Oropharyngeal Dysphagia (OD) and sarcopenia have been recognized as geriatric syndromes and have shown a higher prevalence in institutionalized elderly, being associated with increased socioeconomic burdens. The objectives were to investigate the presence of sarcopenia and risk of OD in a geriatric population and to analyse the relationship between the factors associated with Sarcopenic Dysphagia (SOD). We have observed that female gender, low educational level and score ≥4 on the SARC-F screening test are associated with higher odds of being at risk for OD, sarcopenia, and even probable SOD. Based on the results, we suggested including a Speech and Language Therapist in the multidisciplinary geriatric teams in order to improve the prevention of OD, sarcopenia and SOD, avoiding its consequences.publishe

Matos, Maria Assunção

Portinha, Susana

Sá Couto, Pedro

English

Repositório Institucional da Universidade de Aveiro

Keywords:aging; oropharyngeal dysphagia;sarcopenia; sarcopenicdysphagia; speech andlanguage therapyCorresponding author:Susana Portinhasusana.portinha@gmail.comConflict of interest:The authors declare no conflictof interestsFirst published: 22JUN2021EXTENDED ABSTRACT© 2020 The Authors. This is an open access article distributed under CC BY license, whis license allows reusersto distribute, remix, adapt, and build upon the material in any medium or format, so long as attribution is givento the creator. The license allows for commercial use (https://creativecommons.org/licenses/by/4.0/).Open AccessPublicationJ. Stat. Health Decis. 2021;3(1):38-39 | https://doi.org/10.34624/jshd.v3i1.24820 38A11 Cross-sectional study to investigate the presence ofsarcopenic dysphagia in a Portuguese geriatricpopulation.Susana Portinha1, Pedro Sa-Couto2, Maria Assunção Matos31Physical Medicine and Rehabilitation Service at Tomar Unit of the Centro Hospitalar Médio Tejo (CHMT, EPE), Avenida Maria de Lourdes Mello e Castro, 2300-625 Tomar, Portugal.2Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, 3810-193 Aveiro,Portugal.3Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal.IntroductionOropharyngeal Dysphagia (OD) and sarcopenia have been recognized as geriatric syndromes and haveshown a higher prevalence in institutionalized elderly, being associated with increased socioeconomicburdens [1-3]. Prevalence of Sarcopenic Dysphagia (SOD) seems to increase with the average age of pop-ulation [4]. The objectives are to investigate the presence of sarcopenia and risk of OD in aninstitutionalized geriatric population and to analyse the relationship between the factors associated withSOD.MethodsCross-sectional study conducted in two nursing homes in Tomar.All participants included in the studywere aged ≥65 years and living in nursing homes. The OD was screened using The Gugging SwallowingScreen (GUSS) [5]. Sarcopenia was assessed according to the criteria defined by the European WorkingGroup on Sarcopenia in Older People [6]. To identify individuals at risk for sarcopenia, the SARC-F ques-tionnaire [7] was used. To assess for evidence of sarcopenia, muscle strength was measured using ahandheld Jamar dynamometer. To confirm sarcopenia by detection of low muscle mass, muscle quantitywas calculated using Bioelectrical Impedance Analysis (BIA). In addition, to evaluate the sarcopeniaseverity, usual walking speed (meters per second - m/s) on a 4-m course was used as an objective measureof physical performance. The nutritional status was screened using the Mini Nutritional Assessment -Short Form (MNA-SF), and independence in daily living activities (ADL) was assessed using the BarthelIndex (BI). The sample was