On the validity of measuring change over time in routine clinical assessment: a close examination of item-level response shifts in psychosomatic inpatients

Objective

Significant life events such as severe health status changes or intensive medical treatment often trigger response shifts in individuals that may hamper the comparison of measurements over time. Drawing from the Oort model, this study aims at detecting response shift at the item level in psychosomatic inpatients and evaluating its impact on the validity of comparing repeated measurements.

Study design and setting

Complete pretest and posttest data were available from 1188 patients who had filled out the ICD-10 Symptom Rating (ISR) scale at admission and discharge, on average 24 days after intake. Reconceptualization, reprioritization, and recalibration response shifts were explored applying tests of measurement invariance. In the item-level approach, all model parameters were constrained to be equal between pretest and posttest. If non-invariance was detected, these were linked to the different types of response shift.

Results

When constraining across-occasion model parameters, model fit worsened as indicated by a significant Satorra–Bentler Chi-square difference test suggesting potential presence of response shifts. A close examination revealed presence of two types of response shift, i.e., (non)uniform recalibration and both higher- and lower-level reconceptualization response shifts leading to four model adjustments.

Conclusions

Our analyses suggest that psychosomatic inpatients experienced some response shifts during their hospital stay. According to the hierarchy of measurement invariance, however, only one of the detected non-invariances is critical for unbiased mean comparisons over time, which did not have a substantial impact on estimating change. Hence, the use of the ISR can be recommended for outcomes assessment in clinical routine, as change score estimates do not seem hampered by response shift effects.

     

Effects of the Caregiver Interaction Profile Training on Caregiver–Child Interactions in Dutch Child Care Centers: A Randomized Controlled Trial

Background

Previous studies underscore the need to improve caregiver–child interactions in early child care centers.

Objective

In this study we used a randomized controlled trial to examine whether a 5-week video feedback training can improve six key interactive skills of caregivers in early child care centers: Sensitive responsiveness, respect for autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions.

Method

A total of 139 caregivers from 68 early child care groups for 0- to 4-year-old children in Dutch child care centers participated in this RCT, 69 in the intervention condition and 70 in the control condition. Caregiver interactive skills during everyday interactions with the children were rated from videotape using the Caregiver Interaction Profile (CIP) scales at pretest, posttest, and follow-up 3 months after the posttest.

Results

Results at posttest indicate a significant positive training effect on all six caregiver interactive skills. Effect sizes of the CIP training range between d = 0.35 and d = 0.79. Three months after the posttest, caregivers in the intervention group still scored significantly higher on sensitive responsiveness, respect for autonomy, verbal communication, and fostering positive peer interactions than caregivers in the control group with effect sizes ranging between d = 0.47 and d = 0.70.

Conclusions

This study shows that the quality of caregiver–child interactions can be improved for all six important caregiver skills, with a relatively short training program. Possible ways to further improve the training and to implement it in practice and education are discussed.

     

Risk adjustment of self-reported clinical outcomes in Dutch mental health care

Aim

A meaningful comparison of clinical outcomes of mental health care providers requires risk adjustment of case mix variables that affect treatment outcome. The first goal of the present study was to describe the risk adjustment method we applied to routine outcome monitoring data in The Netherlands. Second, the consequences of risk adjustment for the ranking of providers were investigated.

Subject and methods

Using an observational study design, pre- and posttest self-report assessments of symptoms were obtained for 31,849 adults with common mental health problems, such as mood and anxiety disorders. Regression analyses were performed to predict the posttest symptom level using socio-demographics and clinical characteristics as predictors.

Results

Results showed that the posttest level of symptoms was best predicted by the symptom level at baseline, followed by the baseline level of functioning, age, socioeconomic status and some diagnoses. For the majority of the providers, risk adjustment did not markedly change their ranking.

Conclusion

The baseline level of symptoms is the best predictor of the posttest level. The other investigated case mix variables only have a modest influence on the performance of providers. Risk adjustment is particularly necessary when consequences are related to the performance of an individual provider. These results contribute to the limited literature on risk adjustment in mental health care by using a large national data set.

     

Randomized Video-Feedback Intervention in Home-Based Childcare: Improvement of Children’s Wellbeing Dependent on Time Spent with Trusted Caregiver

Background

The childcare environment offers a wide array of developmental opportunities for children. Providing children with a feeling of security to explore this environment is one of the most fundamental goals of childcare.

