Characterization of swallowing in older adults with dementia

TL;DR

This study found that older adults with more severe dementia have greater swallowing difficulties, suggesting the need for targeted interventions.

Contribution

The study provides new evidence linking dementia severity to specific swallowing impairments in older adults.

Findings

Severe dementia (CDR 3) showed greater oral spillage of liquids compared to neurotypical individuals.

Moderate and severe dementia groups had higher rates of coughing and reduced laryngeal movement during swallowing.

Swallowing impairments increased with dementia severity, highlighting the need for specific interventions.

Abstract

To analyze swallowing in older adults with dementia through clinical evaluation at a referral center for elderly healthcare.

Retrospective, cross-sectional, observational study with older people, stratified by the Clinical Dementia Rating (CDR). Characterization was based on data extracted from medical records, including functional, cognitive, and mood assessments. The clinical evaluation of swallowing consisted of food offered in three consistencies, analyzing 13 items and functional classification.

The sample included 149 older adults – 47 neurotypical (CDR 0), 37 with mild dementia (CDR 1), 40 with moderate dementia (CDR 2), and 25 with severe dementia (CDR 3). The groups differed significantly, indicating greater changes in swallowing according to the severity of dementia. For instance, CDR 3 had greater changes in oral spillage of liquids than CDR 0 (p=0.012*). Cough with solids and drop in oxygen saturation with liquids were greater in CDR 3 than in CDR 1 (p=0.039* and p=0.047*, respectively). CDR 3 also had a higher frequency of reduced laryngeal excursion with nectar than CDR 2 (p=0.044*). Only positive cervical auscultation with nectar showed greater change in CDR 2 than in CDR 1 (p=0.019*). Oral residue of solids had a greater change in CDR 1 than in CDR 0 (p=0.030*).

The severity of dementia was associated with swallowing impairments, highlighting the need for specific interventions in this population.

Analisar a função de deglutição em idosos com demência através de avaliação clínica em um Centro de Referência em Assistência à Saúde do Idoso.

Estudo observacional transversal retrospectivo com idosos, estratificados através do Clinical Dementia Rating (CDR). A caracterização ocorreu a partir de dados extraídos dos prontuários e que incluíram avaliação funcional, cognitiva e de humor. A avaliação clínica da deglutição consistiu na oferta de alimentos em três consistências, analisando treze itens e classificação funcional.

Participaram 149 idosos: 47 neurotípicos (CDR 0), 37 com demência leve (CDR 1), 40 com demência moderada (CDR 2) e 25 com demência grave (CDR 3). Houve diferenças significativas entre os grupos, indicando maior alteração na deglutição conforme a gravidade da demência. Por exemplo, o CDR 3 apresentou maior alteração para escape oral para líquidos em comparação ao CDR 0 (p=0,012*). Tosse para sólidos e queda na saturação de oxigênio para líquidos foram maiores no CDR 3 do que CDR 1 (p=0,039* e p=0,047*, respectivamente). O CDR 3 também mostrou maior frequência de excursão laríngea reduzida para néctar em comparação ao CDR 2 (p=0,044*). Apenas a ausculta cervical positiva para néctar mostrou maior alteração no CDR 2 do que CDR 1 (p=0,019*). O resíduo oral para sólidos mostrou maior alteração no CDR 1 comparado ao CDR 0 (p=0,030*).

Houve associação entre a gravidade da demência e comprometimentos na deglutição, evidenciando a necessidade de intervenções específicas nessa população.

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