Preliminary Development of a Screening Tool for Pre-Clinical Dysphagia in Community Dwelling Older Adults

Abstract

Evidence suggests that community dwelling older adults (CDOA) are at risk for dysphagia (swallowing difficulties). Dysphagia is often unidentified until related morbidities like under nutrition or pneumonia occur. These cases of unidentified dysphagia, prior to any clinical intervention, may be termed ‘pre-clinical dysphagia’. Identifying pre-clinical dysphagia is challenged by the lack of validated tools appropriate for CDOA. This study addresses preliminary development of a novel patient reported outcome (PRO) screening tool for pre-clinical dysphagia. Initially, 34 questions were developed from literature review and expert opinion. Following pilot testing (n = 53), the questionnaire was revised and tested on 335 additional CDOA. Face validity, content validity, item analysis, reliability (internal consistency), and construct validity (exploratory factor analysis) measures were completed. Psychometric validation resulted in a 17-question PRO tool. Construct analysis identified a three-factor model that explained 67.345% of the variance. Emergent factors represented swallowing effort, physical function, and cognitive function. The results revealed strong construct validity and internal consistency (Cronbach’s α = 0.90). A novel, simple PRO incorporating multiple function domains associated with aging demonstrated strong preliminary psychometric properties. This tool is more comprehensive and aging-focused than existing dysphagia screening tools. Inclusion of multiple domains may be key in early identification of pre-clinical dysphagia.

Proposta De Instrumento De Rastreio Para Disfagia Na Atenção Primária À Saúde

“…Dos 15 estudos selecionados nesta revisão da literatura, seis foram realizados nos Estados Unidos (DEPIPPO et al, 1994;LOGEMAN et al, 1999;TURNER LAWRENCE et al, 2009;EDMIASTON et al, 2010;BELAFSKY et al, 2008;MADHAVAN et al, 2018). As amostras dos 15 estudos variaram de 32 a 482 participantes e a idade variou de 20 a 97 anos de idade.…”

“…Após a realização da revisão de escopo em busca dos instrumentos de rastreio para disfagia já existentes, verificou-se que a maioria das publicações foram feitas a partir de 2008de (BELAFSKY et al, 2008TURNER-LAWRENCE et al, 2009;EDMIASTON et al, 2010;ROFES et al, 2012;MANDYSOVÁ et al, 2015;OSTROFSKY et al, 2016;ALMEIDA et al, 2017;PAPADOPOULOU et al, 2017;KYEONG EUN UHM et al, 2018;MADHAVAN et al, 2018;JÚNIOR et al, 2020;KARWAI TSANG et al, 2020;SADEGHI et al, 2020).…”

Validação de um instrumento multiprofissional para rastreio do risco de broncoaspiração em ambiente hospitalar

“…", houve concordância entre todos os juízes em validade e relevância. O critério converge com a literatura, pois Madhavan et al (2018), em seus estudos, coloca o critério de inclusão pacientes > 60 anos já que há evidências no que se refere às mudanças na deglutição, nutrição e habilidades físicas a partir da sexta década de vida (Madhavan et al, 2018).…”

“…", foi validado pelos juízes. Convergindo com alguns estudos, pois Cavalcante e Matos (2015) constataram que a implantação da prática correta de higiene oral nos pacientes críticos, contribuiu com uma significativa redução de infecções em unidade de terapia intensiva (Cavalcante & Matos, 2015) e Madhavan e seus colaboradores (2018), ao desenvolverem uma ferramenta de triagem para identificação da disfagia, incluíram como um dos norteadores a saúde bucal (Madhavan et al, 2018).…”

Mapping the Ethical Issues of Brain Organoid Research and Application

“…Despite the clear utility of brain organoids, many challenges remain including the incomplete recapitulation of brain structure, size, maturity, vascularization, lamination and lack of input/output systems, external stimuli, and non-neuroectodermal cells. Currently, researchers are trying to tackle these challenges by comparing brain organoids to human fetal tissues to decipher the lack of developmental maturity and diversity (Pollen et al 2019;Bhaduri et al 2020), transplanting brain organoids into animal brains for the host vascularization (Mansour et al 2018), slicing organoids for better layered-organization (Qian et al 2020), fusing organoids or spheroids (that is, aggregated neural tissues) to make input/output systems (Xiang et al 2019), and adding non-neuroectodermal cells such as microglia and oligodendrocyte to create more complete cerebral tissues (Madhavan et al 2018;Ormel et al 2018). These approaches have been under development and many scientists are aiming to enhance the cerebral organoids to fully recapitulate the developing human brain for better disease modeling.…”