Objective

In the current study the effectiveness of Video-feedback Intervention to promote Positive Parenting-Child Care (VIPP-CC) was tested on children’s wellbeing in home-based childcare in a randomized controlled trial.

Methods

Forty-seven children and their caregivers were randomly assigned to the intervention group or control group. Children’s wellbeing, caregiver sensitivity, and global childcare quality were observed during a pretest and a posttest.

Results

We did not find an overall intervention effect on child wellbeing, but a significant interaction effect with months spent with a trusted caregiver was present. Children who were less familiar with the caregiver showed an increase in wellbeing scores in both the intervention and control group, but for the group of children who were more familiar with the caregiver, wellbeing increased only in the intervention group.

Conclusions

Although there was no overall effect of the VIPP-CC on children’s wellbeing, the VIPP-CC seems effective in children who have been cared for by the same trusted caregiver for a longer period of time.

     

The impact of a home-based computerized cognitive training intervention on fall risk measure performance in community dwelling older adults,a pilot study

Objectives

Cognitive intervention studies have reported improvements in various domains of cognition as well as a transfer effect of improved function post training. Despite the availability of web based cognitive training programs, most intervention studies have been performed under the supervision of researchers. Therefore, the purpose of this study was to first, examine the feasibility of a six week home based computerized cognitive training (CCT) program in a group of community dwelling older adults and, second, to determine if a CCT program which focused on set shifting, attention, and visual spatial ability impacted fall risk measure performance.

Design

This pilot study used a pretest/posttest experimental design with randomization by testing site to an intervention or control group.

Participants

Community dwelling older adults (mean age = 74.6 years) participated in either the control (N=25) or the intervention group (N=19).

Intervention

Intervention group subjects participated in 6 weeks of home based CCT 3x/week for an average of 23 minutes/session, using an online CCT program.

Measurements

Comparisons of mean scores on three measures of physical function (usual gait speed, five times sit to stand, timed up and go) were completed at baseline and week 7.

Results

Following the completion of an average of 18 sessions of CCT at home with good adherence (86%) and retention (92%) rates, a statistically significant difference in gait speed was found between groups with an average improvement of 0.14m/s in the intervention group.

Conclusion

A home based CCT program is a feasible approach to targeting cognitive impairments known to influence fall risk and changes in gait in older adults.

     

Protein enrichment of familiar foods as an innovative strategy to increase protein intake in institutionalized elderly

Objective

To increase the protein intake of older adults, protein enrichment of familiar foods and drinks might be an effective and attractive alternative for oral nutritional supplements (ONS). We performed a pilot study to test whether these products could help institutionalized elderly to reach a protein intake of 1.2 gram per kg body weight per day (g/kg/d).

Design

Intervention study with one treatment group (no control group). Dietary assessment was done before and at the end of a 10-day intervention.

Setting

Two care facilities in Gelderland, the Netherlands: a residential care home and a rehabilitation center.

Participants

22 elderly subjects (13 women, 9 men; mean age 83.0±9.4 years).

Intervention

We used a variety of newly developed protein enriched regular foods and drinks, including bread, soups, fruit juices, and instant mashed potatoes.

Measurements

Dietary intake was assessed on two consecutive days before and at the end of the intervention, using food records filled out by research assistants. Energy and macronutrient intake was calculated using the 2013 Dutch food composition database. Changes in protein intake were evaluated using paired t-tests.

Results

Protein intake increased by 11.8 g/d (P=0.003); from 0.96 to 1.14 g/kg/d (P=0.002). This increase is comparable to protein provided by one standard portion of ONS. The intake of energy and other macronutrients did not change significantly. At the end of the intervention more elderly reached a protein intake level of 1.2 g/kg/d than before (9 vs 4). Protein intake significantly increased during breakfast (+3.7 g) and during the evening (+2.2 g).

Conclusion

Including familiar protein enriched foods and drinks in the menu helped to meet protein recommendations in institutionalized elderly.

     

Measurement invariance,the lack thereof,and modeling change

Purpose

Measurement invariance issues should be considered during test construction. In this paper, we provide a conceptual overview of measurement invariance and describe how the concept is implemented in several different statistical approaches. Typical applications look for invariance over things such as mode of administration (paper and pencil vs. computer based), language/translation, age, time, and gender, to cite just a few examples. To the extent that the relationships between items and constructs are stable/invariant, we can be more confident in score interpretations.

