Oropharyngeal dysphagia frequency in older adults living in nursing homes: an integrative review

Xavier, Jessica Soares; Gois, Amanda Cibelly Brito; Travassos, Letícia de Carvalho Palhano; Pernambuco, Leandro

doi:10.1590/2317-1782/20202020153

person Jessica Soares Xavier

schoolPrograma Associado de Pós-graduação em Fonoaudiologia, Universidade Federal da Paraíba – UFPB - João Pessoa (PB), Brasil.

0000-0002-2694-7177

person Amanda Cibelly Brito Gois

schoolPrograma de Pós-graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte – UFRN - Natal (RN), Brasil.

0000-0001-7610-5771

person Letícia de Carvalho Palhano Travassos

schoolPrograma de Pós-graduação em Modelos de Decisão e Saúde, Universidade Federal da Paraíba – UFPB – João Pessoa (PB), Brasil.

0000-0002-3012-2100

person Leandro Pernambuco

schoolPrograma Associado de Pós-graduação em Fonoaudiologia, Universidade Federal da Paraíba – UFPB - João Pessoa (PB), Brasil.schoolPrograma de Pós-graduação em Modelos de Decisão e Saúde, Universidade Federal da Paraíba – UFPB – João Pessoa (PB), Brasil.schoolDepartamento de Fonoaudiologia, Universidade Federal da Paraíba – UFPB - João Pessoa (PB), Brasil.

0000-0001-6246-9769

Conflict of interests: nothing to declare.

Correspondence address: Leandro Pernambuco Departamento de Fonoaudiologia, Universidade Federal da Paraíba – UFPB Cidade Universitária, João Pessoa (PB), Brasil, CEP: 58051-900. E-mail:
leandroapernambuco@gmail.com

JSX contributed to the data collection and analysis, writing, and final review of the article; ACBG and LCPT contributed to the data collection and analysis; LP contributed to the design, guidance, data analysis, writing, and final review of the article.

Figures (1)
Tables (4)

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Figure 1 Flowchart for article selection

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Base de dados Descritores Pubmed/Medline ((((“nursing homes”[MeSH Terms]) OR (“nursing home”[Title/Abstract])) OR (“long term care facilities”[Title/Abstract])) OR (“home for the aged”[Title/Abstract])) AND (((((“deglutition”[MeSH Terms]) OR (deglutition disorder[MeSH Terms])) OR (dysphagia[Title/Abstract])) OR (swallowing[Title/Abstract])) OR (deglutition[Title/Abstract])) Web of Science TS=((dysphagia OR (deglutition OR swallow*)) AND (“nursing home” OR (“nursing homLes” OR “long term care facility” OR “long term care facilities”))) Scopus TITLE-ABS-KEY((dysphagia OR (deglutition OR swallow*)) AND (“nursing home” OR (“nursing homes” OR “long term care facility” OR “long term care facilities”))) LILACS “DISFAGIA” [Palavras] and “INSTITUICAO DE LONGA PERMANENCIA PARA IDOSOS” [Palavras] SciELO “DISFAGIA” [Palavras] and “INSTITUICAO DE LONGA PERMANENCIA PARA IDOSOS” [Palavras]

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Box 1 Analysis matrix with the characteristics of the studies included in the integrative review

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Box 2 Classification of methodological quality of studies according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines

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Database Descriptors Pubmed/Medline ((((“nursing homes”[MeSH Terms]) OR (“nursing home”[Title/Abstract])) OR (“long term care facilities”[Title/Abstract])) OR (“home for the aged”[Title/Abstract])) AND (((((“deglutition”[MeSH Terms]) OR (deglutition disorder[MeSH Terms])) OR (dysphagia[Title/Abstract])) OR (swallowing[Title/Abstract])) OR (deglutition[Title/Abstract])) Web of Science TS=((dysphagia OR (deglutition OR swallow*)) AND (“nursing home” OR (“nursing homLes” OR “long term care facility” OR “long term care facilities”))) Scopus TITLE-ABS-KEY((dysphagia OR (deglutition OR swallow*)) AND (“nursing home” OR (“nursing homes” OR “long term care facility” OR “long term care facilities”))) LILACS “DISFAGIA” [Palavras] and “INSTITUICAO DE LONGA PERMANENCIA PARA IDOSOS” [Palavras] SciELO “DISFAGIA” [Palavras] and “INSTITUICAO DE LONGA PERMANENCIA PARA IDOSOS” [Palavras]

