Introduction
Materials and Methods
Eligibility Criteria
Search Strategy and Study Selection
Database and search terms | Number of records |
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Embase: (Swallowing/OR Dysphagia/) AND (Prevalence/OR Incidence/OR Epidemiology/) AND (rehabilitation/OR rehabilitation care/OR rehabilitation center/OR rehabilitation medicine/OR rehabilitation nursing/OR nursing home/OR hospital/OR hospice/OR hospice care/OR hospice nursing/) OR ((swallow OR dysphag* OR deglut*).ab,ti. AND (Prevalence* OR incidence*).ab,ti. AND (((nursing AND home) OR (nursing AND homes) OR rehabilitation* OR hospice* OR palliat*)ab,ti. OR (hospital OR hospitals)ti.)) | 898 |
PubMed: (("Deglutition"[Mesh] OR "Deglutition Disorders"[Mesh]) AND ("Prevalence"[Mesh] OR "Epidemiology"[Mesh] OR "Incidence"[Mesh]) AND ("Hospitals"[Mesh] OR "Hospital Medicine"[Mesh] OR "Hospital Mortality"[Mesh] OR "Cardiology Service, Hospital"[Mesh] OR "Physical Therapy Department, Hospital"[Mesh] OR "Outpatient Clinics, Hospital"[Mesh] OR "Occupational Therapy Department, Hospital"[Mesh] OR "Nursing Staff, Hospital"[Mesh] OR "Medical Staff, Hospital"[Mesh] OR "Hospitals, Urban"[Mesh] OR "Hospitals, Military"[Mesh] OR "Tertiary Care Centers"[Mesh] OR "Hospitals, Chronic Disease"[Mesh] OR "Secondary Care Centers"[Mesh] OR "Hospitals, Private"[Mesh] OR "Hospitals, Veterans"[Mesh] OR "Hospitals, State"[Mesh] OR "Hospitals, Special"[Mesh] OR "Hospitals, Public"[Mesh] OR "Hospitals, General"[Mesh] OR "Hospitals, Municipal"[Mesh] OR "Hospitals, Federal"[Mesh] OR "Hospitals, District"[Mesh] OR "Hospitals, County"[Mesh] OR "Hospitals, Convalescent"[Mesh] OR "Hospitals, Community"[Mesh] OR "Hospitals, Rehabilitation"[Mesh] OR "Hospice Care"[Mesh] OR "Hospices"[Mesh] OR "Hospice and Palliative Care Nursing"[Mesh])) OR ((swallow*[Title/Abstract] OR dysphag*[Title/Abstract] OR deglut*[Title/Abstract]) AND (Prevalence*[Title/Abstract] OR incidence*[Title/Abstract]) AND ((nursing[Title/Abstract] AND home[Title/Abstract]) OR (nursing[Title/Abstract] AND homes[Title/Abstract]) OR rehabilitation*[Title/Abstract] OR hospital[Title/Abstract] OR hospitals[Title/Abstract] OR hospice*[Title/Abstract] OR palliat*)) | 1294 |
Methodological Quality Assessment
Data Extraction
Data Synthesis and Risk of Bias
Meta-analysis
Results
Study Selection
Synthesis of Methodological Quality
Author (alphabetical order) Journal | Study design (NHMRC)a AXIS score | Study setting and country Study period | Underlying medical diagnosis and recruitment criteria Time of screening/assessment | Sample characteristics: size, gender (male; female), age (years) | Description of OD terminology as used in study | Screening/Assessment for prevalence calculation Tester | Prevalence data |
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Abubakar et al. [35] Niger Postgrad Med J | Prospective cohort (II) AXIS 15/20; 75% | Tertiary teaching hospital, Nigeria April 2015–Jan 2017 | Acute stroke Inclusion: consecutive inclusion at hospital (no specified ward; first acute stroke (ischemic and hemorrhagic); confirmed stroke with CT or MRI Exclusion: diseases that could interfere with swallowing: motor neuron disease, previous stroke, cerebral palsy, and chronic obstructive airway diseases; presented 1 week post-stroke onset (6); depressed sensorium (5) Time of assessment: within 72 h of first stroke | 94 (M = 53; F = 41) Mean age (SD): 55.5 (15.7) | Dysphagia: any difficulty associated with swallowing | - 3-oz water swallow (DePippo et al.) [94] - Swallow provocative test (Warnecke et al.) [95] Dysphagia: - cough or wet/hoarse voice quality - latency of swallowing after either injection > 3 s. (Teramoto and Fukuchi) [96] Tester: NR | Overall Dysphagia 34.04% (32/94)* Dysphagia per gender M = 32.1% (17/53); F = 36.6% (15/41) Dysphagia per age group < 65 years 32.8% (21/64); ≥ 65 years 36.7% (11/30) NB Unclear prevalence calculation (i.e., fail one or both tests) |
Andrade et al. [50] Einstein (Sao Paulo) | Retrospective cross-sectional (IV) AXIS 16/20; 80% | Philanthropic hospital, Brazil Jan-Dec 2014 | Mixed (gastrointestinal tract disease, cardiovascular disease, respiratory tract disorders, fractures, and neurologic diseases Inclusion: all adults and older individuals hospitalized, no specified ward Exclusion: intensive care unit, pregnant and puerperal women Time of assessment: NR | 909 (M = 419; F = 490) Mean age (SD): 54 (20.2) Age group: < 60: 534/909; ≥ 60: 375/909 | Dysphagia: a swallowing difficulty in the passage of food from oral cavity to the stomach; at risk of dysphagia | - Eating Assessment Tool EAT-10 Brazilian Portuguese version (Gonçalves et al.) [97] Dysphagia: EAT-10 score ≥ 3 Tester: NR | Overall “risk” of dysphagia 10.5% (95/909) Dysphagia per gender M = 11.0% (46/419); F = 10.0% (49/490) Dysphagia per age group < 60 years 6.9% (37/534); ≥ 60 years 15.5% (58/375) |
Arnold et al. [51] PLoS One | Retrospective cohort (III-2) AXIS 18/19; 95% | Hospital, Switzerland Jan 2012-Nov 2013 | Acute stroke Inclusion: consecutive acute ischemic stroke patients admitted to tertiary stroke center Exclusion: NR Time of assessment: within 24 h of admission | 570 (M = 366; F = 204) Mean age (SD): 65.1, (NR); Age range: (19.6–94.7) | Dysphagia | - Data accessed from Bernese Stroke Registry: Dysphagia: GUSS score of ≤ 19 GUSS score < 10 = severe dysphagia; required tube feeding Tester: physiotherapists experienced and trained in dysphagia | Overall Dysphagia 20.7% (118/570) Dysphagia per gender M = 21.3% (78/366); F = 19.6% (40/204) Subgroup Dysphagia vs tube feeding (118/570) without tube feeding: 68.6% (81/118); with tube feeding: 31.3% (37/118) |