divided into 4 groups, based on the diagnosis: G1 - Without pathology; G2 -Only being at risk of having OD; G3 - Only with sarcopenia; G4 -With probable SOD. For testing the exist-ent association between qualitative variables, the Chi-Square test was used when the requirement wereverified (otherwise, the Fisher exact test was used). For Gender group analysis, the independent t-test wasused (when normality was present or the Mann-Whitney test was used, if otherwise). Comparisons weremade between the different groups (using one-way analysis of variance), univariate analyses were per-formed to find the predictors for each group (using logistic regression), and finally, a correlational studybetween the different scales used (using Spearman correlation). All the results were produced using IBMSPSS Statistics V25.0 (Armonk, NY), and considered significant if p-value<0.05.ResultsWe studied 36 institutionalized elderly people (23 women; 13 men; age 88.0 ± 5.6), 55.6% were at riskfor DO, 52.8% had sarcopenia and 36.1% were probable SOD (see Table 1 for sample characterization andfurther details). Literacy was lower (p<.05) in women. The prevalence of malnutrition based on MNA-SFwas 19.4%. The most elderly were independent in ADL (91.7%). The results of the univariate analysis ofindividuals in different groups showed that the SARC-F questionnaire was a significant predictor(OR=9.0; CI95%=1.285-63.025) for the risk of having SOD.DiscussionThe prevalence of OD risk and sarcopenia has increased with age and with the risk of malnutrition ormalnourishment.We have observed that female gender, low educational level and score ≥4 on the SARC-Fscreening test are associated with higher odds of being at risk for OD, sarcopenia, and even probable SOD.J. Stat. Health Decis. 2021;3(1):38-39 | https://doi.org/10.34624/jshd.v3i1.24820 39EXTENDED ABSTRACTPrevalence of sarcopenic dysphagia in the geriatric population.We found that the use of badly adjusted artificial teeth increases odds for sarcopenia by 50%, and that thiscondition was a significant predictor (p<0.05) of risk for OD. Based on the results, we suggested includinga Speech and LanguageTherapist in the multidisciplinary geriatric teams to improve the prevention of OD,sarcopenia, and SOD, avoiding its consequences.Ethics committee and informed consentThe current research was approved by an independent ethics committee and subjects gave their informed consent before they wereenrolled in the study.References1. Ortega O, Martín A, Clavé P. Diagnosis and management of oropharyngeal dysphagia among older persons, state ofthe art. J Am Med Dir Assoc. 2017;18(7):576-582. https://doi.org/10.1016/j.jamda.2017.02.0152. Payne M, Morley J. Dysphagia, dementia and frailty. J Nutr Health Aging. 2018;22(5):562-565. https://doi.org/10.1007/s12603-018-1033-53. Carrión S, Cabré M, Monteis R, et al. Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohortof older patients admitted with an acute disease to a general hospital. Clin. Nutr. 2015; 34: 436–442. https://doi.org/10.1016/j.clnu.2014.04.0144. Wakabayashi H, Takahashi R, Murakami T. The prevalence and prognosis of sarcopenic dysphagia in patients whorequire dysphagia rehabilitation. J Nutr Health Aging. 2019;23(1):84-88.https://doi.org/10.1007/s12603-018-1117-25. Almeida J, Amaral C, Lucas I, et al. (2017). GUSS. 2017. https://gussgroupinternational.files.wordpress.com/2019/01/portuguese-1.pdf. Accessed July 7, 2019.6. Cruz-Jentoft A, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Ageand Ageing. 