Dysphagia in older patients admitted to a rehabilitation setting after an acute hospitalization: the role of delirium

Key summary pointsAimTo evaluate the prevalence of dysphagia in older patients at admission and at discharge from a rehabilitation setting, and to analyze its related factors, focusing in particular to delirium.FindingsThe prevalence of dysphagia at admission and at discharge was 14.81% and 12.8%, respectively, with a higher rate (50%) in patients admitted with a neurological and orthopaedic (35.06%) diagnosis. Delirium was the main factor associated with dysphagia at rehabilitation admission, independently of other clinical conditions.MessageThere is a need to further investigate the association between delirium and dysphagia in order to determine the changes in dysphagia prevalence according to delirium resolution and to identify the best tool for the assessment of dysphagia in delirious patients. IntroductionDysphagia is a swallowing disorder that affects 8% of the world population. However, data are lacking on its prevalence in a heterogeneous group of older patients. The aim of this study is to evaluate the prevalence of dysphagia at admission and at discharge, and its related factors, in particular delirium, in older patients admitted to a rehabilitation setting.MethodsRetrospective cohort study of patients 65 years and older admitted to a rehabilitation ward after an acute hospitalization. The presence of dysphagia at admission was screened with the 3OZ Test and confirmed by a speech-therapist. The association between clinical factors and dysphagia was investigated with a multivariate logistic regression analysis.ResultsWe included 1040 patients, (65% females, mean age 81.9 +/- 7.2 years). The prevalence of dysphagia at admission was 14.8% and 12.8% at discharge, while the prevalence of delirium among patients with dysphagia was of 31.2% vs 6.4% among patients without dysphagia. The severity of dysphagia was moderate. In the multivariate logistic regression, delirium was associated with dysphagia at admission (OR 2.06; Confidence Interval, CI 1.08-3.23) along with a pre-hospital impairment in the Instrumental-Activities-of-Daily-Living (OR-1.26; CI - 1.1; - 1.10), a change in Barthel Index from pre-hospital to hospital admission (OR-1.02; CI - 1.01 to 1.04), comorbidity (OR 1.12; CI 0.94;1.29) and the number of antibiotics (OR-1.63; CI - 1.01;2.62).ConclusionDelirium was the main factor associated with dysphagia at rehabilitation admission. The study underlines the importance of screening dysphagia in delirious patients and warrants future studies to determine the changes in dysphagia prevalence according to delirium resolution.