Department of Rehabilitation, Fondazione Camplani Casa di Cura "Ancelle della Carità", Cremona, Italy.
REFiT Bcn Research Group, Vall d'Hebron Institute of Research (VHIR) and Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain.
Eur Geriatr Med. 2023 Jun;14(3):485-492. doi: 10.1007/s41999-023-00773-2. Epub 2023 Apr 13.
Dysphagia is a swallowing disorder that affects 8% of the world population. However, data are lacking on its prevalence in a heterogeneous group of older patients. The aim of this study is to evaluate the prevalence of dysphagia at admission and at discharge, and its related factors, in particular delirium, in older patients admitted to a rehabilitation setting.
Retrospective cohort study of patients 65 years and older admitted to a rehabilitation ward after an acute hospitalization. The presence of dysphagia at admission was screened with the 3OZ Test and confirmed by a speech-therapist. The association between clinical factors and dysphagia was investigated with a multivariate logistic regression analysis.
We included 1040 patients, (65% females, mean age 81.9 ± 7.2 years). The prevalence of dysphagia at admission was 14.8% and 12.8% at discharge, while the prevalence of delirium among patients with dysphagia was of 31.2% vs 6.4% among patients without dysphagia. The severity of dysphagia was moderate. In the multivariate logistic regression, delirium was associated with dysphagia at admission (OR 2.06; Confidence Interval, CI 1.08-3.23) along with a pre-hospital impairment in the Instrumental-Activities-of-Daily-Living (OR-1.26; CI - 1.1; - 1.10), a change in Barthel Index from pre-hospital to hospital admission (OR-1.02; CI - 1.01 to 1.04), comorbidity (OR 1.12; CI 0.94;1.29) and the number of antibiotics (OR-1.63; CI - 1.01;2.62).
Delirium was the main factor associated with dysphagia at rehabilitation admission. The study underlines the importance of screening dysphagia in delirious patients and warrants future studies to determine the changes in dysphagia prevalence according to delirium resolution.
吞咽障碍影响着全球 8%的人口。然而，在异质老年患者群体中，关于其流行率的数据尚缺乏。本研究旨在评估康复环境中，急性住院后入住康复病房的老年患者入院时和出院时吞咽障碍的流行率及其相关因素，特别是谵妄。
这是一项回顾性队列研究，纳入了年龄在 65 岁及以上、急性住院后入住康复病房的患者。入院时通过 3OZ 测试筛查吞咽障碍，并由言语治疗师进行确认。使用多变量逻辑回归分析调查了临床因素与吞咽障碍之间的关联。
我们纳入了 1040 名患者（65%为女性，平均年龄 81.9±7.2 岁）。入院时吞咽障碍的流行率为 14.8%，出院时为 12.8%，而吞咽障碍患者中谵妄的流行率为 31.2%，无吞咽障碍患者中谵妄的流行率为 6.4%。吞咽障碍的严重程度为中度。在多变量逻辑回归中，入院时谵妄与吞咽障碍相关（OR 2.06；95%置信区间，CI 1.08-3.23），此外，还与入院前在工具性日常生活活动方面的损害（OR-1.26；CI-1.1；-1.10）、入院前到入院时 Barthel 指数的变化（OR-1.02；CI-1.01 至 1.04）、合并症（OR 1.12；CI 0.94；1.29）和抗生素数量（OR-1.63；CI-1.01；2.62）相关。
谵妄是与康复入院时吞咽障碍相关的主要因素。本研究强调了在谵妄患者中筛查吞咽障碍的重要性，并需要进一步的研究来确定根据谵妄的缓解情况，吞咽障碍的流行率变化。
