Association Between Dysphagia and Inpatient Outcomes Across Frailty Level Among Patients ≥ 50 Years of Age.
Seth M Cohen, Deborah Lekan, Thomas Risoli and 4 others
PMID 31811381WHAT IT FOUND
Hospitalized adults 50 and older with dysphagia stayed longer, cost more, and had more complications than those without, regardless of frailty level.
This held true even for non-frail patients. Dysphagia is an independent risk factor for poor outcomes, not just a marker of being frail.
Key findings
01Dysphagia was consistently associated with four adverse inpatient outcomes (length of stay, cost, non-routine discharge, medical complications) across all levels of frailty.
02The association between dysphagia and adverse outcomes was strongest in non-frail patients, with odds ratios ranging from 1.28 to 2.5.
03Dysphagia was not associated with in-hospital mortality among frail patients, suggesting frailty itself is a stronger predictor of death.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study relied on billing codes, which likely undercoded dysphagia and frailty, though codes for dysphagia are considered specific. It could not determine the severity or exact cause of dysphagia. The data did not distinguish whether dysphagia or complications were present before admission or developed during the stay. Readmissions and post-discharge outcomes were not captured. The study excluded rehabilitation and long-term acute care hospitals.
Declared interests
Seth Cohen is a consultant for Zsquare and a Data Safety Monitoring Board Member for Syneos Health. Stephanie Misono has NIH K23DC016335 funding from the NIDCD. Heather Whitson is supported by the Duke Claude D. Pepper Older American Independence Center.
The easy way to misread this
Do not assume dysphagia is only a marker of frailty. The study found that dysphagia was associated with worse outcomes even in non-frail patients, with stronger odds ratios in that group than in frail patients. Ignoring swallowing issues in seemingly robust older adults may miss a significant risk factor for complications and longer stays.