Baroni et al. [36] Arq Gastroenterol | Prospective cross-sectional (IV) AXIS 15/20; 75% | Tertiary hospital, Brazil May 2005-July 2006 | Stroke Inclusion: consecutive patients admitted with (177) ischemic or (35) hemorrhagic cerebral vascular accident (CVA); clinical history of previous stroke Exclusion: any other neurological or structural changes that might interfere with swallowing process; inconclusive imaging exam (CT/MRI), coma and/or clinical ventilation with no possibility for clinical evaluation of swallowing Time of Assessment: 0–5 days of stroke (172/212); 11–20 days of stroke (14/212); 21–60 days of stroke (26/212) | 212 (M = 125; F = 87) Mean age (SD) 63.5 (NR) Age group: < 60 years (72/212); ≥ 60 years (140/212) | Dysphagia, oropharyngeal dysfunction; swallowing dysfunction NB Use of terminology interchangeably throughout article | - Clinical evaluation: a sample of liquid consistency (3, 5, 7 mL and/or a free volume of water), paste (3, 5, 7 mL and/or a free volume of thickened juice) & solids (free volume of cracker or bread) Swallowing dysfunction: one or more changes/alterations in any of the following: absence of lip seal, food escape, nasal reflux, residue in oral cavity, altered cervical auscultation, altered laryngeal elevation, vocal quality, resp. changes, cough, choking, fatigue, need for multiple swallows, compensatory maneuver during swallowing and escape of stained food through tracheostomy on blue dye test NB Unclear if dysfunction must be present on all consistencies or only one. No cut off for cervical auscultation specified Tester: speech therapist | Overall Swallowing dysfunction 63% (134/212)* Swallowing dysfunction per gender M = 63.2% (79/125); F = 63.2% (55/87) Swallowing dysfunction per age group < 60 years: 55.6% (40/72); 60 + years: 67.1% (94/140) Subgroup swallowing dysfunction severity (134/212) Mild 19% (26/134); Moderate 38% (51/134); Severe 43% (57/134) |
Beharry, et al. [52] J Stroke Cerebrovasc Dis | Retrospective cohort (III-2) AXIS 16/20; 80% | Hospital stroke unit and/or intensive care, Switzerland January 1–December 31, 2015 | Acute stroke Inclusion: all patients admitted within 24 h of acute ischemic stroke Exclusion: NR Time of assessment: Within 7 days of admission | 340 (M = 183; F = 157) Median age (IQR; range): 75 (18; 21–96) | Swallowing disorders | - Data extracted from stroke registry; patient medical records and notes of speech therapist and nurse - Modified version of Burke Dysphagia Screening Test (DePippo et al.) [99] Swallowing disorder if: 1. Cough or hoarse voice after screen = failed test OR 2. Patient complained of swallowing disorder without swallow screen and food texture had to be adapted OR 3. Patient required specialized speech therapy in first 7 days Tester: screening by nurse | Overall swallowing disorders using combination of swallowing disorder criteria 23.6%(?) (81/340) Overall swallowing disorder- screening test 34.5% (51/148; nmissing = 192) Swallowing disorder per gender M = 49.4% (40/81) F = 50.6% (41/81) NB Inconsistencies in prevalence calculations within population tested |
Blanař et al. [28] J Adv Nurs | Retrospective cross-sectional (IV) AXIS 18/20; 90% | Multicenter; 237 departments in general hospitals geriatric hospitals, nursing homes and other healthcare facilities with ≥ 50 beds, Austria 2012–2016 | Mixed (cancer, blood, digestive system, respiratory, psychological, cardiovascular, and musculoskeletal system diseases, dementia and diabetes mellitus) Inclusion: 18 years, available on day of measurement Exclusion: not available on day of measurement, refusal to participate, poor cognitive state Time of assessment: NR | 17 580 (M = 7 489; F = 10 091) Mean age (SD): 67.8 (18.1) Hospital Mean age (SD): 64.4 (NR) Nursing home Mean age (SD): 81.1 (NR) | Dysphagia; lower capacity to swallow, difficulty while swallowing, potentially unsafe while swallowing | - Data extracted from database: Dysphagia: ask the patient of she/he had problems swallowing Tester: 2 nurses | Overall dysphagia all settings 6.6% (1155/17 580) Overall dysphagia hospital 5.3% (792/14 913) Dysphagia per gender – hospital M = 5.8% (398/6847) F = 4.9 (394/8063) Overall dysphagia nursing home 13.6% (363/2667) Dysphagia per gender – nursing home M = 16.4% (105/642) F = 12.7% (258/2025) |
Brogan, et al. (1) [54] Dysphagia | Retrospective cohort (III-2) AXIS 17/20; 85% | Tertiary hospitals (6), Australia 2010 | Stroke Inclusion: current admission of patients with primary diagnosis of stroke or CVA, regardless of stroke history; ischemic strokes 63.6% (339); hemorrhagic strokes 26.1% (139); not recorded 10.3% (55) Exclusion: subarachnoid or subdural hemorrhage; developed more than one infection (3) Time of assessment: on admission, days 3–4, and days 6–7 | 533 (M = 292; F = 241) Mean age (SD): 71 (14.9) 378 follow-up after one week | Dysphagia; swallowing problems | - Medical record review with standardized data collection form Dysphagia: documented diagnosis by treating speech pathologist in medical record entry Tester: collected from medical records by speech pathologists NB Specific criteria for dysphagia diagnosis was not specified | Overall Dysphagia 58.5% (?) (312/533) NB Unclear where patient numbers come from (i.e., premorbid vs on admission?) Subgroup Dysphagia over time in follow-up group (378/533) dysphagia on admission: 67.2%(?) (254/378); dysphagia on days 3–4: 52.1% (197/378); dysphagia on day 7: 46.0% (174/378) NB Unclear inclusion criteria for follow-up group and reasons for decrease in dysphagia (i.e., resolved, deceased, etc.) Subgroup Nasogastric tube (NGT) in follow-up group 1st week 18.4% (98/532; nmissing = 1); NGT within 1st week; had dysphagia on admission 95.9%(?) (93/98) |