Methods

A series of simulated examples are reported which highlight different kinds of non-invariance, the impact it can have, and the effect of appropriately modeling a lack of invariance. One example focuses on the longitudinal context, where measurement invariance is critical to understanding trends over time. Software syntax is provided to help researchers apply these models with their own data.

Results

The simulation studies demonstrate the negative impact an erroneous assumption of invariance may have on scores and substantive conclusions drawn from naively analyzing those scores.

Conclusions

Measurement invariance implies that the links between the items and the construct of interest are invariant over some domain, grouping, or classification. Examining a new or existing test for measurement invariance should be part of any test construction/implementation plan. In addition to reviewing implications of the simulation study results, we also provide a discussion of the limitations of current approaches and areas in need of additional research.

     

Testing measurement invariance of the patient-reported outcomes measurement information system pain behaviors score between the US general population sample and a sample of individuals with chronic pain

Purpose

In order to test the difference between group means, the construct measured must have the same meaning for all groups under investigation. This study examined the measurement invariance of responses to the patient-reported outcomes measurement information system (PROMIS) pain behavior (PB) item bank in two samples: the PROMIS calibration sample (Wave 1, N = 426) and a sample recruited from the American Chronic Pain Association (ACPA, N = 750). The ACPA data were collected to increase the number of participants with higher levels of pain.

Methods

Multi-group confirmatory factor analysis (MG-CFA) and two item response theory (IRT)-based differential item functioning (DIF) approaches were employed to evaluate the existence of measurement invariance.

Results

MG-CFA results supported metric invariance of the PROMIS–PB, indicating unstandardized factor loadings with equal across samples. DIF analyses revealed that impact of 6 DIF items was negligible.

Conclusions

Based on the results of both MG-CFA and IRT-based DIF approaches, we recommend retaining the original parameter estimates obtained from the combined samples based on the results of MG-CFA.

     

Bias in retrospective assessment of perceived dental treatment effects when using the Oral Health Impact Profile

Purpose

Aim of this exploratory study was to investigate whether a retrospective assessment of oral health-related quality of life (OHRQoL) using the Oral Health Impact Profile (OHIP) is susceptible to bias such as implicit theory of change and cognitive dissonance.

Methods

In this prospective clinical study, a sample of 126 adult patients (age 17–83 years, 49% women) requiring prosthodontic treatment was consecutively recruited. The OHRQoL was assessed using the 49-item OHIP at baseline and at follow-up. Additionally, patients were asked at follow-up to retrospectively rate their oral health status at baseline (retrospective pretest or then-test) and the change in oral health status using a global transition question. Furthermore, patients’ ratings of overall oral health and general health were used as validity criteria for the OHRQoL assessments. Response shift was calculated as the difference between the initial and retrospective baseline assessments.

Results

Baseline and retrospective pretest did not differ substantially in terms of internal consistency and convergent validity. Response shift was more pronounced when patients perceived a large change in OHRQoL during treatment. Retrospective pretests were more highly correlated with the baseline than with the follow-up assessment.

Conclusion

Findings suggest that retrospective assessments of OHRQoL using the OHIP-49 are susceptible to bias. Cognitive dissonance is more likely to appear as a source of bias than implicit theory of change.

     

Assessment of the Dermatology Life Quality Index (DLQI) in a homogeneous population under lifetime arsenic exposure

Purpose

The psychometric property of the Dermatology Life Quality Index (DLQI) is underappreciated in public health settings. Our study aimed to assess the reliability, validity, and measurement invariance of DLQI in a homogeneous population with arsenic-related skin lesions and symptoms.

Methods

A cross-sectional study was conducted in communities under lifetime arsenic exposure. The DLQI was measured through a face-to-face interview. Skin examinations were performed by certificated dermatologists. The intensity of itching was measured by a numerical rating scale. Reliability, structural validity, and measurement invariance were determined using classical and modern test theories, including confirmatory factor analysis and item response models.

Results

465 participants with arsenic-related skin lesions and symptoms completed the DLQI assessment. The Cronbach’s alpha was 0.79, and the split-half reliability was 0.77. A two-factor model exhibited the best model fit among models evaluated, but local dependencies among items were identified. The model showed good root mean square error of approximation (0.031) and acceptable Tucker–Lewis index (0.92). Multi-group confirmatory factor analysis showed no measurement invariance across subgroups of age, gender, ethnicity, and intensity of itching.

