqueira MEC de, et al. Metodologia e perfil sociodemográfico, cognitivo e de fragilidade de idosos comunitários de sete cidades brasileiras: Estudo FIBRA. Cad Saúde Pública. 2013;29(4):778-92. https://doi.org/10.1590/S0102-311X2013000400015
Bahat G, Yilmaz O, Durmazoglu S, Kilic C, Tascioglu C, Karan MA. Association between dysphagia and frailty in community dwelling older adults. J Nutr Health Aging. 2019;23(6):571-7. https://doi.org/10.1007/s12603-019-1191-0
McCoy YM, Varindani Desai R. Presbyphagia versus dysphagia: identifying age-related changes in swallow function. Perspectives. 2018;3(15):15-21. https://doi.org/10.1044/persp3.SIG15.15
Rivelsrud MC, Hartelius L, Bergström L, Løvstad M, Speyer R. Prevalence of oropharyngeal dysphagia in adults in different healthcare settings: a systematic review and meta-analyses. Dysphagia. 2023;28:76-121. https://doi.org/10.1007/s00455-022-10465-x
Takizawa C, Gemmell E, Kenworthy J, Speyer R. A systematic review of the prevalence of oropharyngeal dysphagia in stroke, Parkinson's disease, Alzheimer's disease, head injury, and pneumonia. Dysphagia. 2016;31(3):434-41. https://doi.org/10.1007/s00455-016-9695-9
Lopes de Oliveira T, Griep RH, Guimarães JN, Giatti L, Chor D, Mendes da Fonseca MJ. Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): socio-occupational class as an effect modifier for the relationship between adiposity measures and self-rated health. BMC Public Health. 2019;19(1):734. https://doi.org/10.1186/s12889-019-7072-y
Saraiva MD, Venys AL, Abdalla FLP, Fernandes MS, Pisoli PH, Sousa DM da RV, et al. AMPI-AB validity and reliability: a multidimensional tool in resource-limited primary care settings. BMC Geriatrics. 2020;20(1):124. https://doi.org/10.1186/s12877-020-01508-9
Prefeitura de São Paulo. Secretaria Municipal da Saúde. Coordenação da Atenção Básica. Área Técnica de Saúde da Pessoa Idosa. Documento Norteador Unidade de Referência à Saúde do Idoso [Internet]. São Paulo: Prefeitura de São Paulo [accessed on March 13, 2022]. Available at: https://www.prefeitura.sp.gov.br/cidade/secretarias/upload/saude/arquivos/ANEXOSDOCNORTURSI21122016.pdf
Mangilli LD, Moraes DP, Medeiros GC. Protocolo de avaliação fonoaudiológica preliminar (PAP). In: Andrade CRF, Limongi SCO (Eds.). Disfagia: prática baseada em evidências. São Paulo: Sarvier; 2012. p. 45-61.
Padovani AR, Medeiros GC, Andrade CRF. Protocolo fonoaudiológico de introdução e transição da alimentação por via oral (PITA). In: Andrade CRF, Limongi SCO (Eds.). Disfagia: prática baseada em evidências. São Paulo: Sarvier; 2012. p. 74-85.
Rockville MD. American Speech-Language-Hearing Association National Outcome Measurement System (NOMS). Adult Speech-Language Pathology training manual. ASHA; 1998.
Mello RP, Xavier MO, Tomasi E, Gonzalez MC, Demarco FF, Bielemann RM. Dysphagia perception among community-dwelling older adults from a municipality in southern Brazil. Dysphagia. 2022;37:879-88. https://doi.org/10.1007/s00455-021-10347-8
Kurosu A, Osman F, Daggett S, Peña-Chávez R, Thompson A, Myers SM, et al. Factors associated with self-reported dysphagia in older adults receiving meal support. J Nutr Health Aging. 2021;25(10):1145-53. https://doi.org/10.1007/s12603-021-1700-9
Igarashi K, Kikutani T, Tamura F. Survey of suspected dysphagia prevalence in home-dwelling older people using the 10-Item Eating Assessment Tool (EAT-10). PLoS One. 2019;14(1):e0211040. https://doi.org/10.1371/journal.pone.0211040
Perez RA, Tejada CAO, Triaca LM, Bertoldi AD, dos Santos AMA. Socioeconomic inequality in health in older adults in Brazil. Dialogues Health. 2022;1:100009. https://doi.org/10.1016/j.dialog.2022.100009
Nishida T, Yamabe K, Honda S. Dysphagia is associated with oral, physical, cognitive and psychological frailty in Japanese community-dwelling elderly persons. Gerodontology. 2020;37(2):185-90. https://doi.org/10.1111/ger.12455
Rech RS, de Goulart BNG, dos Santos KW, Marcolino MAZ, Hilgert JB. Frequency and associated factors for swallowing impairment in community-dwelling older persons: a systematic review and meta-analysis. Aging Clin Exp Res. 2022;34(12):2945-61. https://doi.org/10.1007/s40520-022-02258-x