Brogan et al. (2) [53] Neuroepidemiology | Retrospective cohort (III-2) AXIS 17/20; 85% | Tertiary hospitals (6), Australia 2010 | Stroke Inclusion: current admission of patients with primary diagnosis of stroke or CVA, regardless of stroke history Exclusion: subarachnoid or subdural hemorrhage; developed more than one infection (3) Time of assessment: first week post-stroke | 533 (M = 292; F = 241) Mean age (SD): 71 (14.9) | Dysphagia; swallowing problems | - Medical record review with standardized data collection form Dysphagia: based on documented diagnosis by treating speech pathologist in medical record entry Tester: speech pathologist | Overall Dysphagia 61.5% (328/533) NB Inconsistencies in recorded dysphagia prevalence from same study sample as Brogan et al. [53] (1) |
Carrión et al. [55] Clin Nutr | Prospective cohort (II) AXIS 18/19; 95% | Hospital, acute geriatric unit, Spain Jan 1 2005-Dec 31 2009 | Mixed acute illness (diseases of the circulatory, respiratory, genitourinary, and digestive systems) Inclusion: consecutive, ≥ 70 years; acute disease; able to undergo V-VST Exclusion: none Time of assessment: upon admission | 1662 (M = 637; F = 1025) Mean age (SD): 85.1 (6.23) | Oropharyngeal dysphagia (OD) | Oropharyngeal dysphagia: impairment in efficacy and/or safety of the swallow Tester: geriatric unit nurse trained in V-VST; speech pathologist support when in doubt | Overall Oropharyngeal dysphagia 47.4% with 95% CI 45–49.8 (788/1662)* Oropharyngeal dysphagia per gender M = 47.6% (303/637); F = 47.3% (485/1025) |
Chen et al. [37] BMC Geriatrics | Prospective cross-sectional (IV) AXIS 13/20; 65% | Nursing homes (18), China Study period: May–July 2019 | NR Inclusion: ≥ 60 years; ability to answer questions or have help from caregivers familiar to situation; written consent from participant or family member Exclusion: intellectual disabilities Time of assessment: NR | 775 (M = 305; F = 470) Mean age (SD): 81.3 (9.5) Age group: 60–69 years (93/775) 70–79 years (192/775) ≥ 80 years (490/775) | Dysphagia; symptoms and signs of dysphagia | - Eating Assessment Tool (EAT-10) (Belafsky et al.) [75] NB no reference for Chinese version of EAT-10 Risk of dysphagia: total EAT-10 score ≥ 3 Tester: trained nurses and post-graduate students | Overall “risk” of dysphagia 31.1% (241/775)*** Risk of dysphagia per gender M = 41.9% (101/241); F = 58.1% (140/241) |
Crary et al. [56] Dysphagia | Prospective cohort (II) AXIS 16/20; 80% | Tertiary hospital, primary stroke center, USA Study period: NR | Acute stroke Inclusion: consecutive, acute ischemic stroke Exclusion: pre-stroke history OD, head/neck surgery or trauma, neurological disorder to impact swallowing ability Time of assessment: on admission | 67 (M = 29; F = 38) Mean age (SD): 65.7 (NR) | Dysphagia | Tester: speech-language pathologist trained in MASA | Overall dysphagia 37.3% (25/67)* Oropharyngeal dysphagia per gender M = 34.5% (10/29); F = 39.5% (15/38) |
De Cock et al. [57] Eur J Neurol | Prospective cross-sectional (IV) AXIS 19/20; 95% | University hospital, stroke unit, Belgium March 2018-October 2019 | Stroke Inclusion: diagnosis first-ever ischemic stroke; ≥ 18 years, Dutch speaking, admitted within 48 h after onset of acute stroke symptoms Exclusion: history of other diseases influencing swallowing, speech and or language (e.g., dementia, Parkinson’s disease, oral carcinomas, mental retardation) Time of assessment: immediately upon arrival at stroke unit | 151 (M = 85; F = 66) Mean age (SD; range): 67 (14; 25–79) | Dysphagia | - Standardized water-swallowing test (90 ml) (De Bodt et al.) [100] Dysphagia: suspected penetration or aspiration of liquids Failed screening: referred to bedside examination with Mann Assessment of Swallowing Ability (MASA) to discard or confirm dysphagia; some of these patients referred to FEES or VFSS Functional Oral Intake Scale (FOIS) was taken on dysphagic stroke patients Tester: trained speech-language pathologist | Overall dysphagia 23% (35/151)* Dysphagia per gender M = 22.4% (19/85); F = 24.2% (16/66) NB no reported data for VFSS, FEES or FOIS |
Diendéré et al. [38] Nutrition | Prospective cohort (II) AXIS 14/20; 70% | Hospitals (2), Burkina Faso November 2015 – August 2016 | Stroke Inclusion: stroke: 59.9% (133) ischemic; 40.1% (89) hemorrhagic Exclusion: comatose, early discharge, no consent (336) Time of assessment: admission (Day 0), day 8 and day 14 (if clinical notification of dysphagia had been made of dysphagia between day 8 and day 14) Admission was 2.3 (1.4) days after stroke | 222 (M = 121; F = 101) Mean age (SD): 60.5 (14.2) Age group < 65 years (130/222) ≥ 65 years (92/222) | Dysphagia | - Practical Aspiration Screening Schema system (Zhou et al.) [101]: a combination of Echelle Clinique Prédictive de Fausse Route (Guinvarch et al.) [102] and DePippo 3 oz test (DePippo et al.) [94] Dysphagia: < 14 points on Echelle Clinique Predictive de Fausse Route or; 14–28 points on Echelle Clinique Predictive de Fausse Route and producing cough or wet or gargly voice within a minute after 3 oz water test Tester: students of medicine | Overall Dysphagia day 0: 37.4% (95% CI: 31.0–44.1) (83/222)* Subgroup dysphagia day 8: 28.4% (95% CI: 22.2–35.3) (56/197); day 14: 15.8% (95% CI: 10.8–21.8) (29/184) |
