Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 3:18:1233-1248.
doi: 10.2147/CIA.S409828. eCollection 2023.

Associations Between Dysphagia and Adverse Health Outcomes in Older Adults with Dementia in Intensive Care Units: A Retrospective Cohort Study

Hongtao Cheng #  1   2 , Xingwen Deng #  3 , Jieyao Li #  4 , Yonglan Tang  1   2 , Shiqi Yuan  5 , Xiaxuan Huang  5 , Zichen Wang  1 , Fuling Zhou  6 , Jun Lyu  1   7
Affiliations

Associations Between Dysphagia and Adverse Health Outcomes in Older Adults with Dementia in Intensive Care Units: A Retrospective Cohort Study

Hongtao Cheng et al. Clin Interv Aging. .

Abstract

Background: Dysphagia is common in elderly patients with dementia and is one of the common clinical geriatric syndromes. It imposes a heavy burden on patients and their caregivers and is becoming an important public health problem. This study examined the association between dysphagia in older dementia patients in the ICU and the subsequent adverse health outcomes they experience.

Patients and methods: A retrospective analysis of adults (≥65 years) with dementia in ICUs of a Boston tertiary academic medical center was conducted. Using the International Classification of Diseases' Ninth and Tenth Revisions, dementia patients were identified. The study cohort comprised 1009 patients, median age 84.82 years, 56.6% female, predominantly White (72.9%). Patients were grouped based on swallowing function: dysphagia (n=282) and no-dysphagia (n=727). Dysphagia was identified via positive bedside swallowing screening. Primary outcomes were 90- and 180-day mortality, secondary outcomes included aspiration pneumonia, pressure injury, and delirium. Cohort characteristics were compared using the Wilcoxon rank-sum and chi-square tests. Dysphagia and outcomes correlations were examined via Kaplan-Meier survival analysis, Cox proportional-hazards regression models, logistic regression models, and subgroup analysis.

Results: After adjusting for covariates, the results from multivariate Cox proportional-hazards regression indicated that dysphagia was significantly associated with increased 90-day (HR=1.36, 95% CI=1.07-1.73, E-value=1.78) and 180-day (HR=1.47, 95% CI=1.18-1.82, E-value=1.94) mortality; the multifactorial logistic regression results indicated that dysphagia was associated with significant increases in pressure injury (OR=1.58, 95% CI=1.11-2.23, E-value=1.83) and aspiration pneumonia occurrence (OR=4.04, 95% CI=2.72-6.01, E-value=7.54), but was not significantly associated with delirium prevalence (OR=1.27, 95% CI=0.93-1.74).

Conclusion: Dysphagia is likely to increase the risk of adverse health outcomes in older adults with dementia in ICU, and these adverse outcomes mostly include 90- and 180-day mortality, aspiration pneumonia, and pressure injury.

Keywords: delirium; dementia; dysphagia; intensive care unit; mortality; older adults.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Inclusion and exclusion flowchart of the study.
Figure 2
Figure 2
Kaplan-Meier survival curves between groups. P-value calculated by Log rank test<0.001 showed dysphagia group had lower survival probability or higher mortality than no-dysphagia group.
Figure 3
Figure 3
Forest plot for subgroup analysis in 180-day survival rates. P-value calculated by Log rank test <0.001 showed dysphagia group had lower survival probability than no-dysphagia group.
Figure 4
Figure 4
Discharge locations of dementia older patients with and without dysphagia.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Gale SA, Acar D, Daffner KR. Dementia. Am J Med. 2018;131(10):1161–1169. doi:10.1016/j.amjmed.2018.01.022 - DOI - PubMed
    1. Raz L, Knoefel J, Bhaskar K. The neuropathology and cerebrovascular mechanisms of dementia. J Cereb Blood Flow Metab. 2016;36(1):172–186. doi:10.1038/jcbfm.2015.164 - DOI - PMC - PubMed
    1. Jia L, Quan M, Fu Y, et al. Dementia in China: epidemiology, clinical management, and research advances. Lancet Neurol. 2020;19(1):81–92. doi:10.1016/S1474-4422(19)30290-X - DOI - PubMed
    1. Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673–2734. doi:10.1016/S0140-6736(17)31363-6 - DOI - PubMed
    1. Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a delphi consensus study. Lancet. 2005;366(9503):2112–2117. doi:10.1016/S0140-6736(05)67889-0 - DOI - PMC - PubMed