Conclusions

The DLQI had acceptable psychometric properties, but measurement invariance was not observed across different groups of participants.

     

Evaluating measurement invariance across assessment modes of phone interview and computer self-administered survey for the PROMIS measures in a population-based cohort of localized prostate cancer survivors

Purpose

To evaluate measurement invariance (phone interview vs computer self-administered survey) of 15 PROMIS measures responded by a population-based cohort of localized prostate cancer survivors.

Methods

Participants were part of the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study. Out of the 952 men who took the phone interview at 24 months post-treatment, 401 of them also completed the same survey online using a home computer. Unidimensionality of the PROMIS measures was examined using single-factor confirmatory factor analysis (CFA) models. Measurement invariance testing was conducted using longitudinal CFA via a model comparison approach. For strongly or partially strongly invariant measures, changes in the latent factors and factor autocorrelations were also estimated and tested.

Results

Six measures (sleep disturbance, sleep-related impairment, diarrhea, illness impact—negative, illness impact—positive, and global satisfaction with sex life) had locally dependent items, and therefore model modifications had to be made on these domains prior to measurement invariance testing. Overall, seven measures achieved strong invariance (all items had equal loadings and thresholds), and four measures achieved partial strong invariance (each measure had one item with unequal loadings and thresholds). Three measures (pain interference, interest in sexual activity, and global satisfaction with sex life) failed to establish configural invariance due to between-mode differences in factor patterns.

Conclusions

This study supports the use of phone-based live interviewers in lieu of PC-based assessment (when needed) for many of the PROMIS measures.

     

Testing the measurement invariance of the University of Washington Self-Efficacy Scale short form across four diagnostic subgroups

Purpose

The University of Washington Self-Efficacy Scale (UW-SES) was originally developed for people with multiple sclerosis (MS) and spinal cord injury (SCI). This study evaluates the measurement invariance of the 6-item short form of the UW-SES across four disability subgroups. Evidence of measurement invariance would extend the UW-SES for use in two additional diagnostic groups: muscular dystrophy (MD) and post-polio syndrome (PPS).

Methods

Multi-group confirmatory factor analysis was used to evaluate successive levels of measurement invariance of the 6-item short form, the UW-SES: (a) configural invariance, i.e., equivalent item-factor structures between groups; (b) metric invariance, i.e., equivalent unstandardized factor loadings between groups; and (c) scalar invariance, i.e., equivalent item intercepts between groups. Responses from the four groups with different diagnostic disorders were compared: MD (n = 172), MS (n = 868), PPS (n = 225), and SCI (n = 242).

Results

The results of this study support that the most rigorous form of invariance (i.e., scalar) holds for the 6-item short form of the UW-SES across the four diagnostic subgroups.

Conclusions

The current study suggests that the 6-item short form of the UW-SES has the same meaning across the four diagnostic subgroups. Thus, the 6-item short form is validated for people with MD, MS, PPS, and SCI.

     

Defining rehabilitation success in older adults with dementia–results from an inpatient geriatric rehabilitation unit

Objective

To quantify the magnitude of functional recovery in older adults with and without dementia admitted to an inpatient geriatric rehabilitation program by measuring change in measures of global physical function and physical therapy treatment outcomes.

Design

Retrospective cohort study.

Setting

Rehabilitation academic hospital.

Participants

Consecutive subjects, with (N=65, age 81.9±6.0 y) and without (N=157, age 82.8±7.2 y) a dementia diagnosis, had assessment data at admission and discharge from inpatient geriatric rehabilitation unit.

Interventions

Not applicable.

Measurements

The Functional Independence Measure (FIM) was used to estimate level of independence on activities of daily living. The Berg Balance Scale (BBS), Timed Up & Go Test (TUG) and 2 Minute Walk Test (2MWT) were used to estimate functional mobility and endurance. The FIM (total, motor subscale, cognitive subscale scores) were used to calculate rehabilitation efficacy and efficiency scores.

Results

After controlling for confounding, there was no group difference for gains on the BBS, TUG, 2MWT; there was no group difference on rehabilitation efficacy and efficiency values based on the FIM motor subscale. The magnitude of the rehabilitation gain using the total FIM score was statistically different between groups, people with dementia having smaller gains.