Falsetti et al. [58] J Stroke Cerebrovasc Dis | Prospective cohort (II) AXIS 16/18; 89% | Hospital; Neurorehabilitation unit, Italy January 2005- December 2006 | Stroke Inclusion: consecutive patients admitted with previous ischemic 74.1% (112) and hemorrhagic 25.8% (39) stroke Exclusion: patients with history of head and neck damage, neurologic disease other than cerebrovascular disorder, previous dysphagia Mean duration of disease (time from stroke) 14 days Time of assessment: clinical bedside test within 24 h of admission; videofluoroscopy (VFSS) within first week of admission | 151 (M = 77; F = 74) Mean age (SD): 79.4 (6.2) | Dysphagia: disorder of deglutition affecting the oral, pharyngeal and/or esophageal phases of swallowing; oropharyngeal dysphagia | - Clinical bedside test: Step 1) identify level of consciousness and collaboration (patients with level of cognitive functioning (LCF) < 4 were immediately considered dysphagic) and oral motor and sensory assessment (voice quality; speech and language; swallowing of saliva; movements of cricoid cartilage; lips, tongue, and velopharynx; gag reflex; preservation of pharyngeal sensation; capability of voluntary cough) Step 2) swallowing of 5 mL of water with concomitant pulse oximetry, observing signs of oral-facial apraxia (loosening of water from lips, delay in swallowing, abnormality or absence of tongue movements) or signs of penetration /aspiration (‘‘wet’’ or ‘‘gurgly’’ voice, coughing, > 2% decrease of basal value of oxygen saturation at pulse oximetry Step 3) swallowing at least 20 mL of water, with the same procedures above Dysphagia: abnormality in ≥ 1 item in any of the above steps - Videofluoroscopy (VFSS) with standard protocol (on patients who failed clinical testing within first week of admission) -patient swallowed in sequence 5 ml and 10 ml of solution of barium of different consistency (liquid at later attempts of the examination) Cessation of the VFSS if significant aspiration Dysphagia: Classified as no dysphagia; dysphagia affecting oral phase; dysphagia affecting pharyngeal phase; mixed dysphagia Ordinal penetration–aspiration scale was used for scoring airway invasion Tester: doctor | Overall Dysphagia (clinical bedside test) 41% (62/151)** Overall Dysphagia per phase (clinical bedside test) (62/151) prevalently oral phase 15.2% (23/151); prevalently pharyngeal phase 9.2% (14/151); prevalently mixed dysphagia 16.6% (25/151) Dysphagia per gender (clinical bedside test) M = 40.3% (31/77); F = 41.9% (31/74) Overall Dysphagia (VFSS) (49/151) 93.9% (46/49) Overall Dysphagia per phase (VFSS) prevalently oral phase 9.9% (15/151); prevalently pharyngeal phase 8.6% (13/151); prevalently mixed dysphagia 9.9% (15/151) Overall Penetration/aspiration (VFSS) penetration: 13.9% (21/151); aspiration: 8.6% (13/151); silent and significant aspiration: 4% (6/151) Overall dysphagia with PEG tube 11.9% (18/151) |
Finestone et al. [59] Arch Phys Med Rehabil | Prospective cross-sectional (IV) AXIS 17/20; 85% | Tertiary hospital; Rehabilitation unit, Canada 14 months | Stroke Inclusion: consecutively admitted stroke patients from acute care at same hospital Exclusion: patients declined to participate (4) Time of assessment: within 4 days of admission, 1 & 2 months, follow-up 2–4 months post-discharge | 49 (M = 32; F = 17) Mean age (SD): M = 60 (NR); F = 62 (NR) Age range: M = 20–77; F = 20–78 | Dysphagia | - Clinical observation Dysphagia: observed choking, coughing, exhibiting vocal quality changes (i.e., wet-sounding voice after food consumption), decreased oral motor function (i.e., weakness on right and/or left sides) or having difficulty swallowing Dysphagia was then verified by bedside assessment or an abnormal videofluoroscopic modified barium swallow Tester: swallowing team; radiologist and/or speech-language pathologist, dietitian & occupational therapist | Overall Dysphagia 47% (23/49)** Overall Tube feedings 14% (7/49) Overall dysphagia 1 month (32/49) 34% (11/32); Dysphagia 2 months (9/32) 33% (3/9) |
Flowers et al. [60] J Commun Disord | Retrospective cohort (III-2) AXIS 16/20; 80% | Tertiary hospital, Canada July 1, 2003–March 31, 2008 | Stroke Inclusion: select patients within 2 weeks of first acute stroke or transient ischemic attack (TIA); ≥ 18 years; had diffusion weighted MR imaging (median time of imaging from stroke onset 75 h /IQR 108 h) Exclusion: random selection of 250 (466); irretrievable data (29) Time of assessment: median of 2 days /IQR 3 days after stroke onset | 221 (M = 124; F = 97) Mean age (SD): 68 (15) | Dysphagia: oropharyngeal dysphagia characterized by abnormal swallowing physiology of the upper aerodigestive tract | - Registry of Canadian Stroke Network’s database; Medical chart review - document the number of patients assessed by speech-language pathologists (SLP) Dysphagia: identified by SLP clinical or instrumental assessment, or presence of enteral feeding tube (NGT) insertion in patients not assessed by SLP Tester: trained research assistant extracted data | Overall Dysphagia (identified by SLP or NGT insertion) 44% (98/221) (95% CI 38–51) Overall Dysphagia (identified by SLP) 40.7% (90/221) Overall Dysphagia (identified by NGT insertion) 3.6% (8/221) Dysphagia per gender M = 46.8% (58/124); F = 41.2% (40/97) |
Gordon et al. [39] Br Med J (Clin Res Ed) | Prospective cohort (II) AXIS 15/20; 75% | District general hospital, England 6 months | Acute stroke Inclusion: consecutive clinical diagnosed acute stroke Exclusion: stroke > 14 days prior to admission or not stroke diagnosis (9) Time of assessment: ≤ 2 days (56/91); ≤ 3 days (26/91); ≤ 13 days (9/91) after stroke | 91 (M = 38; F = 53) Median age (Q1; Q2): 70 (NR) Age range: 26–96 | Dysphagia | - Modified Frenchay dysarthria assessment (Enderby 1983) [103] Dysphagia: inability to drink 50 ml water or choking more than once while attempting to drink 50 ml on 2 occasions Tester: neurologist | Overall Dysphagia 45.1% (41/91)* Dysphagia per gender M = 47.4% (18/38); F = 43.4% (23/53) |
