Association between swallowing function, malnutrition and frailty in community dwelling older people

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Abstract

Background & aims: Swallowing function decreases with age and impacts nutritional state and frailty. The aim of the study was to test the relationship between swallowing function, dysphagia, frailty, malnutrition and depression in community dwelling older participants. Methods: Community dwelling older participants (n = 180), were enrolled (74 men aged 75.9 ± 7.8, 65–91 years, and 107 women aged 75.9 ± 8.0, 65–95 years). Swallowing function was assessed by the Test of Mastication and Swallowing Solids (TOMASS) and the Timed Water Swallow Test (TWST). Dysphagia was identified using Hebrew 10-Item Eating Assessment Tool (H-EAT-10). Frailty was assessed by grip strength and the FRAIL Questionnaire. The Mini Nutritional Assessment - Short Form (MNA-SF) was used to identify nutritional status. Depression was screened with the Geriatric Depression Scale – Short Form (GDS-SF). Results: 18.3% of the participants had a score of 3 or above in H-EAT-10, indicating suspected dysphagia. 17.8% of the participants were malnourished or at risk of malnutrition, and 48.3% were defined as frail or pre-frail. The odds of being malnourished/at risk of malnutrition were 3 times greater in those with suspected dysphagia. The odds of being frail/pre-frail were also 3 times greater in those with suspected dysphagia. Moreover, suspected dysphagia and frail/pre-frail health status coincided in 69.7% of participants. Participants that were malnourished/at risk of malnutrition required more masticatory cycles (p < .05) and more time (p < .05) to eat a cracker and drink 150 mL of water (p < .05), and had reduced swallowing capacity (volume/sec) in the TWST (p < .05) than those who were at normal nutritional statues. Similar results were found for frail/pre-frail participants versus robust health status. A decrease in grip strength was associated with increased (worse) frailty score, decreased nutritional score, decreased chewing function in TOMASS and decreased water drinking function in TWST (p < .05). MNA-SF score, age, GDS-SF score and EAT-10 were the best predictors of FRAIL score. Conclusion: A simple multi-dimensional screen should be employed by trained allied health professionals, nurses and their assistants to improve early identification and early referral to relevant health providers in order to provide preventive intervention for dysphagia, nutrition, frailty and depression.

Original languageEnglish
Pages (from-to)476-485
Number of pages10
JournalClinical Nutrition ESPEN
Volume45
DOIs
StatePublished - Oct 2021

Bibliographical note

Funding Information:
The following 3rd year students served as RAs in the current study and were responsible for data collection: Noa Cohen, Gal Baneno, Achinoam Ben Menahen, Hadas Natan, Shir Moshe, Eliya Malkan, Tsahala Tzadok, Eden Marziano-Benbenishti, Rebecca Sichel-Gozal, Giti Stein, Igy Veksberg, Bracha Ester Hofman. OSW designed the study, analyzed data, performed statistical analysis, wrote paper and had primary responsibility for final content.

Publisher Copyright:
© 2021 European Society for Clinical Nutrition and Metabolism

Keywords

  • Adults
  • Community dwelling
  • Depression
  • Frailty
  • Nutritional status
  • Swallowing function

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

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