Qiu Yufeng, Xue Wenfeng, Chen Yanxin, He Xiaona, Zhao Lancai, Tang Mengling, Zhang Huafang
Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China.
Department of Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China.
Biol Res Nurs. 2025 Apr;27(2):300-315. doi: 10.1177/10998004241290727. Epub 2024 Oct 13.
Dysphagia is a geriatric syndrome, which may lead to complications such as dehydration, malnutrition, aspiration, pneumonia, and a significant reduction in quality of life. The purpose of this study was to construct and validate a prediction model for dysphagia in community-dwelling older adults and provide an assessment tool for the prevention and control of dysphagia. Cross-sectional study. The community-dwelling Chinese older adults. 3655 participants aged 65 years and older were involved, who were randomly divided into the training set and the validation set. Data were collected and analyzed from June 2022 to September 2022. Univariate and multivariate logistic regression analysis were used to identify independent risk factors for dysphagia. We applied R software to develop a nomogram model to predict dysphagia in community-dwelling older adults. The predictive value of the model was assessed by the area under the ROC curve (AUC), the calibration curve was used to evaluate the reliability of the nomogram model for predicting dysphagia in community-dwelling older adults. The model's clinical utility was further evaluated using a Decision Curve Analysis (DCA). The incidence of dysphagia was 11.8% (320/3655). Maximum tongue pressure, number of molars, pneumonia, ADL, sarcopenia, age, neurological diseases, and rheumatic immune diseases were selected as risk predictors for dysphagia. The prediction model demonstrated fair discriminative ability with the AUC was 0.709 (95%CI: 0.679-0.739) in the training set and 0.693 (95%Cl: 0.640-0.747) in the validation set, the calibration is adequate, and the Hosmer and Lemeshow test showed values of 0.163 and 0.415, respectively. The DCA curve of our model shows a positive clinical net benefit. The prediction model established in this study was of a certain predictive value for the risk of dysphagia in community-dwelling older adults. By estimating the likelihood of future outcomes or the onset of certain diseases, it can assist medical personnel in formulating preventive strategies, lessening the workload of nurses, and also diminishing the financial burden on patients, thereby enhancing their overall quality of life.
吞咽困难是一种老年综合征，可能导致脱水、营养不良、误吸、肺炎等并发症，并显著降低生活质量。本研究的目的是构建并验证社区居住老年人吞咽困难的预测模型，并提供一种吞咽困难预防和控制的评估工具。横断面研究。研究对象为居住在社区的中国老年人。纳入3655名65岁及以上的参与者，他们被随机分为训练集和验证集。于2022年6月至2022年9月收集并分析数据。采用单因素和多因素逻辑回归分析来确定吞咽困难的独立危险因素。我们应用R软件开发了一个列线图模型，以预测社区居住老年人的吞咽困难。通过ROC曲线下面积（AUC）评估模型的预测价值，校准曲线用于评估列线图模型预测社区居住老年人吞咽困难的可靠性。使用决策曲线分析（DCA）进一步评估模型的临床实用性。吞咽困难的发生率为11.8%（320/3655）。最大舌压、磨牙数量、肺炎、日常生活活动能力、肌肉减少症、年龄、神经系统疾病和风湿免疫疾病被选为吞咽困难的风险预测因素。预测模型显示出较好的判别能力，训练集中AUC为0.709（95%CI：0.679 - 0.739），验证集中为0.693（95%Cl：0.640 - 0.747），校准良好，Hosmer和Lemeshow检验值分别为0.163和0.415。我们模型的DCA曲线显示出积极的临床净效益。本研究建立的预测模型对社区居住老年人吞咽困难风险具有一定的预测价值。通过估计未来结果或某些疾病发生的可能性，它可以帮助医务人员制定预防策略，减轻护士的工作量，也减轻患者的经济负担，从而提高他们的整体生活质量。
