Madhavan A, LaGorio L A, Crary M A, Dahl W J, Carnaby G D
Aarthi Madhavan, Department of Speech, Language, and Hearing Sciences, University of Florida, PO Box 100174, Gainesville, FL 32610,
J Nutr Health Aging. 2016;20(8):806-815. doi: 10.1007/s12603-016-0712-3.
This review clarifies current information regarding the prevalence of and risk factors associated with dysphagia (swallowing disorders) in the community dwelling elderly (CDE). A better understanding of prevalence and characteristics of dysphagia in the CDE will help to determine the scope of this problem. Understanding the scope of dysphagia is a critical first step towards early identification, management, and prevention of dysphagia related morbidities in the CDE.
Studies identified from multiple electronic databases (MEDLINE (Pubmed), PsychInfo, Google Scholar, EBSCO, PROQUEST, Web of Science and WorldCat dissertations and theses) evaluating prevalence and risk factors for dysphagia in the CDE were reviewed. Data from all eligible studies were abstracted by the first author and independently reviewed by two raters, using the Newcastle-Ottawa scale (NOS).
15 studies (n = 9947 participants) were eligible for inclusion. Studies included were all observational: 14 cross-sectional and 1 prospective cohort. Significant heterogeneity was observed in methodology among studies of dysphagia in the CDE. The average NOS study quality rating was 4.54 points (SD: 0.9), with a mode of 4 points (range 3-6). Only 6 of the 15 studies were identified as high quality research studies, with a mean of 5.33 points (SD: 0.47). Among reviewed studies, the prevalence of swallowing difficulty in the CDE ranged from 5% to 72%. However, the average prevalence of dysphagia estimated from the 6 high quality studies was 15%. Reported risk factors associated with dysphagia include advancing age; history of clinical disease; and physical frailty, including reduced ability to carry out activities of daily living.
Research on dysphagia in CDE is modest and consists mostly of observational studies with diverse methodology. However, prevalence rate of 15% from the high quality research suggests a significant public health impact of this impairment. Identification of specific risk factors that cause dysphagia in the CDE is premature, given the rigor of published studies. Future research efforts should focus on developing a valid definition and assessment of dysphagia in this population before clarifying causative risk factors.
本综述阐明了有关社区居住老年人（CDE）吞咽困难（吞咽障碍）患病率及相关危险因素的现有信息。更好地了解CDE中吞咽困难的患病率和特征将有助于确定该问题的范围。了解吞咽困难的范围是早期识别、管理和预防CDE中吞咽困难相关疾病的关键第一步。
对从多个电子数据库（MEDLINE（PubMed）、PsychInfo、谷歌学术、EBSCO、PROQUEST、科学网和世界大学图书馆论文数据库）中检索到的评估CDE中吞咽困难患病率和危险因素的研究进行综述。所有符合条件的研究数据由第一作者提取，并由两名评估者使用纽卡斯尔-渥太华量表（NOS）进行独立审查。
15项研究（n = 9947名参与者）符合纳入标准。纳入的研究均为观察性研究：14项横断面研究和1项前瞻性队列研究。CDE吞咽困难研究在方法上存在显著异质性。NOS研究质量平均评分为4.54分（标准差：0.9），众数为4分（范围3 - 6）。15项研究中只有6项被确定为高质量研究，平均分为5.3分（标准差：0.47）。在综述的研究中，CDE中吞咽困难的患病率在5%至72%之间。然而，根据6项高质量研究估计的吞咽困难平均患病率为15%。报告的与吞咽困难相关的危险因素包括年龄增长；临床疾病史；以及身体虚弱，包括进行日常生活活动的能力下降。
关于CDE中吞咽困难的研究较少，且大多是方法多样的观察性研究。然而，高质量研究得出的15%的患病率表明这种损伤对公共卫生有重大影响。鉴于已发表研究的严谨性，确定导致CDE中吞咽困难的具体危险因素还为时过早。未来的研究应在明确致病危险因素之前，专注于为该人群制定有效的吞咽困难定义和评估方法。
