Montero Lorena, Fauró Àngela, Gómis Gemma, Rodríguez-Romero Rocío, Santos-Ruiz Susana, Aguilar Miriam, Alcaraz Alicia, Devant-Altimir Meritxell, García Nuria I, Gómez Elena, García Noelia, Guerrero Lucía, Lascorz Alejandro, Martínez Eva, Muntalà María T, Pujol Jana, Serna Amaya, Sibelo Laura, Vázquez Melba, Roura-Rovira Silvia, González-de Paz Luis
Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain.
Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Dysphagia. 2024 Sep 23. doi: 10.1007/s00455-024-10761-8.
Oropharyngeal Dysphagia (OD) increases the risk of hospitalization and the use of health services; however, it is often detected and studied in institutionalized patients with limited attention given to the community. The aim of this study was to determine the prevalence of OD and its associated factors after conducting a program consisting of a systematic assessment of OD for in patients living independently in their dwellings and requiring home-based care. We conducted a cross-sectional study involving a systematic assessment of disabled and elderly patients enrolled in a home-based primary care program at three urban centers (Barcelona, Spain). OD was assessed using the Volume-Viscosity Swallow Test. Data on morbidity, incontinence, functional independence, pressure sore risk, brain deficit, social risk, nutritional status, and healthcare utilization were collected. Prevalence was determined, and differences between OD and non-OD patients were analysed using independent tests. Associations between OD and hospital admissions, emergency department visits, emergency home ambulance use, and consultations with family physicians or primary care nurses were examined using logistic regression models adjusted for covariates. We included 1,002 patients with a mean age of 88.75 years old (SD = 8.19), 73.05% of whom were female. The prevalence of OD was 25.95% (95% CI 23.26%-28.78%). OD was associated with past pneumonia episodes (adjusted OR: 5.09, 95% CI: 2.2-11.79), increased frequency of cough and common cold (adjusted OR: 1.11, 95% CI: 1.05-1.18), and more family physician consultations (adjusted OR: 1.07, 95% CI: 1.03-1.10). These findings highlight that OD remains an underdiagnosed geriatric syndrome in the community setting. Implementing systematic OD diagnoses assessments, especially among home care-based patients could reduce the incidence of secondary pneumonia, decrease cough episodes, and lower the frequency of clinician consultations.
口咽吞咽困难（OD）会增加住院风险和医疗服务的使用；然而，它通常在机构化患者中被检测和研究，而对社区患者的关注有限。本研究的目的是在对独立居住在家中且需要居家护理的患者进行了一项包括对口咽吞咽困难进行系统评估的项目后，确定口咽吞咽困难的患病率及其相关因素。我们进行了一项横断面研究，对西班牙巴塞罗那三个城市中心参加居家初级保健项目的残疾和老年患者进行了系统评估。使用容量 - 粘度吞咽测试对口咽吞咽困难进行评估。收集了发病率、失禁、功能独立性、压疮风险、脑功能缺陷、社会风险、营养状况和医疗利用的数据。确定患病率，并使用独立检验分析口咽吞咽困难患者和非口咽吞咽困难患者之间的差异。使用针对协变量进行调整的逻辑回归模型检查口咽吞咽困难与住院、急诊就诊、紧急家庭救护车使用以及与家庭医生或初级保健护士会诊之间的关联。我们纳入了1002名平均年龄为88.75岁（标准差 = 8.19）的患者，其中73.05%为女性。口咽吞咽困难的患病率为25.95%（95%可信区间23.26% - 28.78%）。口咽吞咽困难与既往肺炎发作（调整后的比值比：5.09，95%可信区间：2.2 - 11.79）、咳嗽和普通感冒频率增加（调整后的比值比：1.11，95%可信区间：1.05 - 1.18）以及更多的家庭医生会诊（调整后的比值比：1.07，95%可信区间：1.03 - 1.10）相关。这些发现突出表明，在社区环境中，口咽吞咽困难仍然是一种诊断不足的老年综合征。实施系统的口咽吞咽困难诊断评估，尤其是在居家护理患者中，可以降低继发性肺炎的发生率，减少咳嗽发作次数，并降低临床医生会诊频率。