Conclusion

Older adults with a diagnosis of dementia are capable of making motor function recovery during inpatient sub-acute rehabilitation comparable to their peers without a dementia diagnosis. The metric used to evaluate functional recovery influences the determination of rehabilitation success between groups. Rehabilitation success should be defined among people with a dementia diagnosis by a change in the motor subscale of the FIM, rather than the total FIM score or the gain relative to the maximal FIM score.

     

Exploring measurement invariance by gender in the profile of mood states depression subscale among cancer survivors

Purpose

The Profile of Mood States-Short Form (POMS-SF) is a well-validated tool commonly used in medical/clinical research. Less attention has been paid to the measurement invariance of the POMS—the degree to which the structure and items behave similarly for different groups (e.g., women and men). This study investigated the measurement invariance of the POMS Depression subscale across gender groups in a sample of cancer survivors.

Methods

The POMS Depression subscale has 8 items (Unhappy, Sad, Blue, Hopeless, Discouraged, Miserable, Helpless, and Worthless). Invariance was measured using multigroup confirmatory factor analysis. This study used data from American Cancer Society Studies of Cancer Survivors-II, a population-based survey of adult cancer survivors (n = 9170).

Results

We found factor structures and factor loadings were invariant for gender groups, but moderate differential item functioning (DIF) in the question containing the word blue.

Conclusion

With regard to cancer survivors’ gender, we found the Depression subscale of the POMS-SF had configural invariance, and partial metric and scalar invariance. This suggests that results should be interpreted with caution, especially when gender is considered important. More broadly, our finding suggests that questions with the word blue may introduce DIF into other measures of depressive mood. More research is needed to replicate these findings in other samples and with other instruments.

     

Measuring everyday functional competence using the Rasch assessment of everyday activity limitations (REAL) item bank

Objective

Traditional patient-reported physical function instruments often poorly differentiate patients with mild-to-moderate disability. We describe the development and psychometric evaluation of a generic item bank for measuring everyday activity limitations in outpatient populations.

Study design and setting

Seventy-two items generated from patient interviews and mapped to the International Classification of Functioning, Disability and Health (ICF) domestic life chapter were administered to 1128 adults representative of the Dutch population. The partial credit model was fitted to the item responses and evaluated with respect to its assumptions, model fit, and differential item functioning (DIF). Measurement performance of a computerized adaptive testing (CAT) algorithm was compared with the SF-36 physical functioning scale (PF-10).

Results

A final bank of 41 items was developed. All items demonstrated acceptable fit to the partial credit model and measurement invariance across age, sex, and educational level. Five- and ten-item CAT simulations were shown to have high measurement precision, which exceeded that of SF-36 physical functioning scale across the physical function continuum. Floor effects were absent for a 10-item empirical CAT simulation, and ceiling effects were low (13.5%) compared with SF-36 physical functioning (38.1%). CAT also discriminated better than SF-36 physical functioning between age groups, number of chronic conditions, and respondents with or without rheumatic conditions.

Conclusion

The Rasch assessment of everyday activity limitations (REAL) item bank will hopefully prove a useful instrument for assessing everyday activity limitations. T-scores obtained using derived measures can be used to benchmark physical function outcomes against the general Dutch adult population.

     

Age and IQ Explained Working Memory Performance in a RCT with Fatty Fish in a Group of Forensic Inpatients

Objectives

To investigate the effect of a long-term fatty fish intervention on a pure cognitive mechanism important for self-regulation and mental health, i.e. working memory (WM), controlling for age and IQ.

Design

A randomized controlled trial.

Setting

A forensic facility.

Participants

Eighty-four young to middle aged male forensic inpatients with psychiatric disorders.

Intervention

Consumption of farmed salmon or control meal (meat) three times a week during 23 weeks.

Measurement

Performance on WM tasks, both accuracy and mean reaction time, were recorded pre and post intervention.

Results

Performance on a cognitive functioning tasks taxing WM seemed to be explained by age and IQ.

Conclusion

Fatty fish consumption did not improve WM performance in a group of young to middle aged adults with mental health problems, as less impressionable factors such as aging and intelligence seemed to be the key components. The present study improves the knowledge concerning the interaction among nutrition, health and the aging process.

     

Geschlechtsspezifische Verzerrungen bei der Erfassung von Depressivität

Background

Aspects of mental health are often assessed in population surveys. However, especially answers to sensitive questions can be biased. For this reason, a validation of the used instruments with regard to potential bias is of high relevance.