2019; 48: 16–31. https://doi.org/10.1093/ageing/afy1697. Malmstrom T, Morley J. SARC-F: A simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc. 2013Aug; 14(8):531-2. doi: 10.1016/j.jamda.2013.05.018Table 1 – Sample characterizationCharacteristic Total, n=36 Male, n=13(36.1%)Female, n=23(63.9%)StatisticalresultsaAge, (years), M±SD 88.0±5.6 88.0±5.6 88.0±5.8 t(34)=0.0p=0.983MNA-SF, (no units), M±SD 12.0±1.5 12.4±1.0 11.8±1.7 t(34)=1.2p=0.245BI, (no units), M±SD 84.5±14.8 90.0±9.8 81.8±16.5 t(34)=1.6p=0.112SARC-F, (no units), M±SD 3.4±2.9 1.9±2.5 4.2±2.7 U=74p=0.012*Lips strength, (kPa), M±SD 19.5±5.3 18.9±6.3 19.9±4.7 t(34)=-0.6p=0.567Tongue strength, (kPa), M±SD 33.8±14.0 35.8±16.1 32.7±13.0 t(34)=0.6p=0.530ASM, (Kg), M±SD 15.4±3.7 18.8±4.0 13.4±1.5 U=28.5p<0.001**Maximum grip strength, (Kg), M±SD 18.5±5.9 22.7±6.6 16.1±3.9 U=53.5p=0.002**Gait speed, (m/s) M±SD 0.55±0.25 0.68±0.22 0.48±0.24 t(34)=2.6p=0.01**Literacy, n (%)<4th grade 18 (50.0) 3 (16.7) 15 (83.3) χ2(1)=5.9≥4th grade 18 (50.0) 10 (55.6) 8 (44.4) p=0.015*Dentition status, n (%)Natural teeth/Artificial teeth w. a. 18 (50.0) 8 (44.4) 10 (55.6)Artificial teeth bad adjusted 9 (25.0) 2(22.2) 7 (77.8) Fisher=1.4Absence of teeth 9 (25.0) (33.3) 6 (66.7) p=0.587Nutritional status (MNA-SF), n (%)Normal 28 (77.8) 11 (39.3) 17 (60.7) χ2(1)=0.550Risk malnutrition/ Malnourished 8 (19.4) 2 (25.0) 6 (75.0) p=0.682Physical function, n (%)Dependent 3 (8.3) 0 (0.0) 3 (100) χ2(1)=0.550Independent 33 (91.7) 13 (36.1) 20 (60.6) p=0.682Sarcopenia risk screening (SARC-F), n(%)Yes (cut-off) 16 (44.4) 3 (18.8) 13 (81.3) χ2(1)=3.8No 20 (55.6) 10 (50.0) 10 (50.0) p=0.052*Sarcopenia, n (%)Yes 19 (52.8) 7 (36.8) 12 (63.2) χ2(1)=0.009No 17 (47.2) 6 (35.3) 11 (64.7) p=1.00Risk of OD, n (%)Yes (cut-off) 20 (55.6) 6 (30.0) 14 (70.0) χ2(1)=0.73No 16 (44.4) 7 (43.8) 9 (56.3) p=0.493Probable SOD, n (%)Yes 13 (36.1) 5 (38.5) 8 (61.5) χ2(1)=0.049No 23 (63.9) 8 (34.8) 15 (65.2) p=1.00M=mean; SD=standard deviation; ASM= Appendicular Skeletal Muscle Mass; MNA-SF= Mini Nutritional Assessment– Short Form;BI= Barthel Index; SARC-F= Simple Questionnaire to Rapidly Diagnose Sarcopenia; kPa= kilopascals; ASM= Appendicular SkeletalMuscle Mass; Kg= kilograms. n=sample size; Artificial teeth w. a.=artificial teeth well adapted; MNA-SF= Mini NutritionalAssessment–Short Form; SARC-F=Simple Questionnaire to Rapidly Diagnose Sarcopenia; n.a.=not available/ not applicable;OD=Oropharyngeal dysphagia; SOD= Sarcopenic dysphagia. a-P-Value (p) from T-test (t), Mann-Whitney test (U), Fisher exact test(Fisher) or Chi-square test(χ2). *p≤0.05; **p≤0.01

Cross-sectional study to investigate the presence of sarcopenic dysphagia in a Portuguese geriatric population

Oropharyngeal Dysphagia (OD) and sarcopenia have been recognized as geriatric syndromes and have shown a higher prevalence in institutionalized elderly, being associated with increased socioeconomic burdens. The objectives were to investigate the presence of sarcopenia and risk of OD in a geriatric population and to analyse the relationship between the factors associated with Sarcopenic Dysphagia (SOD). We have observed that female gender, low educational level and score ≥4 on the SARC-F screening test are associated with higher odds of being at risk for OD, sarcopenia, and even probable SOD. Based on the results, we suggested including a Speech and Language Therapist in the multidisciplinary geriatric teams in order to improve the prevention of OD, sarcopenia and SOD, avoiding its consequences

Sa-Couto, Pedro

PROA-UA (Univ. de Aveiro)

https://proa.ua.pt/index.php/jshd/article/download/24820/18183

Cross-sectional study to investigate the presence of sarcopenic dysphagia in a Portuguese geriatric population

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