Recognizing the Importance of Dysphagia: Stumbling Blocks and Stepping Stones in the Twenty-First Century

Dziewas, Rainer; Beck, Anne Marie; Clavé, Père; Hamdy, Shaheen; Heppner, Hans Jürgen; Langmore, Susan E.; Leischker, Andreas; Martino, Rosemary; Pluschinski, P; Roesler, Andreas; Shaker, Reza; Warnecke, Tobias; Sieber, Cornel; Volkert, Dorothee; Wirth, Rainer

doi:10.1007/s00455-016-9746-2

Cited by 79 publications

(63 citation statements)

References 23 publications

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“…The questions covered the common swallowing disturbances that appeared in the oral and pharyngeal phases of swallowing. Five questions (questions [1][2][3][4][5] were related to the oral phase of swallowing and 10 questions (questions 6-15) were related to the pharyngeal phase. Fourteen questions were rated by a four-point (0-3) scale (0 for no disturbance and 3 for severe disturbance), and one was a ''yes/no'' question (yes was scored 2.5 and no was scored 0.5).…”

Section: Methodsmentioning

confidence: 99%

“…2 Oropharyngeal dysphagia can result in insufficient nutrition by affecting respiratory safety and effective swallowing. 3 The common causes of dysphagia among elderly are neuromuscular disorders, degenerative neurological syndromes like dementia and upper digestive tract cancer. 4,5 With aging, there is reduction of oral, pharyngeal and oesophageal functions and hence the elderly, who are otherwise healthy are also at risk of developing dysphagia.…”

Section: Introductionmentioning

confidence: 99%

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Swallowing difficulties among healthy elderly: prevalence and aetiology

Khader

Somayaji

Mubeena

2018

Int J Otorhinolaryngol Head Neck Surg

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Background: Dysphagia is a common problem among elderly individuals. Very few studies have been done to know the prevalence of dysphagia among healthy elderly individuals. So a study was done to assess the prevalence of swallowing difficulties among healthy elderly individuals and to find out the various causes for it in them. Methods: 259 elderly individuals were screened using the swallowing disturbance questionnaire to assess the prevalence of swallowing disorders. Those individuals with swallowing disorders were further subjected to modified Barium swallow to know the aetiology. Results: Of the 259 elderly individuals screened, 85 were females and 174 were males. The mean age and standard deviation was 66.16±6.233. The prevalence of swallowing difficulties was 20.1%, with no significant difference in the gender wise distribution or age wise distribution. Among the various aetiologies diagnosed, idiopathic cause is the commonest, followed by oesophageal neoplasm (21.1%), and then the achalasia cardia (9.6%). Among oesophageal neoplasm, mid-thoracic esophageal neoplasm (9.6%) is the commonest. Conclusions: Considering the time and cost involved, it is not feasible to subject all elderly for instrumental swallowing evaluation like videofluoroscopy. Hence it would be beneficial to screen the elderly individuals for dysphagia and educate them regarding its importance, as dysphagia can also be associated with serious underlying pathology and complications such as aspiration.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Swallowing difficulties among healthy elderly: prevalence and aetiology

Khader

Somayaji

Mubeena

2018

Int J Otorhinolaryngol Head Neck Surg

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“…In spite of its impact on the further clinical course post-stroke dysphagia (PSD) is often underdiagnosed [8,9], possibly because there is no clear consensus about diagnostic guidelines especially regarding the patient profile that should be screened [10]. Although clinical dysphagia screening methods have been proven to be effective in reducing pneumonia and mortality [11] they lack sensitivity in detecting silent aspiration.…”

Section: Introductionmentioning

confidence: 99%

Predicting Dysphagia with National Institute of Health Stroke Scale: Distinction between Infra- and Supratentorial Region is Essential

et al. 2018

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Background: For the early detection of post-stroke dysphagia (PSD), valid screening parameters are crucial as part of a step-wise diagnostic procedure. This study examines the role of the National Institute of Health Stroke Scale (NIH-SS) as a potential low-threshold screening parameter. Methods: During a ten-year period, 687 newly admitted patients at University Hospital Muenster were included in a retrospective analysis, if they had ischemic or haemorrhagic stroke confirmed by neuroimaging and had received NIH-SS scoring and endoscopic swallowing evaluation upon admission. The NIH-SS score was correlated with dysphagia severity as measured by the validated 6-point fiberoptic endoscopic dysphagia severity score (FEDSS), and the ideal cut-off score to predict PSD, defined as FEDSS > 1, was calculated. Supra- and infratentorial strokes were analysed separately due to their differing role in the pathophysiology of neurogenic dysphagia. Results: NIH-SS and dysphagia severity show a significant positive correlation in the whole study population (R² = 0.745) as well as in both analysed subgroups (R² = 0.494 for supra- and R² = 0.646 for infratentorial strokes, p < 0.0005, respectively). For supratentorial strokes, the ideal NIH-SS cut-off is > 9 (sensitivity 68.3%, specificity 61.5%, positive predictive value 89.7%, negative predictive value 28.4%). For infratentorial strokes, a lower ideal cut-off > 5 was calculated (sensitivity 67.4%, specificity 85.0%, positive predictive value 95.1%, negative predictive value 37.8%). Conclusions: NIH-SS may be used as an adjunct to predict dysphagia in acute stroke patients with moderate sensitivity and specificity. Differentiation between supra- and infratentorial regions is essential not to miss dysphagia in infratentorial stroke.

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“…They suggest that “more dysphagia specialists are needed through 2060 and beyond because of projections of continued population ageing resulting in ever increasing referral rates for swallow assessments.” Dysphagia experts are underrepresented, and there is need for additional resources, administrative support, training, and interprofessional communication as the synergy of collaboration can enhance the science in conjunction with quality research. This requires funding and other resources as well as engagement with industry, including the pharmaceutical industry . Dysphagia is a universal topic, as evidenced by research and discussion on this topic from around the globe, as well as the call to unite in this area …”

Section: Providing Care Currently With a View Toward The Futurementioning

confidence: 99%

“…Access to highly qualified healthcare personnel to detect, assess, and treat persons with symptoms of dysphagia may be limited in many settings, including rural and long‐term care facilities . Periodic monitoring throughout the continuum of care for changes in patient status has the potential for improvement, including having adequate healthcare resources and increasing awareness of dysphagia impact both personally and economically.…”

Section: Providing Care Currently With a View Toward The Futurementioning

confidence: 99%

Dysphagia: Interprofessional Management, Impact, and Patient‐Centered Care

et al. 2018

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Dysphagia affects a multitude of people worldwide with tremendous impact on the affected individual, families, and caregivers. Understanding dysphagia, as well as the status of screening, evaluation, and treatment, aids in the knowledge required by a interprofessional team to holistically care for patients with dysphagia and their caregivers. The impact of dysphagia includes potential associated risk and a cascade of effects. Conversations regarding meeting nutrition and fluid needs with consideration for quality of life need to be integrated into the plan of care for individuals with dysphagia.

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Recognizing the Importance of Dysphagia: Stumbling Blocks and Stepping Stones in the Twenty-First Century

Cited by 79 publications

References 23 publications

Swallowing difficulties among healthy elderly: prevalence and aetiology

Swallowing difficulties among healthy elderly: prevalence and aetiology

Predicting Dysphagia with National Institute of Health Stroke Scale: Distinction between Infra- and Supratentorial Region is Essential

Dysphagia: Interprofessional Management, Impact, and Patient‐Centered Care

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