Original Study
The Impact of Dysphagia on Mortality of Nursing Home Residents: Results From the nutritionDay Project

https://doi.org/10.1016/j.jamda.2018.03.016Get rights and content

Abstract

Objectives

Dysphagia is a frequent finding in nursing home residents. The aim of this study is to evaluate the association of dysphagia and mortality in nursing home residents and identify further risk factors for mortality in residents with dysphagia.

Design

One-day, annually repeated cross-sectional study, evaluating the nutritional situation of nursing home residents with 6-month mortality as outcome.

Setting

191 nursing homes from 14 countries in Europe and the United States participating in the nutritionDay study between 2007 and 2012.

Participants

Data of all nursing home residents in the nutritionDay study aged 65 years or older with available information about dysphagia and outcome were analyzed.

Measurements

Residents’ characteristics and mortality rate were calculated by group comparison, and mortality risk was calculated by multivariate regression analysis with adjustment for potential confounding factors.

Results

10,185 residents (78% female) with a mean age of 85 ± 8.1 years were included in the analysis. Dysphagia was reported in 15.4% of residents. The 6-month mortality of residents with dysphagia was significantly higher than of those without dysphagia (24.7% vs 11.9%; P < .001). The multivariate regression analysis revealed dysphagia [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.24-1.68, P < .001] along with body mass index <20 (OR 1.78, 95% CI 1.55-2.03, P < .001) and weight loss >5 kg (OR 1.61, 95% CI 1.37-1.88, P < .001) as independent and significant risk factors for mortality. Because of significant interaction, a disproportionately high mortality of 38.9% was found in residents with dysphagia accompanied by previous weight loss >5 kg (OR for interaction 1.44; 95% CI 1.03-2.01; P = .032). Tube feeding was reported in 14.6% of residents with dysphagia. The mortality rate of dysphagic residents receiving tube feeding vs those who were not was not significantly different (21.4% vs 25.3%; P = .244).

Conclusion

In this nutritionDay study, dysphagia was identified as an independent risk factor for mortality in nursing home residents. Residents with dysphagia accompanied by weight loss are at a particularly high risk of mortality and should therefore receive special attention.

Section snippets

Methods

The nutritionDay project evaluates the nutritional situation of hospital patients and nursing home residents in the form of an annual, voluntary 1-day cross-sectional survey. The survey was first performed in hospitals.10, 11 In 2007, the project was extended to nursing homes.12 Outcome data are obtained after 30 days in hospital patients and after 6 months in nursing home residents. The following analysis is based on the complete data set of nutritionDay in nursing homes obtained from 2007 to

Results

A total of 191 nursing homes with 26,651 nursing home residents from 14 countries participated in the survey between 2007 and 2012. After exclusion of residents with incomplete data, 10,185 data sets could be analyzed. Reasons for exclusion were missing outcome data (n = 12,656), age <65 years (n = 1976), missing or implausible anthropometric data (n = 914), probable repeaters (n = 807), and missing data on dysphagia (n = 113).

Mean age of the participants was 85.2 ± 8.1 years, and 78% were

Discussion

It is well known that dysphagia is highly prevalent in older subjects, particularly in nursing home residents. In fact, reported prevalence rates greatly vary because of the different definitions of dysphagia and diagnostic methods. The relatively low prevalence of 15.4% reported in this survey has to be valued as the rate of obvious, that is, symptomatic dysphagia, rather than the true prevalence. In this study, dysphagia was determined by the simple question if the resident has dysphagia or

Conclusion

In this large nutritionDay study, dysphagia was identified as an independent risk factor for 6-month mortality in nursing home residents. In particular, residents with dysphagia accompanied by weight loss are at a disproportionately high risk of mortality and should therefore receive special attention.

Acknowledgments

We like to thank all participating nursing homes for supporting the nutritionDay.

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The authors declare no conflicts of interest.

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