Care assessment related to dysphagia in the frail elderly

Abstract

The purpose of the present study was to investigate some symptoms related to dysphagia, comprehensive health status, and oral care in the frail elderly. The subjects were 92 elderly individuals (30 men, 62 women) above 65 years in a nursing home. The risk factors of dysphagia were evaluated by 15 items of self-assessment and 18 items of assessment by their caregivers. Both assessments contained 12 identical items. Basic ADL, cognitive status, and QOL were evaluated by the Barthel index, HDS-R, and PGC morale scale respectively. The status of oral care was evaluated by the frequency of tooth cleaning a day and the number of total anaerobic bacteria or streptococci in the dental plaque. “Chewing difficulty with hard food” was frequently found (21.74%) in the self-assessment, while “fever” was frequently found in the caregiver's assessment (20.65%). Also, in the duplicate items in both assessments, “anamnesis of pneumonia” showed a high agreement (k=0.85), while “decline of appetite” had a low agreement (k=0.27). These results suggest that dual assessment is effective to detect dysphagia. We also investigated the relationship among dysphagia, comprehensive health status, and oral hygiene. The status of dysphagia was related only to the Barthel index (p<0.01). These results suggest that subjects with decreased basic ADL tend to have some risk factors related to dysphagia, and that subjects with dysphagia risk factors need to improve oral care to prevent aspiration pneumonia.