Factors and Outcomes Associated With Dysphagia in Hospitalized Persons With Dementia |
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| Affiliation: | 1. Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA;2. Division of Hospital Medicine, Department of Medicine, Northwell Health, Manhasset, NY, USA;3. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA;1. Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA;2. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA;3. Department of Economics, Farmer School of Business, Miami University, Oxford, OH, USA;4. Scripps Gerontology Center, Miami University, Oxford, OH, USA;5. Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA;6. Division of Geriatrics, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA;7. Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, NY, USA;1. Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA;2. Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;3. MGH Institute of Health Professions, Boston, MA, USA;4. Meyers Primary Care Institute, Worcester, MA, USA;5. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA;1. University of Connecticut Health Center, Center on Aging, Farmington, CT, USA;2. Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA;1. Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia;2. Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia |
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| Abstract: | ObjectivesDysphagia is prevalent in older adults with dementia, particularly in the acute care setting. The objective of this study was to use an innovative approach to extract a more representative sample of patients with dysphagia from the electronic health record (EHR) to determine patient characteristics, hospital practices, and outcomes associated with dysphagia in hospitalized persons with dementia.DesignA retrospective study of hospitalized adults (aged ≥65 years) with dementia was conducted in 7 hospitals across the greater New York metropolitan area.Setting and ParticipantsData were obtained from the inpatient EHR with the following inclusion criteria: age ≥65 years; admitted to one of 7 health system hospitals between January 1, 2019, and December 31, 2019; and documented past medical diagnosis of dementia (based on International Classification of Diseases, Ninth Revision).MethodsA diagnosis of dysphagia was defined as nurse documentation of a positive bedside swallow screening, nurse documentation of “difficulty swallowing” as reason for not performing bedside swallow screening, and physician documentation of a dysphagia diagnosis.ResultsOf adults with dementia (N = 8637), the average age was 84.5 years, 61.6% were female, and 18.1% were Black and 9.3% Hispanic. Dysphagia was identified in 41.8% (n = 3610). In multivariable models, dysphagia was associated with invasive mechanical ventilation [odds ratio (OR) 4.53, 95% CI 3.55-5.78], delirium (OR 1.53, 95% CI 1.40-1.68), increased length of stay (B = 3.29, 95% CI 2.98-3.60), and mortality (OR 4.44, 95% CI 3.54-5.55).Conclusions and ImplicationsGiven its high prevalence, underrecognition, and associated poor outcomes, improving large-scale dysphagia identification can impact clinical care and advance research in hospitalized persons with dementia. |
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| Keywords: | Dysphagia dementia hospitalized older adults bedside swallow screening electronic health record data |
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