Objectives

This paper addresses the potential existence of gender bias in a commonly used questionnaire assessing depressive symptoms. It is hypothesized that gender differences in depressiveness to the disadvantage of women can be traced back to some extent to the survey mode as well as to the depressiveness instrument itself.

Materials and Methods

In order to examine this hypothesis, data from the pretest and the main survey of the German lidA-study is used. Within the survey the simplified Beck-Depression-Inventory (BDI-V) is applied for the measurement of depressive symptoms. Two survey modes were used in the pretest to measure depressiveness. Using mean comparisons and factor analyses, stratified for gender, possible gender bias is examined.

Results and Discussion

The results show evidence of gender bias with regard to the survey mode. Factor analyses show that symptoms for depressiveness have a different relevance and are structured differently for men and women. This should be taken in account when assessing depressiveness.

     

The Effects of Green Tea Extract on Working Memory in Healthy Women

Objectives

This study aimed to examine the effects of green tea extract on working memory in healthy younger (21 - 29 y) and older (50 - 63 y) women.

Design

A single-blind, placebo-controlled, crossover design was used.

Setting

A university laboratory.

Participants

Twenty non-smoking Caucasian women were recruited in the younger (10) and older (10) age group.

Intervention

Subjects received 5.4 g green tea extract (at least 45% epigallocatechin-3-gallate) or placebo (cornstarch) within a 24-hour period.

Measurements

Working memory was measured by reading span and N-back task paradigm. Blood sample (20 mL) was collected and measured for plasma malondialdehyde (MDA) and total antioxidant capacity (TEAC) concentration. A 24-hour recall was conducted for each treatment period to ensure similar dietary patterns.

Results

Green tea extract significantly improved reading span performance in older women, indicated by higher absolute and partial scores of reading span. No significant changes were observed in the younger group. N-back latencies and accuracies were not significantly different after green tea treatment in either age group. Plasma concentration of MDA and TEAC were not different after green tea extract in either group.

Conclusion

Acute supplementation of decaffeinated green tea extract may enhance working memory capacity of women between 50 to 63 years of age. This study provides preliminary evidence that consumption of green tea extract may enhance the cognitive performance in older adults and thus provide potential chemopreventive benefits in this group. The mechanism should be explored in future research.

     

Association between Oropharyngeal Dysphagia and Malnutrition in Dutch Nursing Home Residents: Results of the National Prevalence Measurement of Quality of Care

Objectives

Nursing home residents often suffer from multi-morbidities and geriatric syndromes leading to lower quality of life or mortality. Oropharyngeal dysphagia (OD) and malnutrition are profound conditions in this complex profile of multi-morbidities and are associated with deprived mental –and physical health status, e.g. aspiration pneumonia or dehydration. This study aimed to assess the association between OD and malnutrition in Dutch nursing home residents.

Design

Data for this cross-sectional study were obtained from the annual National Prevalence Measurement of Quality of Care (LPZ).

Setting

The National Prevalence Measurement of Quality of Care was conducted in Nursing Homes in The Netherlands.

Participants

Participants were nursing home residents age 65 or older and admitted to psychogeriatric- or somatic wards.

Measurements

The measurements were taken by trained nurses from the participating nursing homes. Anthropometric measurements and unintended weight loss (%) were assessed to determine nutritional status (malnutrition). OD was assessed by means of a standardized questionnaire assessing clinically relevant symptoms of OD such as swallowing problems or sneezing/coughing while swallowing. Cox regression was applied to assess the association between malnutrition and clinically relevant symptoms of OD in older Dutch nursing home residents.

Results

Approximately 12% of the residents suffered from swallowing problems and 7% sneezed/coughed while swallowing liquids or solid foods. Approximately 10% of the residents was malnourished. Residents with OD symptoms were more often malnourished compared to residents without OD symptoms. Approximately 17% of the problematic swallowers were concurrently malnourished. Increased risk for malnutrition was found in residents suffering from swallowing problems (PR 1.5, 95%CI 1.2–1.9), as well as in residents that sneezed/ coughed while swallowing (PR 1.3, 95%CI 1.0–1.7). Stratification based on wards revealed that problematic swallowers from somatic wards were at a high risk of malnutrition (PR 1.9, 95%CI 1.3–2.8).

Conclusion

Clinically relevant symptoms of oropharyngeal dysphagia, such as swallowing problems and sneezing/coughing while swallowing are associated with increased risk of malnutrition in psychogeriatric and somatic Dutch nursing home residents.