How common is dysphagia in older adults living at home and what are the potential risk factors?
Dysphagia, or difficulty swallowing food or drink, can lead to poorer health outcomes and serious complications such as aspiration pneumonia. Dysphagia can often go undetected and is known to be common amongst hospitalised older adults and those living in institutional care. Less is known about the prevalence of dysphagia amongst older adults who live at home. This commentary critically appraises a systematic review that determines prevalence rates and risk factors for dysphagia in the community-dwelling elderly.
Dysphagia has frequently been defined as, ‘difficulty moving food from mouth to stomach’ (Logemann, 1998). An individual can experience dysphagia for a multitude of reasons; these include progressive neurological conditions, stroke, physiological conditions or sarcopenia (Baijens et al, 2016). Dysphagia is more prominently associated with older patients (Altman et al, 2010). It is estimated that between 50-75% of nursing home residents and 10% of acutely hospitalised older adults experience dysphagia (Lugger, 1994; O’Loughlin and Shanley, 1998). Its prevalence is less clear in the community-dwelling elderly (CDE)—older adults who live independently and do not require institutionalised or ‘skilled care’ in their daily lives (Madhavan et al, 2016).
Dysphagia can go unrecognised for numerous reasons, including the perception of severity, subtle compensatory techniques when eating and drinking, reluctance to seek professional help and misperception of the causes (Chen et al, 2009; Holland et al, 2011; Smithard, 2018a; 2018b; Jardine et al, 2020; Leslie and Smithard, 2021). Undiagnosed dysphagia is problematic, as it can be a contributing factor for malnutrition and/or dehydration, weight loss, reduced quality of life and potentially worse health outcomes, including life-threatening complications such as aspiration pneumonia (Baijens et al, 2016; Wirth, 2016; Melgaard et al, 2018). This is particularly concerning for older adults, who are more likely to believe that swallowing difficulties are a natural part of aging and incorrectly accept their swallowing disabilities as normal (Chen et al, 2009).
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