Researchers Observe Link Between Frailty, Dysphagia, Adverse Outcomes

Managing dysphagia important for reducing risk in vulnerable populations

Older man holding juice glass

Although dysphagia is not considered a normal sign of aging, managing it should be an important consideration in reducing the risk for serious health issues in patients over age 50, according to recent Duke research.

In a study published in December 2019 in Dysphagia, researchers examined whether the link between dysphagia and adverse patient outcomes differed by frailty conditions. The study involved a national, inpatient medical and surgical cohort of adults ages 50 and older categorized as non-frail, pre-frail, and frail. Because frailty is a common geriatric syndrome associated with adverse health outcomes, researchers accounted for frailty status when examining whether dysphagia is independently associated with poor inpatient outcomes.

Results showed that dysphagia was associated with four out of five adverse health outcomes in an inpatient setting and was more common among frail patients than pre-frail and non-frail patients. The data suggest that dysphagia is not only a marker of disease severity but is an independent risk factor for poor outcomes, including:

  • longer length of hospital stay
  • non-routine discharges, such as a need for home health care after discharge
  • medical and surgical complications
  • higher overall medical costs

Seth M. Cohen, MD, MPH, otolaryngologist and lead author of the study, notes that because that because various medical and surgical conditions can lead to dysphagia, the condition  crosses all specialties, including neurology, oncology, gastroenterology, pulmonology, geriatrics, and internal medicine. “We all see the huge impact on quality of life that dysphagia creates in older adults. Impaired or unsafe swallowing can also lead to serious health risks, including malnutrition, dehydration, weight loss, respiratory infections, and functional decline.”

Duke geriatrician Heather E. Whitson, MD, director of the Duke Center for the Study of Aging and Human Development, was an author of the Dysphagia study.

Cohen says that Duke otolaryngologists are actively working with nutritionists, geriatricians, and speech pathologists to study dysphagia and frailty from a population health standpoint, looking at new, noninvasive ways to assess swallowing function, design better treatments, improve preoperative assessment for those who are at risk, and help patients leave the hospital faster and maximize the value of rehabilitation in their recovery.

Cohen recommends that providers in all specialties be vigilant about identifying their patients who may be at risk for developing dysphagia. “It is an underrecognized, undertreated, and undermanaged condition,” he cautions. “Providers should try to involve speech-language pathologists and otolaryngologists early to assess a patient’s swallowing function and design strategies to help before the condition begins to affect their overall health. Dysphagia has a real health impact but there are good treatments available and there are things we can do to reduce the problem and improve patient care in general.”