Caregiver-reported swallowing difficulties,malnutrition, and mortality among older people in assisted living facilities

Objective

The aim of this study is to explore the prevalence of swallowing difficulties (SWD) and their associations with nutritional status, eating habits, nutritional care, and mortality among older people in assisted living.

Design

A cross-sectional study with interviews and nutritional assessments at baseline and 3-year follow-up for mortality.

Setting

Assisted living facilities in the Helsinki metropolitan area, Finland.

Participants

All residents (N=1466) in assisted living facilities.

Measurements

Personal interviews yielded information on demographics, medical history, functional status, SWDs and eating habits. Residents’ nutritional status was assessed with the Mini Nutritional Assessment (MNA). Three-year mortality data were retrieved from central registers.

Results

SWDs were common; 11.8% of subjects suffered from them. Those with SWDs were older, more often female, and more frequently had Parkinson’s disease, chronic obstructive pulmonary disease (COPD), and chronic/ recurrent infections than those without SWDs. No differences were present between the groups in prevalence of stroke or dementia, but more severe cognitive decline occurred among those with SWDs. According to the MNA, 30.6% of those with SWDs were malnourished (<17 points), whereas the respective figure for those without SWDs was 11.0% (p <.001). Those with SWDs ate more often fluid or puréed food (27.8% vs. 3.8%, p <.001), ate more often little or quite little of their food portion (32.6% vs. 23.5%, p <.010), and consumed less fluids (< 5 cups/day 51.7% vs. 35.6%, p<.001) than those without SWDs. Of those with SWDs, 55.0% died by the end of follow-up, whereas the respective figure for those without SWDs was 41.5%. In logistic regression analysis using age, sex, comorbidities, and MNA as covariates, SWDs continued to predict mortality (OR=1.49, 95% CI=1.04 ?2.12).

Conclusions

SWDs are common and associated with poor nutrition and risk of death of patients in assisted living facilities. Nurses should be trained to assess SWDs and nutritional problems in order to take optimal care of these residents.