Groher and Bukatman [40] Dysphagia | Prospective cross-sectional (IV) AXIS 12/18; 67% | Hospitals (2); primary, secondary and tertiary care, USA April 1985 | Mixed (CVA, central nervous system/dementia, head and neck cancer, trauma, neurodegenerative diseases, Guillain-Barré, Multiple Sclerosis, Parkinson’s disease, Huntington’s disease, ALS, gastrointestinal and middle-stage systemic diseases) Inclusion: various disorders; only patients identified by both examiners Exclusion: pre-operative or post-operative course with expected swallowing dysfunction as a result; hospital services including psychiatry, pediatrics, neonatology, obstetrics, and inpatient substance abuse; not identified by both examiners (2) Time of assessment: NR | 1072 Hospital 1 = 462 Hospital 2 = 610 (M = NR; F = NR) Mean age (SD): NR | Swallowing dysfunction: oral ingestion or pharyngeal motility disorders; swallowing disorders | - Cardex review: -standard form; missing information was gathered from medical records Swallowing dysfunction: presence of one of two criteria: -reported signs of choking, drooling or inability to complete an attempted swallow; -history of aspiration pneumonia with a diagnosis of primary or secondary neuromuscular disease Tester: hospital service’s head nurse and investigator from each hospital | Overall Swallowing dysfunction 12.2% (131/1072) Hospital 1: 12% (54/462) Hospital 2: 13% (77/610) NB Inconsistencies of numbers in table and reported results |
Hollaar et al. [72] Geriatr Nurs | Retrospective cross-sectional (IV) AXIS 17/20; 85% | Nursing homes (3), Netherlands Nursing home 1: April 2011-April 2012 Nursing home 2: April 2012-April 2013 Nursing home 3: April 2013-April 2014 | NR Inclusion: ≥ 65 years; variety of diagnosis Exclusion: residents discharged during examination period (43) Time of assessment: NR | 373 (M = 113; F = 260); Mean age (SD): 83.3 (8.0) Nursing home 1: (M = 30; F = 50); Mean age (SD): 79.2 (7.6) Nursing home 2: (M = 20; F = 66); Mean age (SD): 85.2 (5.4) Nursing home 3: (M = 63; F = 144); Mean age (SD): 84.2 (8.6) | Dysphagia | - Medical electronic file review Dysphagia if any of the following: -history of nursing home-acquired pneumonia (NHAP); -report of clinical swallowing assessment by speech therapist at nursing home; -confirmation by consulting speech therapist or elderly care physician (in case of doubt) Tester: researchers | Overall Dysphagia 16% (59/373) |
Huppertz et al. [41] J Nutr Health Aging | Retrospective cross-sectional (IV) AXIS 15/20; 75% | Nursing home, Netherland 1 day in 2016 or 2017 | NR Inclusion: ≥ 65 years; living in somatic- and psychogeriatric wards; include only 2017 data if resident participated in both years Exclusion: residents that received palliative care at the day of the measurements Time of assessment: NR | 6349 (M = 1892; F = 4457) Mean age (SD): 84.5 (7.5) Psychogeriatric wards: 66% (4190/6349); Somatic wards: 34% (2159/6349) | Oropharyngeal dysphagia: swallowing problems | - Standardized questionnaire: National prevalence measure of quality of care which included 2 questions related to oropharyngeal dysphagia: 1) “Does the client have swallowing problems?” 2) “Does the client sneeze or cough while swallowing food or liquids?” Swallowing problems: answer yes to question(s) NB Unclear if one or both questions need to be answered “yes” to be classified swallowing problems Tester: trained nurses | Overall swallowing problems 12.1% (769/6349) Overall Sneeze/cough while swallowing 6.9% (439/6349) Overall Swallowing problems with additional sneeze/cough while swallowing 5.6% (361/6349) Swallowing problems per gender M = 40.6% (769/1892); F = 12% (499/4457) |
Hägglund et al. [25] Dysphagia | Prospective cross-sectional (IV) AXIS 15/20; 75% | Short-term care units; five counties, Sweden Study period: NR | NR Inclusion: ≥ 65 years old; diagnosis causing short- term care Exclusion: declined to participate (63) Time of assessment: NR | 391 (M = 182; F = 209) Median age (Q1;Q2): 84 (NR) M = 81 (NR) F = 85 (NR) Age years: < 75 16.1% (63/391) 75–84 38.1 (149/391) ≥ 85 45.8% (179/391) Age range: M = 65–98; F = 65–110 | Swallowing dysfunction; dysphagia Swallowing capacity: volume of swallowed water divided by time | - Teaspoon test with 3 teaspoons of water (prior to WST): if aspiration signs, no WST (score: 0 mL/s) Swallowing dysfunction: abnormal swallowing capacity and/or signs of aspiration Abnormal swallowing capacity: unable to swallow > 10 mL/s Signs of aspiration: cough, voice change, and/or voice change without cough after swallow Tester: eight registered dental hygienists and one speech-language pathologist with specific training on all assessments | Overall Swallowing dysfunction 63.4% (248/385; nmissing = 6)*** Overall Abnormal swallowing capacity 55% (213/385; nmissing = 6) Overall Signs of aspiration 34% (127/377; nmissing = 14); Overall cough 24% (90/377; nmissing = 14); Overall voice change 18% (65/368; nmissing = 24); Overall voice change without cough 10% (37/368; nmissing = 24) Swallowing dysfunction per gender M = 64% (116/180; nmissing = 2); F = 64% (132/205; nmissing = 4) Abnormal swallowing capacity per gender M = 49% (89/180; nmissing = 2); F = 60% (124/205; nmissing = 4) Swallowing dysfunction per age group < 75 12.9% (32/62); 75–84 37.5% (93/148); ≥ 85 49.6% (123/175) Abnormal swallowing capacity per age group < 75 13.6% (29/62); 75–84 36.6% (78/148); > 85 49.8% (106/175) Signs of aspiration per gender M = 39.1% (70/179; nmissing = 3); cough 28.5% (51/179; nmissing = 3); voice change 22%% (39/177; nmissing = 5); voice change without cough 10% (37/177; nmissing = 5); F = 28.8% (57/198; nmissing = 11); cough 19.7% (39/198; nmissing = 11); voice change 13.6% (26/191; nmissing = 18); voice change without cough 9.4% (18/191; nmissing = 18) |
Jørgensen et al. [61] Clin Nutr ESPEN | Prospective cross-sectional (IV) AXIS 16/19; 84% | Hospitals (3), Denmark June –October 2016 | Mixed (infection/fever, dehydration/dizziness/fall, pneumonia/aspiration pneumonia, pulmonary disease, poor general condition/diarrhea, other) Inclusion: consecutive patients admitted to medical or geriatric wards Exclusion: if previous contact with occupational therapist during admittance; not sufficiently alert to give informed consent and participate in test; language barrier for informed consent and test participation Time of assessment: NR | 110 (M = 46; F = 62) Mean age (SD): 75 (12.4) | Oropharyngeal dysphagia (OD) | - Volume-Viscosity Swallow Test (V-VST) (Clavé et al. 2008) [74] Oropharyngeal dysphagia: one or several signs of impaired safety and/or efficacy during trials the V-VST Signs of impaired safety: cough, changes in voice quality, a decrease in oxygen saturation ≥ 3% Impaired efficacy: impaired labial seal, oral residue, piecemeal deglutition, pharyngeal residue Testers: occupational therapists, trained in V-VST | Overall Oropharyngeal dysphagia 34.5% (38/110)* Overall signs of impaired safety 6.4% (7/110); Overall signs of impaired efficacy 16.4% (18/110); Overall signs of both impaired safety and efficacy 11.8% (13/110) |