Author, year, and location (ascending)	Sample	Sex	Age	Concept of oropharyngeal dysphagia	Instrument	Frequency of oropharyngeal dysphagia *
Roque et al., 2010, Brazil⁽³¹⁾	30 older adults living in one LTCF	100% female	83.7 ± 10.7 years	Not defined clearly	Meal characteristics; environment; attitudinal and behavioral aspects; dependency for food-related activities and assistance required/provided; oral aspects; swallowing problems, and difficulty breathing evaluated	23.3%
						(CI of 95%: 8.17-38.42)
						Margin of error of the estimate = 30.25%
Camacho et al., 2011, Spain⁽³²⁾	1.777 older adults living in 66 LTCFs	80.8% female	>85 anos 52,08%, de 75 a 84 anos 36,45% e de 65 a 74 anos 11,45%	Difficulty swallowing food or drinks	Questionnaire prepared by the Geriatric Home Care Unit (UADG) advised by Nestlé Nutrition	5.4%
						(CI of 95%: 4.34-6.45)
						Margin of error of the estimate = 2.10%
Ferrero López et al., 2012, Spain⁽³³⁾	40 older adults living in five LTCFs	72.5% female	83.7 ± 6.3 years	Both structural and functional changes in swallowing	Volume-Viscosity Swallow Test (V-VST) for t detection of Oropharyngeal Dysphagia	65%
						(CI of 95%: 50.21-79.78)
						Margin of error of the estimate = 29.56%
Bomfim et al., 2013, Brazil⁽¹²⁾	30 older adults living in one LTCF	100% female	83.7 ± 10.5 years	Changes in feeding dynamics	Based on the speech therapy Dysphagia Risk Evaluation Protocol - DREP	63.3%
						(CI of 95%: 46.05-80.54)
						Margin of error of the estimate = 34.49%
Park et al., 2013, South Korea⁽³⁴⁾	395 older adults living in two LTCFs	76.5% female	80.7 ± 8.0 years	Swallowing impairment	Gugging Swallowing Screen (GUSS)	52.7%
						(CI of 95%: 47.77-57.62)
						Margin of error of the estimate = 9.84%
Nogueira and Reis, 2013, Portugal⁽³⁵⁾	266 older adults living in eight LTCFs	75% female	82 ± 10 years	Addresses presbyphagia	3-oz Water Swallow Test (3OZwst) and Dysphagia Self-Test (DST)	38.2%
						(CI of 95%: 32.36-44.03)
						Margin of error of the estimate = 11.67%
Van der Maarel-Wierink et al., 2014, Netherlands⁽¹⁸⁾	8119 residents aged ≥65 in 119 LTCFs	74% female	84.0 ± 7.0 years	Symptom that refers to difficulty or discomfort during the progression of the bolus from the oral cavity into the stomach	Questionnaire filliing by caregivers and resident's answer to the question: “Do you experience swallowing problems?”	9%
						(CI of 95%: 8.37-9.62)
						Margin of error of the estimate = 1.24%
