Current Status and Influencing Factors of Dysphagia among the Elderly in Communities: a Cross-sectional Study

Abstract

Background Dysphagia, a prevalent geriatric syndrome, has been witnessing an upward trend in incidence rates, potentially leading to severe complications like aspiration pneumonia and asphyxia. Despite its significance, research on the prevalence and determinants of dysphagia among community-dwelling elderly remains scarce. Objective This study aims to ascertain the prevalence of dysphagia among Shanghai's elderly community by identifying influencing factors and analyzing occurrence rates and determinants across different age brackets. Methods Employing a cross-sectional survey approach, the study was conducted from July 2022 to May 2023. Using convenience sampling, the study involved 358 individuals aged 60 and above, selected from the outpatient and home care services of five community health service centers in Huangpu, Baoshan and Fengxian Districts of Shanghai. Demographic data were collected, and measurements of the Appendicular Skeletal Muscle Index (ASMI), grip strength, and walking speed were taken. The Eating Assessment Tool-10 (EAT-10) was utilized to assess the risk of dysphagia among the elderly. Results Out of the 358 community-dwelling elderly individuals surveyed, 80 (22.3%) exhibited symptoms of dysphagia (EAT-10≥3) (dysphagia group). Multivariate Logistic regression analysis identified advanced age (≥80 years) (OR=18.484, 95%CI=3.571-95.679), depressive state (OR=4.135, 95%CI=1.280-13.364), and a history of choking (OR=13.650, 95%CI=4.345-42.877) as significant risk factors for dysphagia (P<0.05). Conversely, a high Barthel Index (OR=0.891, 95%CI=0.832-0.953) and a robust ASMI (OR=0.330, 95%CI=0.199-0.547) emerged as protective factors (P<0.05). When stratified by age, the prevalence rates of dysphagia were 5.0% (6/119), 11.1% (16/144), and 61.1% (58/95) for the age groups 60-69, 70-79, and ≥80 respectively, with statistically significant differences (P<0.05). Significant disparities were noted between dysphagia and non-dysphagia groups in terms of BMI, ASMI, and depression status for ages 60-69 (P<0.05), grip strength, calf circumference, depression, Barthel Index, and choking history for ages 70-79 (P<0.05), and ASMI, grip strength, walking speed, Barthel Index, MMSE scores, and choking history for ages ≥80 (P<0.05). Within the dysphagia cohort, ASMI and grip strength in the 70-79 and ≥80 age groups were lower compared to the 60-69 age group (P<0.05). The walking speed of individuals aged ≥70 was reduced relative to those aged 60-69 (P<0.05). Additionally, individuals aged ≥80 showed a higher choking incidence and scored lower on the Barthel Index and MMSE than those aged 60-79 (P<0.05) . Conclusion The prevalence of dysphagia among community-dwelling elderly in Shanghai is notably high and progressively increases with age, with a corresponding rise in influencing factors. It is imperative to intensify dysphagia screening, particularly among the elderly with depressive symptoms or a history of choking. Enhancing muscle mass and self-care capabilities, coupled with age-specific preventive measures, can substantially alleviate the disease burden and improve prognoses.

Keywords

• dysphagia|elderly|prevalence|communities|root cause analysis