Kampman et al. [62] Neurohospitalist | Retrospective (period I) & Prospective (period II) cross-sectional (IV) AXIS 14/18; 78% | University hospital, Norway Period I; June 1, 2012–May 31 2013 Period II; December 1, 2013–May 31, 2014 | Stroke Inclusion: patients admitted with cerebral infarction or intracerebral hemorrhage on day of stroke or the day after; stayed in stroke unit for at least 48 h after admission Exclusion: patients receiving terminal care only; those who died during the first 2 weeks after the stroke Time of assessment: 0–1 days | Period I 199 (M = 110; F = 89) Median age (Q1;Q2): 75 (NR) Age range: 20–94 Period II 86 (M = 53; F = 33) Median age (Q1;Q2): 75 (NR) Age range: 22–92 | Dysphagia; swallowing problems | - Swallow test 1 teaspoons water 3 times; if cough, give teaspoon thick liquid; if cough again, stop test and contact speech therapist or other qualified personnel; if swallowing is okay, have patient drink 1/3 glass of water (about 50 ml) with or without thickener NB Unclear criteria for dysphagia (i.e., cough on one or all trials) Tester: NR | Overall Dysphagia 23.2% (57/285nmissing = 40)* Period I: 23.3%(?) (39/168nmisssing = 31) Period II: 23.4% (18/77nmissing = 9) NB overall prevalence reported for total included, not tested |
Kidd et al. [42] Q J Med | Prospective cohort (II) AXIS 14/20; 70% | Hospital, UK Study period: NR | Acute stroke Inclusion: consecutive, first acute stroke; conscious; Excluded: other neurological disorder that may give rise to dysphagia or dysphagia due to other reasons; unable to obtain verbal consent from the patient or their next of kin Time of assessment: Within 72 h of stroke onset; Re-assessment Day7 and Day14 after stroke and 3 months | 60 (M = 25; F = 35) Mean age (SD): 72 (9.5) | Dysphagia; aspiration; swallowing problem | - Water-swallowing screen and videofluoroscopy (VFSS) Screen: 50 ml water swallow test given in 5 ml aliquots Dysphagia: cough, choke, altered voice quality, fail water swallow test Videofluoroscopy determined aspiration NB not all patients with dysphagia aspirated and some patients who aspirated did not test positive for dysphagia Tester: NR | Overall dysphagia water swallow 42% (25/60)* Subgroup dysphagia—over time Day 7 19% (10/51); Day 14 10% (4/37) |
Lindroos et al. [27] J Nutr Health Aging | Prospective cross-sectional (IV) AXIS 15/20; 75% | Assisted living facilities (33), Finland 2007 | Mixed (Dementia, stroke, Parkinson’s disease, COPD, chronic or recurrent infections) Inclusion: residents ≥ 65 years Exclusion: refused (628); admitted for temporary respite care (111); did not have swallowing data available (9) Time of assessment: NR | 1466 (M = 323; F = 1143) Mean age (SD): 83 (NR) | Swallowing difficulties; dysphagia: a difficulty or discomfort during progression of a bolus from the mouth to the stomach | - Structured questionnaire with patient and closest caregiver Swallowing difficulties: - answered yes to question asking if they experienced swallowing difficulties; - had observed difficulties at bedside assessment; or had prior difficulties observed with resident’s eating and feeding Tester: trained nurses | Overall Swallowing difficulties 11.8% (173/1466) Swallowing difficulties per gender M = 15% (26/323); F = 85% (147/1143) |
Mañas-Martinez et al. [43] Endocrinol Diabetes Nutr | Retrospective cohort (III-2) AXIS 12/20; 60% | Tertiary Hospital, Spain January-March 2012 Follow-up via electronic case history until April 2014 | Mixed (pneumonia, heart failure, anemia, urinary tract infection, other) Inclusion: acute disease admitted to internal medicine ward Exclusion: unable to cooperate in the EAT-10 test due to advanced dementia or severe neurological disease in the absence of a proxy Time of assessment: within 48 h of admission | 90 (M = 56; F = 34) Mean age (SD): 83 (11.8) | Oropharyngeal dysphagia (OD); at risk of OD | - Medical chart review OD: EAT-10 score of ≥ 3 Tester: NR | Overall OD 56.7% (51/90) |
Mateos-Nozal et al. [63] JAMDA | Prospective cross-sectional (IV) AXIS 18/20; 90% | University hospital, acute geriatric unit, Spain Study period: NR | Mixed acute (heart failure, respiratory infection, urinary tract infection, abdominal infection, other) Inclusion: ≥ 80 years Exclusion: previously included in the study (84), end of life situation (68); permanent low level of consciousness (43); no consent (12); enteral nutrition (10); not tested within first 2 days of admission (31) Time of assessment: ≤ 48 h of admission | 329 (M = 104; F = 225) Mean age (SD); 93.5 (4.1) | Oropharyngeal dysphagia (OD); Difficulty forming or moving bolus from oral cavity to esophagus | - Volume-Viscosity Swallow Test- (V-VST) (Clavé et al.) [74] OD: one or several signs of impaired safety and/or efficacy during trials the V-VST Signs of impaired safety or efficacy: cough, changes in voice quality, a decrease in oxygen saturation, poor labial seal, multiple swallows, and oropharyngeal residue Tester: trained nurse | Overall OD 82.4% (271/329)* OD per gender M = 76.9% (80/104); F = 84.9% (191/225) |