Sarabia-Cobo et al., 2016, Spain⁽³⁶⁾	2384 older adults living in 12 LTCFs	73.4% female	88.7 ± 6.8 years	Indicates difficulty in moving food or liquids from the mouth and esophagus into the stomach	Eating Assessment Tool-10 (EAT_10) and 3-oz Water Swallow Test (3OZwst)	69,60%
						(CI of 95%: 67.75-71.44)
						Margin of error of the estimate = 3.69%
Yatabe et al., 2017, Japan⁽³⁷⁾	236 residents aged ≥60 in eight LTCFs	76.2% women in the dentate group and 52.6% in the edentulous group	87.7 ± 6.4 years	Disturbance of any part of the swallowing process	Modified Water Swallow Test (MWST)	16.9%
			for the dentate group and 89.0 ± 7.1 years for the edentulous group			(CI of 95%: 12.11-21.68)
						Margin of error of the estimate = 9.56%
Streicher et al., 2017, Europe and North America⁽³⁸⁾	23.549 residents aged ≥65 in 926 LTCFs	75.7% female	Between 79-90 years	Impaired and potentially unsafe intake of liquids and / or solid foods	Local staff information and resident medical record	13.4%
						(CI of 95%: 12.96-13.83)
						Margin of error of the estimate = 0.87%
Namasivayam-MacDonald et al., 2017, Canada⁽³⁹⁾	639 older adults living in 32 LTCFs	69.9% female	86.8 ± 7.8 years	Swallowing impairment	Iowa Oral Performance Instrument Screening Tool for Acute Neuro Dysphagia	59.2%
						(CI of 95%: 55.38-63.01)
						Margin of error of the estimate = 7.62%
Fernández-Getino Sallés, 2018, Spain⁽⁴⁰⁾	30 individuals aged ≥80 living in 31 LTCFs	90% female	89.3 ± 1.1 years	Decreased safety and efficacy of swallowing	Volume-Viscosity Swallow Test (V-VST) for t detection of Oropharyngeal Dysphagia	41.5%
						(CI of 95%: 23.86-59.13)
						Margin of error of the estimate = 35.26
Jukic Peladic et al., 2018, Italy⁽⁴¹⁾	1490 older adults aged ≥65 living in 31 LTCFs	71.5% female	83.5 ± 8.1 years	Difficulty swallowing liquids and/or solid foods	Clinical evaluation	12.8%
						(CI of 95%: 11.10-14.49)
						Margin of error of the estimate = 3.39%
Huppertz et al., 2018, Netherlands⁽⁴²⁾	6349 residents of a nursing home aged ≥65 admitted to psychogeriatric or somatic wards	70.12 female	84.5 ± 7.5 years	Not defined clearly	Based on two questions: “Does the client have swallowing problems?” and “Does the client sneeze or cough while swallowing food or liquids?”	12.1%
						(CI of 95%: 11.29-12.90)
						Margin of error of the estimate = 1.60%
Hoshino et al., 2020, Japan⁽⁴³⁾	312 older adults living in a LTCF	79.5% female	85.2 ± 7.6 years	Not defined clearly	Modified water swallowing test (MWST) combined with cervical auscultation	83.7%
						(CI of 95%: 79.60-87.79)
						Margin of error of the estimate = 8.19%