Pina G de MS, Mota Carvalho R, Silva BS de F, Almeida FT. Prevalence of hyposalivation in older people: A systematic review and meta‐analysis. Gerodontology. 2020;37(4):317-31. https://doi.org/10.1111/ger.12497
Johansson A, Omar R, Mastrovito B, Josefin Sannevik, Carlsson GE, Johansson A. Xerostomia in 75–85‐year‐olds: A longitudinal population study. J Oral Rehab. 2023;50(9):812-21. https://doi.org/10.1111/joor.13512
Wang BJ, Carter FL, Altman KW. Relationship between dysarthria and oral-oropharyngeal dysphagia: the present evidence. Ear Nose Throat J. 2020;0145561320951647. https://doi.org/10.1177/0145561320951647
Patel B, Legacy J, Hegland KW, Okun MS, Herndon NE. A comprehensive review of the diagnosis and treatment of Parkinson’s disease dysphagia and aspiration. Expert Rev Gastroenterol Hepatol. 2020;14(6):411-24. https://doi.org/10.1080/17474124.2020.1769475
Stipancic KL, Borders JC, Brates D, Thibeault SL. Prospective investigation of incidence and co-occurrence of dysphagia, dysarthria, and aphasia following ischemic stroke. Am J Speech Lang Pathol. 2019;28(1):188-94. https://doi.org/10.1044/2018_AJSLP-18-0136
Martínez-Nicolás I, Llorente TE, Ivanova O, Martínez-Sánchez F, Meilán JJG. Many changes in speech through aging are actually a consequence of cognitive changes. Int J Environ Res Public Health. 2022;19(4):2137. https://doi.org/10.3390/ijerph19042137
Michel A, Verin E, Hansen K, Chassagne P, Roca F. Buccofacial apraxia, oropharyngeal dysphagia, and dementia severity in community-dwelling elderly patients. J Geriatr Psychiatry Neurol. 2021;34(2):150-5. https://doi.org/10.1177/0891988720915519
Espinosa-Val MC, Martín-Martínez A, Graupera M, Arias O, Elvira A, Cabré M, et al. Prevalence, risk factors, and complications of oropharyngeal dysphagia in older patients with dementia. Nutrients. 2020;12(3):863. https://doi.org/10.3390/nu12030863
Güner M, Baş AO, Ceylan S, Kahyaoğlu Z, Çöteli S, Ünsal P, et al. Dysphagia is closely related to frailty in mild-to-moderate Alzheimer's disease. BMC Geriatr. 2023;23(1):304. https://doi.org/10.1186/s12877-023-04020-y
Namasivayam-Macdonald AM, Steele CM, Carrier N, Lengyel C, Keller HH. The relationship between texture-modified diets, mealtime duration, and dysphagia risk in long-term care. Can J Diet Pract Res. 2019;80(3):122-6. https://doi.org/10.3148/cjdpr-2019-004
Umay E, Eyigor S, Karahan AY, Keskin D, Karaca G, Unlu Z, et al. Which swallowing difficulty of food consistency is best predictor for oropharyngeal dysphagia risk in older person? Eur Geriatr Med. 2019;10(4):609-17. https://doi.org/10.1007/s41999-019-00206-z
Shimizu A, Fujishima I, Maeda K, Murotani K, Ohno T, Nomoto A, et al. Association between food texture levels consumed and the prevalence of malnutrition and sarcopenia in older patients after stroke. Eur J Clin Nutr. 2022;76:1576-82. https://doi.org/10.1038/s41430-022-01126-1
Banda KJ, Chu H, Chen R, Kang XL, Jen HJ, Liu D, et al. Prevalence of oropharyngeal dysphagia and risk of pneumonia, malnutrition, and mortality in adults aged 60 years and older: a meta-analysis. Gerontology. 2022;68(8):841-53. https://doi.org/10.1159/000520326
Iwakiri R, Hamaya H, Nakayama T, Kataoka A, Murano Y, Okawa T, et al. Multimorbidity, consisting of a combination of chronic diseases and geriatric syndromes, predicts the risk of difficulty in discharge home in older patients admitted to acute care hospital. Geriatr Gerontol Int. 2024;24(Suppl. 1):300-5. https://doi.org/10.1111/ggi.14727
Colón-Emeric C, Lyles KW, Levine DA, House P, Schenck AP, Gorospe J, et al. Prevalence and predictors of osteoporosis treatment in nursing home residents with known osteoporosis or recent fracture. Osteoporos Int. 2007;18:553-9. https://doi.org/10.1007/s00198-006-0260-5
Fucile S, Wright PM, Chan I, Yee S, Langlais ME, Gisel EG. Functional oral-motor skills: do they change with age? Dysphagia. 1998;13(4):195-201. https://doi.org/10.1007/PL00009571
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