Lin Yuzhu, Xu Chen, Song Xue, Tan Qin, Lian Xiaolei
Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
Front Med (Lausanne). 2025 Aug 14;12:1659438. doi: 10.3389/fmed.2025.1659438. eCollection 2025.
Dysphagia is a common complication in elderly patients with frailty, affecting their prognosis and quality of life. Constructing a risk prediction model can help with early screening and intervention.
To investigate the current status of dysphagia in hospitalized elderly patients with frailty, analyze its influencing factors, and construct a risk prediction model for dysphagia in hospitalized elderly patients with frailty.
A total of 300 hospitalized elderly patients with frailty were selected as research subjects using a convenience sampling method from May to December 2024 in a tertiary general hospital in Mianyang. The survey tools included the General Information Questionnaire, Mini Nutritional Assessment-Short Form (MNA-SF), Geriatric Self-Efficacy Scale for Oral Health (GSEOH), Geriatric Oral Health Assessment Index (GOHAI), and 5-Item Geriatric Depression Scale (GDS-15). Data were analyzed using SPSS 26.0 software, and variable selection was conducted using the backward LR method to construct the risk prediction model.
A total of 300 questionnaires were distributed, and 287 valid questionnaires were retrieved, with an effective recovery rate of 95.7%. Among the 287 patients, 103 cases (35.9%) were identified with dysphagia. Among the 202 patients with a history of choking, 80 cases (39.6%) were identified as having swallowing disorders. In contrast, among the 85 patients without a history of choking, 23 cases (27.1%) had swallowing disorders. The difference was statistically significant ( = 4.092, = 0.043). Logistic regression analysis showed that age, history of coughing, polypharmacy, malnutrition, oral health-related self-efficacy, and oral health assessment index were risk factors for dysphagia in elderly patients with frailty ( < 0.05). The constructed risk prediction model was: Logit = 0.770 × Age + 0.919 × Polypharmacy + 1.009 × History of Coughing + 1.208 × Malnutrition - 0.113 × Oral Health-Related Self-Efficacy - 0.262 × Oral Health Assessment Index + 10.200. The Hosmer-Lemeshow goodness-of-fit test indicated no statistically significant difference between the model's predictions and actual outcomes ( = 6.939, = 0.543, > 0.05). The area under the ROC curve (AUC) was 0.875, with a sensitivity of 0.631 and a specificity of 0.891.
The incidence of dysphagia in hospitalized elderly patients with frailty is relatively high. The main influencing factors include age, history of coughing, polypharmacy, malnutrition, oral health assessment index, and oral health-related self-efficacy. Healthcare professionals should enhance their awareness of risk warning, conduct early screening, and implement preventive measures. The constructed risk prediction model demonstrates high calibration and discrimination abilities, providing a valuable reference for the early detection, prevention, and intervention of dysphagia in hospitalized elderly patients with frailty.
吞咽困难是老年衰弱患者常见的并发症，影响其预后和生活质量。构建风险预测模型有助于早期筛查和干预。
调查住院老年衰弱患者吞咽困难的现状，分析其影响因素，并构建住院老年衰弱患者吞咽困难的风险预测模型。
采用便利抽样法，选取2024年5月至12月绵阳市某三级综合医院的300例住院老年衰弱患者作为研究对象。调查工具包括一般信息问卷、微型营养评定简表（MNA-SF）、老年口腔健康自我效能量表（GSEOH）、老年口腔健康评估指数（GOHAI）和老年抑郁量表15项版（GDS-15）。采用SPSS 26.0软件进行数据分析，采用向后LR法进行变量选择以构建风险预测模型。
共发放问卷300份，回收有效问卷287份，有效回收率为95.7%。287例患者中，103例（35.9%）被诊断为吞咽困难。在有呛咳史的202例患者中，80例（39.6%）被诊断为有吞咽障碍。相比之下，在无呛咳史的85例患者中，23例（27.1%）有吞咽障碍。差异有统计学意义（χ² = 4.092，P = 0.043）。Logistic回归分析显示，年龄、咳嗽史、多重用药、营养不良、口腔健康相关自我效能和口腔健康评估指数是老年衰弱患者吞咽困难的危险因素（P < 0.05）。构建的风险预测模型为：Logit P = （0.770×年龄） + （0.919×多重用药） + （1.009×咳嗽史） + （1.208×营养不良） - （0.113×口腔健康相关自我效能） - （0.262×口腔健康评估指数） + 10.200。Hosmer-Lemeshow拟合优度检验表明，模型预测与实际结果之间无统计学显著差异（χ² = 6.939，P = 0.543，P > 0.05）。ROC曲线下面积（AUC）为0.875，灵敏度为0.631，特异度为0.891。
住院老年衰弱患者吞咽困难的发生率较高。主要影响因素包括年龄、咳嗽史、多重用药、营养不良、口腔健康评估指数和口腔健康相关自我效能。医护人员应提高风险预警意识，进行早期筛查并实施预防措施。构建的风险预测模型具有较高的校准度和区分能力，为住院老年衰弱患者吞咽困难的早期发现、预防和干预提供了有价值的参考。