Melgaard, Rodrigo-Domingo and Mørch [64] Geriatrics | Prospective cross-sectional (IV) AXIS 18/20; 90% | Regional hospital, Denmark March 1–August 31, 2016 | NR Inclusion: consecutively admitted to geriatric medicine department; ≥ 60 years old, hospitalized minimum 24 h; able to cooperate in OD test Exclusion: not tested for OD; did not meet inclusion criteria; did not want to participate Time of assessment: NR | 313 (M = 156; F = 157) Mean age (SD): 83.1 (7.81) | Oropharyngeal dysphagia (OD): difficulties moving food from the mouth to stomach | - Minimal Eating Observation Form version II (MEOF-II) (Westergren et al.) [106] Oropharyngeal dysphagia: -one or more signs of impaired safety or efficacy: changes of voice quality, cough, or decrease in oxygen saturation ≥ 3% on V-VST; -a dysfunction in ingestion or deglutition on MEOF-II Tester: trained and experienced occupational therapists | Overall Oropharyngeal dysphagia 50% (156/313) Oropharyngeal dysphagia per gender M = 46.2% (72/156); F = 53.5% (84/157) NB Unclear prevalence calculation (i.e., fail one or both tests) |
Nielsen et al. [65] Clin Nutr ESPEN | Prospective cross-sectional (IV) AXIS 17/20; 85% | Regional hospital, Denmark March 1, 2016–September 1, 2016 | Mixed (cardiopulmonary problems, osteoarticular disease, dementia and psychiatric diseases) Inclusion: admitted to acute geriatric department; ≥ 65 years old; hospitalized minimum 24 h Exclusion: terminal stage illness, severe dementia, in some other way unable to participate, did not wish to participate or transferred from department (105); lack of or insufficient screening (16) Time of assessment: NR | 297 (M = 130; F = 167) Mean age (SD): 83 (7.7) | Eating difficulties; deglutition; swallowing difficulties | - MEOF-II screening instrument (Westergren et al.) [106] Eating difficulties: includes 3 components: ingestion, deglutition and energy/appetite; Dichotomous rating: yes/no Deglutition defined: Problems in manipulation of food in mouth, swallowing difficulties and difficulties in chewing Tester: occupational therapists trained in screening | Overall eating difficulties 55% (163/297) Ingestion difficulties in sitting position 13.4% (40/297); difficulties in manipulation of food on the plate 23.2% (69/297); difficulties in transport of food to the mouth 20.9% (62/297) Deglutition problems in manipulation of food in the mouth 26.6% (79/297); swallowing difficulties 28% (83/297); difficulties in chewing 27.6% (82/297) Energy/appetite eats less than ¾ of served portion 15.2% (45/297) Overall Eating difficulties per gender M = 53% (69/130); F = 56.3% (94/167) NB overall OD includes data not related to OD |
Nogueira and Reis [44] Clin Interv Aging | Prospective, cross-sectional (IV) AXIS 11/20; 55% | Nursing homes (8), Portugal Study period: NR | NR Inclusion: all nursing home residents Exclusion: did not sign informed consent (6) Time of assessment: NR | 266 (M = 66; F = 200) Mean age (SD): 82 (10) | Swallowing disorders; deglutition: may involve both oral and pharyngeal stage of swallowing; swallowing and eating impairments | Swallowing disorders: stop drinking, cough, choke, or have a wet-hoarse vocal quality during the test or for 1 min afterward - The Dysphagia Self-Test (DST) questionnaire was administered to the residents who were able to respond (Logemann et al.) [107] Signs of dysphagia: ≥ 7 difficulties Tester: trained researchers, speech-language therapist | Overall Swallowing disorders with 3 oz WST 38.2%(?) (64/234?) Overall signs of dysphagia on DST (≥ 7 difficulties) 40.1% (90/224; nmissing = 42) NB Unclear prevalence calculation within reported population tested on WST |
Paciaroni et al. [66] Eur Neurol | Prospective cross-sectional (IV) AXIS 14/18; 78% | University hospital, Italy April 2001 – December 2002 | Acute stroke Inclusion: consecutive, acute first stroke (ischemic 343; hemorrhagic 63) admitted to stroke unit; conscious (GCS ≥ 10); medically stable Exclusion: patients with a history of previous swallowing impairment or medical condition that could affect swallowing function Time of assessment: immediately after hospitalization and every 24 h until recovery from dysphagia Mean time from stroke and first assessment 330 min (range 60–720 min) | 406 (M = 219; F = 187) Mean age (SD): 73.2 (11.4) | Dysphagia; swallowing impairment; swallowing dysfunction | Dysphagia: if possible, probable or definite from clinical assessment (Mann et al.) [92] Tester: neurologist | Overall dysphagia 34.7% (141/406)* Dysphagia per gender M = 31% (68/219); F = 39% (73/187) Subgroup Dysphagia per stroke type ischemic stroke 32.1% (110/343); hemorrhagic stroke 49.2% (31/63) |
Park et al. [67] Geriatr Nurs | Prospective cross-sectional (IV) AXIS 16/20; 80% | Nursing homes (2), South Korea July – August 2010 | NR Inclusion: nursing homes with: more than 5 years operation; more than 115 staff members; more than 100; resident’s ≥ 65 years Exclusion: 6 of 8 nursing homes meeting inclusion criteria did not wish to participate; residents unable to follow instructions (47); resident refusal or unable to acquire consent (40) Time of assessment: NR | 395 (M = 93; F = 302) Mean age (SD): 80.7 (8.0) Age group: < 74 years: 92 ≥ 75 years: 303 | Dysphagia: swallowing impairment | Dysphagia: GUSS score 0–14 Severity of risk of aspiration: GUSS score 0 to 9: high; GUSS score 10–14: moderate; GUSS score 15–19: low; GUSS score 20: minimal Tester: five research assistants (experienced and trained registered nurses) | Overall dysphagia 52.7% (208/395)*** Overall Aspiration risk High risk of aspiration 41.1% (162/395); Moderate risk of aspiration 11.6% (46/395) Dysphagia per gender M = 61.3% (57/93); F = 50% (151/302) Dysphagia per age < 74 years 43.5% (40/92); ≥ 75 years 55.4% (168/303) |
