Dysphagia and Mortality
Scharma et al (2001)
Scharma et al (2001)
Patients with no dysphagia have higher survival than the same patient with stroke and dysphagia
Pneumonia and dysphagia
Martino et al (2005)
Martino et al (2005)
Shows dose effect
• Individuals with dysphagia – 3x more likely to have pneumonia
• Individuals with aspiration – 11x more likely to have pneumonia
• Individuals with dysphagia – 3x more likely to have pneumonia
• Individuals with aspiration – 11x more likely to have pneumonia
Pneumonia and dysphagia
Langmore et al (1998)
Langmore et al (1998)
• Inpatient veterans who got pneumonia and who didn’t – 189 patients (mostly male)
• Regression analysis – which variables were predictors for who would get pneumonia
• Regression analysis – which variables were predictors for who would get pneumonia
Biggest predictors for pneumonia:
• Dependency for oral care
• Tube feeding before the pneumonia
Biggest predictors for pneumonia for oral feeders:
• Dependent for feeding
• Now smoking
• Number of medications
Dentate subjects:
Multiple diagnoses
Number of decayed teeth
Excluding tubefed and edentulous subjects:
Dependent for feeding
Multiple medical diagnoses
Pneumonia and dysphagia
Langmore et al (1998)
Significant predictors of aspiration pneumonia
Langmore et al (1998)
Significant predictors of aspiration pneumonia
Dependent for oral care
Number of decayed teeth
Number of medications
Tube feeding
-> Dependent of feeding
->now smoking
multiple diagnoses
-> pneumonia
Number of decayed teeth
Number of medications
Tube feeding
-> Dependent of feeding
->now smoking
multiple diagnoses
-> pneumonia
Pneumonia and dysphagia
Martin-Harris et al (2013)
Martin-Harris et al (2013)
• Swallowing happens after exhaling, during an apneic period
• This maximizes airway protection
• This maximizes airway protection
Pneumonia and dysphagia
Martin-Harris et al (2013)
Cross-system respiratory – swallowing impairment
Martin-Harris et al (2013)
Cross-system respiratory – swallowing impairment
• Swallowing and respiration – both controlled by medulla.
• Two systems overlap.
• COPD, asthma, etc. are at high risk for swallowing problem
• Two systems overlap.
• COPD, asthma, etc. are at high risk for swallowing problem
Dysphagia and Malnutrition
Sitzmann et al (1990)
Sitzmann et al (1990)
• Monitored 90 consecutive patients admitted to hospital with primary diagnosis of dysphagia
• At some point during one year, all were malnourished
• At some point during one year, all were malnourished
Dysphagia and Malnutrition
Davalos et al (1996)
Davalos et al (1996)
• The longer patients hospitalized – more malnourished
• Patients with dysphagia – significantly more malnourished
• Patients with dysphagia – significantly more malnourished
Dysphagia and Malnutrition
Foley et al (2009)
Foley et al (2009)
• Systematic review showed that patients hospitalized with stroke and dysphagia -> malnourished
• Malnourished -> unable to recover as well
• Malnourished -> unable to recover as well
Dysphagia and Malnutrition
Finestone et al (2000 & 2001)
Finestone et al (2000 & 2001)
• Patients with dysphagia at heightened risk for dehydration
• Especially if fluid supplement not provided
• Especially if fluid supplement not provided
Dysphagia and Malnutrition:
Differences in concerns
Differences in concerns
•Clinician experts and Caregivers: 1) Pulmonary 2) Nutrition 3) Psychology
•Patients: 1) Psychology 2) Nutrition 3) Pulmonary
•Patients: 1) Psychology 2) Nutrition 3) Pulmonary
Differences in concerns – Acute vs Chronic patients
•Acute patients -> More concerned about choking to death
•Chronic -> Depression/embarrassment – bigger issue
•Chronic -> Depression/embarrassment – bigger issue
VFS-Based Measures
MBS-IMP
MBS-IMP
Domains scored along a 3-5 point scale
Inter-rate reliability – ≥ 80% agreement
Correlated with nutrition, aspiration pneumonia, QOL, oral diet, etc.
Inter-rate reliability – ≥ 80% agreement
Correlated with nutrition, aspiration pneumonia, QOL, oral diet, etc.
Patient reported outcomes
SSQ
SSQ
Patient’s report of their symptoms
Doesn’t diagnose dysphagia – report of impact of dysphagia
Doesn’t diagnose dysphagia – report of impact of dysphagia
VFS Based Measures
Functional Oral Intake Scale
Functional Oral Intake Scale
Targets swallowing function
Completed by clinician
Level of nutrition, diet level & modifications
Good reliability, validity, sensitivity to change
Stroke patients (302)
Completed by clinician
Level of nutrition, diet level & modifications
Good reliability, validity, sensitivity to change
Stroke patients (302)
Patient reported outcomes
MD Anderson Dysphagia Index
MD Anderson Dysphagia Index
Targets swallowing function
Completed by clinician
Level of nutrition, diet level & modifications
Good reliability, validity, sensitivity to change
Completed by clinician
Level of nutrition, diet level & modifications
Good reliability, validity, sensitivity to change
Dysphagia in Treated Nasopharyngeal Cancer
Hughes et al (2000)
Hughes et al (2000)
38/50 (56%) – reported dysphagia on a questionnaire
46/50 (92%) actually had dysphagia
11/50 (22%) silently aspirating
46/50 (92%) actually had dysphagia
11/50 (22%) silently aspirating