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

Abstract

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.

The association of oral function with dietary intake and nutritional status among older adults: Latest evidence from epidemiological studies

“…The selected studies included 23 observational studies [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] ] (17 cross-sectional [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [33] , [34] , [35] , 37 , 38 , 40 , 42 , 43 , 45 , 46 ] and 6 longitudinal designs [ 28 , 30 , 32 , 36 , 39 , 44 ]) and 4 interventional studies [ [47] , [48] , [49] , [50] ]. The number of study participants ranged between 32 and 28,738.…”

“… Nutritional assessment or screening tools Score interpretation [ # Ref.] Mini Nutritional Assessment The lower the score, the greater the risk for malnutrition [ 25 , 29 , 31 , 35 , 37 , 38 , 43 , 44 ] Geriatric nutritional risk index The lower the score, the greater the risk for malnutrition [ 34 ] Patient-Generated Subjective Global Assessment The higher the score, the greater the risk for malnutrition [ 36 ] Prognostic nutritional index The lower the score, the greater the risk for malnutrition [ 52 ] Minimal Eating Observation and Nutrition Form version II The higher the score, the greater the risk for malnutrition [ 27 ] Malnutrition Universal Screening Tool The higher the score, the greater the risk for malnutrition [ 41 ] [ # Ref.] indicates the reference number for the studies using the tools.…”

“…Among the 17 observational cross-sectional studies [ [25] , [26] , [27] , 29 , 31 , [33] , [34] , [35] , 37 , 38 , [40] , [41] , [42] , [43] , 45 , 46 , 52 ] included in this review, 16 studies [ [26] , [27] , [28] , [29] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , 52 ] revealed an association between oral function and nutrition. One study [ 25 ] found no association.…”

“… Natapov et al [ 46 ] 2018 Community 1776 ≥65 Self-reported chewing problems Dietary intake estimated by 24 h dietary recall method Dietary intakes of energy (1355 kcal [with chewing problems] vs. 1480 kcal [without chewing problems]), dietary fiber (15.3 g vs. 17.6 g), protein (3.2 servings vs. 3.5 servings), and vegetables (2.0 servings vs. 2.4 servings) were lower in study participants with chewing problems than in those without (linear regression model). Nishida et al [ 38 ] 2021 Community 320 ≥65 Dysphagia defined as EAT-10 of ≥3 Malnutrition (MNA-SF<12) and prefrailty or frailty assessed using CHS criteria Dysphagia was associated with malnutrition (logistic regression model, adjusted OR [95% CI] = 4.0 [1.9–8.2]) and frailty status (logistic regression model, adjusted OR [95% CI] = 2.3 [1.0–5.2]). Okamoto et al [ 33 ] 2019 Community 3134 Median (IQR) = 71 (68–75) Number of teeth and occlusal force Low serum albumin (<4.4 g/dL) and low BMI (<21.0 kg/m 2 ) Compared with the women with an occlusal force of ≥500 N, those with an occlusal force of <300 N had higher odds of low serum albumin (logistic regression model, adjusted OR [95% CI] = 1.65 [1.06–2.55] for the group with 100–300 N and 1.95 [1.15–3.31] for the group with <100 N).…”

Analyses of Swallowing Function and Its Related Factors in Community-Dwelling Elderly Patients: A Case-Control Study

“…In addition, the subjects were limited to the patients due to the retrospective study and the sample size was not enough. However, we tried to calculate the sample size based on the previous studies [21,23,45], and the prevalence of these factors were wide varieties and it was difficult to calculate the sample size. The data analyses regarding the differences between genders and specific findings in each gender were not conducted due to the limitation of sample size.…”