Dysphagia Profiles Among Inpatients with Dementia Referred for Swallow Evaluation

Abstract

Background: Alzheimer's disease and related dementias (ADRD) patients who are hospitalized often develop oropharyngeal dysphagia, increasing risk for adverse outcomes, such as aspiration pneumonia. However, prevalence estimates of dysphagia are highly variable and often based on patient report or clinical testing rather than visualization of the swallow. Objective: The aims of this study were to determine prevalence and severity of dysphagia among inpatients with ADRD referred for swallowing evaluation. Methods: Electronic health record (EHR) abstraction of ADRD diagnosis and presence and severity of clinically-determined dysphagia on bedside swallow evaluation (BSE) and videofluoroscopic swallow study (VFSS). Results: 16% (n=268) had an ADRD diagnosis or were taking dementia-specific medication based on the EHR. 75% (n=202) were diagnosed with dysphagia on the BSE. 60% subsequently underwent VFSS (n=122) with dysphagia confirmation in 92% (n=112). ADRD inpatients were significantly more likely to be diagnosed with dysphagia based on the BSE (p<0.0001) than those without ADRD. Additionally, dysphagia on the VFSS was more severe in the ADRD group (p<0.03). Discussion: ADRD individuals may be vulnerable to developing or worsening dysphagia during hospitalization. Results underscore the importance of evaluating swallowing function in hospitalized patients with ADRD in order to facilitate targeted intervention.