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Dysphagia in older patients admitted to a rehabilitation setting after an acute hospitalization: the role of delirium

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Key summary points

AbstractSection Aim

To evaluate the prevalence of dysphagia in older patients at admission and at discharge from a rehabilitation setting, and to analyze its related factors, focusing in particular to delirium.

AbstractSection Findings

The prevalence of dysphagia at admission and at discharge was 14.81% and 12.8%, respectively, with a higher rate (50%) in patients admitted with a neurological and orthopaedic (35.06%) diagnosis. Delirium was the main factor associated with dysphagia at rehabilitation admission, independently of other clinical conditions.

AbstractSection Message

There is a need to further investigate the association between delirium and dysphagia in order to determine the changes in dysphagia prevalence according to delirium resolution and to identify the best tool for the assessment of dysphagia in delirious patients.

Abstract

Introduction

Dysphagia is a swallowing disorder that affects 8% of the world population. However, data are lacking on its prevalence in a heterogeneous group of older patients. The aim of this study is to evaluate the prevalence of dysphagia at admission and at discharge, and its related factors, in particular delirium, in older patients admitted to a rehabilitation setting.

Methods

Retrospective cohort study of patients 65 years and older admitted to a rehabilitation ward after an acute hospitalization. The presence of dysphagia at admission was screened with the 3OZ Test and confirmed by a speech-therapist. The association between clinical factors and dysphagia was investigated with a multivariate logistic regression analysis.

Results

We included 1040 patients, (65% females, mean age 81.9 ± 7.2 years). The prevalence of dysphagia at admission was 14.8% and 12.8% at discharge, while the prevalence of delirium among patients with dysphagia was of 31.2% vs 6.4% among patients without dysphagia. The severity of dysphagia was moderate. In the multivariate logistic regression, delirium was associated with dysphagia at admission (OR 2.06; Confidence Interval, CI 1.08–3.23) along with a pre-hospital impairment in the Instrumental-Activities-of-Daily-Living (OR-1.26; CI − 1.1; − 1.10), a change in Barthel Index from pre-hospital to hospital admission (OR-1.02; CI − 1.01 to 1.04), comorbidity (OR 1.12; CI 0.94;1.29) and the number of antibiotics (OR-1.63; CI − 1.01;2.62).

Conclusion

Delirium was the main factor associated with dysphagia at rehabilitation admission. The study underlines the importance of screening dysphagia in delirious patients and warrants future studies to determine the changes in dysphagia prevalence according to delirium resolution.

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Authors and Affiliations

  1. Department of Rehabilitation, Fondazione Camplani Casa di Cura “Ancelle della Carità”, Cremona, Italy

    Eleonora Grossi, Chiara Rocco, Leone Stilo & Barbara Guarneri

  2. Intermediate Care and Rehabilitation Unit, Azienda Speciale “Cremona Solidale”, Via Zocco 21, 26100, Cremona, Italy

    Simona Gentile & Alessandro Morandi

  3. REFiT Bcn Research Group, Vall d’Hebron Institute of Research (VHIR) and Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain

    Marco Inzitari & Alessandro Morandi

  4. Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain

    Marco Inzitari

  5. School of Medicine and Surgery, University of Milano-Bicocca and Acute Geriatric Unit IRCCS Foundation San Gerardo Hospital, ASST-Monza, Monza, Italy

    Giuseppe Bellelli

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  1. Eleonora Grossi
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Correspondence to Alessandro Morandi.

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Grossi, E., Rocco, C., Stilo, L. et al. Dysphagia in older patients admitted to a rehabilitation setting after an acute hospitalization: the role of delirium. Eur Geriatr Med 14, 485–492 (2023). https://doi.org/10.1007/s41999-023-00773-2

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  • DOI: https://doi.org/10.1007/s41999-023-00773-2

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