STROBE itens	Roque et al., 2010 ⁽ ³¹ ⁾	Camacho et al., 2011 ⁽ ³² ⁾	Ferrero López et al., 2012 ⁽ ³³ ⁾	Bomfim et al., 2013 ⁽ ¹² ⁾	Park et al., 2013 ⁽ ³⁴ ⁾	Nogueira et al., 2013 ⁽ ³⁵ ⁾	Maarel-Wierink et al., 2014 ⁽ ¹⁸ ⁾	Sarabia-Cobo et al., 2016 ⁽ ³⁶ ⁾	Yatabe et al., 2017 ⁽ ³⁷ ⁾	Streicher et al., 2017 ⁽ ³⁸ ⁾	Namasivayam-MacDonald et al., 2017 ⁽ ³⁹ ⁾	Fernández-Getino Sallés, 2018 ⁽ ⁴⁰ ⁾	Jukic Peladic et al., 2018 ⁽ ⁴¹ ⁾	Huppertz et al., 2018 ⁽ ⁴² ⁾	Hoshino et al., 2020 ⁽ ⁴³ ⁾
Title and abstract 1a Indicate the study's design with a commonly used term in the title or the abstract	+	-	+	+	+	+	+	+	+	+	+	+	+	+	+
1b Provide in the abstract an informative and balanced summary of what was done and what was found	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
Introduction 2 Explain the scientific background and rationale for the investigation being reported	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
3 State specific objectives, including any prespecified hypotheses	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
Methods 4 Present key elements of study design early in the paper	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
5 Describe the setting, locations, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
6 Give the eligibility criteria, and the sources and methods of selection of participants	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
7 Clearly define all outcomes, exposures, predictors, potential confounders, and effect modifiers. Give diagnostic criteria, if applicable	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
8 For each variable of interest, give sources of data and details of methods of assessment (measurement). Describe comparability of assessment methods if there is more than one group	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
9 Describe any efforts to address potential sources of bias	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
10 Explain how the study size was arrived at	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
11 Explain how quantitative variables were handled in the analyses. If applicable, describe which groupings were chosen and why	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
12a Describe all statistical methods, including those used to control for confounding	?	+	+	+	+	+	+	+	+	+	+	+	+	+	+
12b Describe any methods used to examine subgroups and interactions	-	-	+	+	+	+	+	+	+	+	+	+	+	+	+
12c Explain how missing data were addressed	-	-	-	+	-	-	-	-	-	-	-	-	?	+	?
12d If applicable, describe analytical methods taking account of sampling strategy	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
12e If applicable, describe analytical methods taking account of sampling strategy	-	-	+	+	+	-	+	+	+	+	+	+	+	+	+
Results 13a Report numbers of individuals at each stage of study?eg numbers potentially eligible, examined for eligibility, confirmed eligible, included in the study, completing follow-up, and analysed	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
13b Give reasons for non-participation at each stage	-	-	+	+	+	+	+	+	?	+	+	+	+	?	+
13c Consider use of a flow diagram	-	-	-	-	+	-	-	-	-	+	-	-	-	-	+
13c Consider use of a flow diagram	-	-	-	-	+	-	-	-	-	+	-	-	-	-	+
14a Give characteristics of study participants (eg demographic, clinical, social) and information on exposures and potential confounders	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
14b Indicate number of participants with missing data for each variable of interest	+	-	-	-	-	-	-	-	-	-	-	-	-	-	?
15 Report numbers of outcome events or summary measures over time	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
16a Give unadjusted estimates and, if applicable, confounder-adjusted estimates and their precision (eg, 95% confidence interval). Make clear which confounders were adjusted for and why they were included	-	-	+	+	+	-	+	+	+	+	+	+	+	+	+
16b Report category boundaries when continuous variables were categorized	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
16c If relevant, consider translating estimates of relative risk into absolute risk for a meaningful	-	-	+	+	+	-	+	+	+	+	+	+	+	+
16c If relevant, consider translating estimates of relative risk into absolute risk for a meaningful	-	-	+	+	+	-	+	+	+	+	+	+	+	+
17 Report other analyses done—eg analyses of subgroups and interactions, and sensitivity analyses	-	-	+	+	+	-	+	+	+	+	+	+	+	+
Discussion 18 Summarize key results with reference to study objectives	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
19 Discuss limitations of the study, taking into account sources of potential bias or imprecision. Discuss both direction and magnitude of any potential bias	+	+	+	+	+	-	+	+	+	+	+	+	+	+	+
20 Give a cautious overall interpretation of results considering objectives, limitations, multiplicity of analyses, results from similar studies, and other relevant evidence	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
21 Discuss the generalizability (external validity) of the study results	+	+	+	+	+	+	+	+	+	+	+	+	+	+	+
Other information 22 Give the source of funding and the role of the funders for the present study and, if applicable, for the original study on which the present article is based	-	-	-	-	-	-	-	-	-	-	-	-	-	-	+

[TFN100] ^*
Confidence interval and margin of error of the estimate calculated by the authors of this study

[2] Caption: CI = Confidence interval; LTCF = long-term care facilities