Screening performance of a 100-mL water swallowing test in community-dwelling older adults: A receiver operating characteristic analysis.

OBJECTIVE: The development of a dysphagia screening test is an urgent issue in the field of frailty prevention among community-dwelling older people. The purpose of this study was to evaluate the screening performance of a 100-mL water swallowing test (WST). METHODS: The study employed a cross-sectional design. Participants were 304 (65 men and 239 women, mean age = 80 years) Japanese community-dwelling older adults aged over 65 years. We investigated swallowing disorder using the 10-item Eating Assessment Tool (EAT-10), and compared choking signs, swallowing time and number of swallows, and their combination in the 100-mL WST. We calculated the sensitivity and specificity of these indices. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off value of swallowing time and number of swallows in the 100-mL WST based on the Youden Index among participants without choking signs. RESULTS: The sensitivity and specificity of choking signs in the 100-mL WST were 20% and 91%, respectively. The discriminating ability of swallowing time and number of swallows among participants without any choking signs was .76 and .72, respectively, in the area under the ROC curve. Diagnostic sensitivity and specificity to discriminate dysphagia from normal swallowing ability were 65% and 74% when the cut-off was >10 s based on maximisation of the Youden Index. The 100-mL WST performed best when the indices of choking signs and swallowing time were combined, with a sensitivity and specificity of 72% and 68%, respectively. CONCLUSIONS: The 100-mL WST would be an adequate screening tool when compared to the EAT-10.

The Influence of Dysphagia on Nutritional and Frailty Status among Community-Dwelling Older Adults.

Malnutrition is a core symptom of the frailty cycle in older adults. The purpose of this study was to investigate whether dysphagia influences nutrition or frailty status in community-dwelling older adults. The study participants were 320 Japanese community-dwelling older adults aged ≥65 years. All participants completed a questionnaire survey that included items on age, sex, family structure, self-rated health, nutritional and frailty status, and swallowing function. Nutritional status was categorized as malnourished, at risk of malnutrition, and well-nourished based on the Mini Nutrition Assessment-Short Form. The participants were then classified into a malnutrition (malnourished/at risk) or a well-nourished group (well-nourished). Frailty was assessed using the Cardiovascular Health Study criteria. The participants were then divided into a frailty (frail/pre-frail) or a non-frailty group (robust). Dysphagia was screened using the 10-item Eating Assessment Tool. Multiple logistic regression analysis was conducted to determine whether dysphagia was associated with nutritional or frailty status. The results revealed that dysphagia influenced both nutrition (odds ratio [OR]: 4.0; 95% confidence interval [CI]: 1.9-8.2) and frailty status (OR: 2.3; 95% CI: 1.0-5.2); therefore, the swallowing function would be an important factor for community-dwelling older adults on frailty prevention programs.

Dysphagia is associated with oral, physical, cognitive and psychological frailty in Japanese community-dwelling elderly persons.

OBJECTIVE: To investigate which domains of frailty are associated with dysphagia in community-dwelling elderly persons. BACKGROUND: Dysphagia is a common cause of aspiration pneumonia in frail elderly persons in Japan. Although frailty is considered to be multidimensional, it is unclear which domains of frailty affect dysphagia. METHODS: The participants were 3475 independent Japanese elderly persons (≥65 years; 1555 men and 1920 women). A self-report questionnaire with a frailty checklist consisting of several domains (lifestyle, physical function, nutrition, oral function, homebound status, cognitive function and depressive mood) was used to determine the participants' characteristics. Dysphagia was defined as impaired swallowing in the oral function domain. To determine the associations between dysphagia and age, sex and the other domains on the frailty checklist, adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were calculated using multiple logistic regression analysis. RESULTS: The multiple logistic regression analysis showed that dysphagia was independently associated with female sex (AOR = 1.35; 95% CI = 1.08-1.68), chewing ability (AOR = 1.70; 95% CI = 1.32-2.18), oral dryness (AOR = 1.94; 95% CI = 1.48-2.54), physical function (AOR = 2.19; 95% CI = 1.66-2.90), cognitive function (AOR = 1.68; 95% CI = 1.34-2.12) and depressive mood (AOR = 1.82; 95% CI = 1.41-2.35). CONCLUSION: Dysphagia was independently associated with oral, physical, cognitive and psychological frailty. These results suggest that frailty prevention strategy including swallowing training might be useful for community-dwelling independent elderly persons aged ≥65 years.