Yesterday our writer David G Smithard MD FRCP, consultant in elderly and stroke medicine, chair of the UK Swallowing Research Group, Hon Reader University of Kent, examined the causes of dysphagia.
Today he studies the statistics of the condition and explains why he thinks dysphagia should be added to the list of Geriatric Syndromes.
Epidemiology of dysphagia
Oropharyngeal dysphagia in the general population varies between 2.3% and 16%. This data is based on self-reported questionnaires or surveys.
Dysphagia is frequently under recognised and under appreciated.
Medical/nursing staff often do not enquire as to whether their patients have difficulty swallowing unless weight loss is evident, yet a proportion of people living in the community, let alone institutions, will have previously unreported swallowing problems.
For many this is gastro-oesophageal reflux.
Dysphagia is a common problem with increasing age; frequently because of accompanying medical problems.
Prevalence data increased with ageing up to 26.7% for participants above the age of 76 years.
Using the Standardised Swallowing Assessment by Perry, Yang et al describe in a Korean longitudinal study an overall prevalence of dysphagia of 33.7% (95% CI, 29.1-38.4%) for people above 65 years living independently.
Barczi and Robbins found prevalence rates near 15% in community dwelling and more independent individuals, and upward of 40% of people living in institutionalised settings such as assisted living facilities and nursing homes.
This is even more so in those people who are frail.
In the presence of frailty, the swallow may be intact on a day-to-day basis, until medication is changed (side effects causing drowsiness, confusion or dry mouth) or illness occurs, then dysphagia will occur.
With the multiple possible aetiologies of dysphagia in this age group it is high time that dysphagia was added to the list of Geriatric Syndromes or Giants (Figure one).
Dysphagia will occur in many disease situations, not just in the presence of neurological disease.
For instance, swallowing requires a period of apnoea, and where this is not possible (lung disease, cardiac failure) dysphagia will occur. See yesterday’s instalment and table for more information.
Come back again tomorrow as we put the presentation and management of dysphagia under the microscope.