14. Older people with swallowing dysfunction and poor oral health are at greater risk of early death

Hägglund P., Koistinen S., Olai L., Ståhlnacke K., Wester P., Levring Jäghagen E. Acta Oto-Laryngologica 2019.

Abstract as published

Aims/Objectives We investigated the associations between swallowing dysfunction, poor oral health and mortality among older people in intermediate care in Sweden. Methods This prospective cohort study investigated 391 older people in 36 intermediate care units (clusters). Swallowing function was assessed with the timed water swallow test (TWST), and oral health with the revised oral assessment guide (ROAG) at baseline. Data were collected on age, sex, education level, multimorbidity, cognitive impairment, care dependency and body mass index (BMI). Time to mortality was recorded during the following year. The mixed effects Cox regression model with cluster as a random factor was used to estimate hazards ratios (HR) with 95 % confidence intervals (CI). Results The median age of the participants was 84 years (interquartile range [IQR]: 11), and 53.3 % were females. Mortality within one year was 25.1 %. In the adjusted model, swallowing dysfunction and poor oral health were both independently associated with mortality (adjusted HR [aHR]: 1.67, 95 % CI 1.02‐2.75; P = .041 and aHR: 1.98, 95 % CI 1.07‐3.65; P = .029, respectively). Participants with combined swallowing dysfunction and poor oral health showed the highest mortality (35.0 %) and 2.6 (95 % CI 1.15‐5.89; P = .022) times higher mortality risk than those with normal swallowing function and good oral health (13.0 %). Conclusions Swallowing dysfunction and poor oral health were identified as independent risk factors for mortality in older people in intermediate care. Although further studies are required to verify these findings, they suggest that systematic assessment of swallowing function and oral health status should be performed for care considerations

Relevance to conditions

Dysphagia: A study to show the relation between swallowing difficulties and early death in an elderly cohort.

Study type

Peer reviewed, Prospective, Cohort pre- and post- study.

Aim

We investigated the associations between swallowing dysfunction, poor oral health and mortality among older people in intermediate care in Sweden.

Methods

Older people in 36 intermediate care units (clusters) were assessed for swallowing ability and oral health.
Data were collected on age, sex, education level, multimorbidity, cognitive impairment, care dependency and body mass index (BMI).
Time to mortality was recorded during the following year.

Patients

391 patients with stroke, F=12, M=18, median age 84 years (range 49 – 84).

Outcome measurements

  • Timed Water Swallow Test (TWST) – lower normal value for swallowing rate ≥ 10 ml / sec
  • Oral health with the Revised Oral Assessment Guide (ROAG).
  • Data were collected on age, sex, education level, multimorbidity, cognitive impairment, care dependency and Body Mass Index (BMI)

Results

  • Mortality within one year was 25.1 %.
  • In the adjusted model, swallowing dysfunction and poor oral health were both independently associated with mortality
    • Swallowing dysfunction adjusted HR (aHR): 1.67, 95 % CI, 1.02‐2.75; (p = 0.041)
    • Oral health aHR: 1.98, 95 % CI 1.07‐3.65; (p = 0.029).
    • Participants with normal swallowing function and good oral health had a mortality rate of 13.0 %.
    • Participants with both swallowing dysfunction and poor oral health showed a mortality rate of 35.0 %. This is 2.6 times (95 % CI 1.15‐5.89; (p = 0.022) the mortality risk of those without these two dysfunctions.

Statistical significance of result

(p = 0.041) mortality associated with swallowing function
(p = 0.029) mortality associated with oral health

Conclusion

Swallowing dysfunction and poor oral health were identified as independent risk factors for mortality in older people in intermediate care. Although further studies are required to verify these findings, they suggest that systematic assessment of swallowing function and oral health status should be performed for care considerations.