Patel and Martin [45] J Nutr Health Aging | Prospective cross-sectional (IV) AXIS 14/20; 70% | Hospital, UK May 1999- February 2000 | Mixed acute illness (chest infection, acute exacerbation of chronic lung diseases, pulmonary edema, gastro-enteritis, and gastrointestinal bleeding) Inclusion: patients admitted to elderly care unit within preceding twenty-four hours of 9am on Mondays and Thursdays Exclusion: NR Time of assessment: After admission preceding 24 h of 9 am Monday and Thursdays | 100 (M = 27; F = 73) Mean age (SD): 81.7 (NR) Age range: 65–98 | Dysphagia | - Nurse clinical observations, food-charts, case-notes, unstructured interviews of patients and/or carers -estimate for whether subject had adequate intake; consumed at least ¾ of their standard diet and any prescribed food supplements -categorization of the reasons for inadequate intake: acute illness, anorexia, oral problems, low mood confusion, catering limitations and dysphagia Dysphagia: NR NB Unclear criteria for determining dysphagia Tester: researchers | Overall dysphagia 6% (6/100) |
Rofes et al. [68] Neurogastroenterol Motil | Prospective cohort (II) AXIS 18/20; 90% | General hospital, Spain May 2010 – September 2014 | Stroke Inclusion: consecutive patients admitted to hospital confirmed stroke diagnosis Exclusion: previous diagnosis of OD; transient ischemic attack; transferred from another hospital Time of assessment: between 24 and 48 h after admission; before oral feeding | 395 (M = 211; F = 184) Mean age (SD): 73.2 (13.13) | Oropharyngeal dysphagia (OD): any sign of impaired efficacy and/or safety of swallow; dysphagia | - Volume-Viscosity Swallow Test (V-VST) (Clavé et al.) [74] Oropharyngeal dysphagia: signs and symptoms of impaired efficacy of swallow: -presence of oral residue (part of the bolus remaining in the oral cavity after swallow); -the efficiency of labial seal (ability to maintain the whole bolus in the oral cavity during the preparatory phase of swallow); -fractional swallow (multiple swallows per bolus) Signs of impaired safety of swallow: -changes in voice quality (including wet voice); cough; decrease in oxygen saturation ≥ 3% Tester: trained nursing staff | Overall OD 45% (178/395)* Oropharyngeal dysphagia per gender M = 40.3% (85/211); F = 50.5% (93/184) |
Rösler et al. [46] J Am Med Dir Assoc | Prospective cohort AXIS 14/20; 70% | Teaching hospital, Germany Study period: NR | Dementia Inclusion: all consecutive patients admitted on acute geriatric ward with documented diagnosis of dementing illness with a minimum duration of 6 months Exclusion: patients with stroke within the previous 12 months; acute disease of the head or neck region; delirium according to Confusion Assessment Method (CAM) short form; intake of bensodiazepines on a regular basis; patients with dementia who were severely impaired in judgment according to neuropsychological evaluation without a legal caregiver; does not want to participate (4); transferred to another hospital (3), suffered stroke (1) Time of assessment: NR | 161 (M = 44; F = 117) Mean age (SD): 82.4 (NR) | Dysphagia: difficulty of swallowing; signs of aspiration NB define dysphagia as aspiration | - Albertinen Dementia Dysphagia Screening (ADDS): a self-composed screening for the risk of aspiration. Combined a water-swallowing test (DePippo et al.; Kidd et al.; Suiter and Leder) [94, 110, 111], pulse oximetry (Zaidi et al.) [112] and a test of different food consistencies (Trapl et al.) [98] Dysphagia: signs of aspiration -presence of at least 2 of the following symptoms: coughing or changes of voice (wet or hoarse vocal quality); a drop in oxygen saturation by ≥ 2% Tester: 2 experienced speech therapists trained with ADDS | Overall Dysphagia WST 35.6% (57/160; nmissing = 1)* Overall dysphagia with apple slice 15.1% (22/144; nmissing = 17); Overall dysphagia with apple puree 6.3% (10/159; nmissing2) |
Sarabia-Cobo et al. [69] Appl Nurs Res | Retrospective cohort (III-2) AXIS 18/20; 90% | Nursing homes (12), Spain 2011 -2013 | Mixed (dementia, cerebrovascular disease, pneumonia, bronco-aspiration) Inclusion: Dementia, cerebrovascular disease, pneumonia Exclusion: NR Time of assessment: NR | 2384 (M = 635; F = 1749) Mean age (SD); (95% CI; range): 88.7 (6.8); (82.1–89.60; 69–101) | Oropharyngeal dysphagia: difficulty swallowing- subjective feeling of difficulty when passing food or liquid from the mouth and esophagus to the stomach; dysphagia | - Medical record review of: - 3 oz Water Swallow Test (DePippo et al.) [94] Oropharyngeal dysphagia: EAT-10 score ≥ 3; wet/hoarse voice quality after swallowing Tester: doctor from each center | Overall OD 69.6% (1659/2384) OD per gender M = 73% (463/635); F = 68.4% (1196/1749) Subgroup OD with NGT or PEG (1659/2348) OD with NGT 16.8% (278/1659); OD with PEG dysphagia 9.4% (156/1659) NB Unclear prevalence calculation (i.e., fail one or both tests) |
Spronk et al. [47] Neurogastroenterol Motil | Prospective cross-sectional (IV) AXIS 15/20; 75% | General hospitals (2), Netherlands November 2017-February 2018 | Mixed (cardiology, surgery, internal medicine, pulmonology, geriatrics, neurology, gastroenterology) Inclusion: All patients ≥ 18 years, admitted to surgical, internal medicine, gastroenterology, pulmonology, neurology, cardiology and geriatric wards Exclusion: no consent, admission duration ≥ 72 h or discharged before researcher could talk to them, cognitive dysfunction and /or delirium, language barriers, no oral intake permitted due to medical reasons or server impairment, severe illness with associated weakness to participate in study, admission to intensive care unit before general ward, unwillingness o shave off beard, as that prevented participation in sEMG signals, patient in contact isolation for infectious reasons Time of assessment: 24–72 h | 205 (M = 108; F = 97) Mean age median (Q1;Q2): 71 (NR) Age range: (60–78) | Dysphagia; swallowing problems, suspected dysphagia | - Eating Assessment Tool (EAT-10) (Belafsky et al.) [75] Score of ≥ 2 used as indication of swallowing problems - Volume-Viscosity Swallow Test (V-VST) (Clavé et al. 2008) [74] Tester: NR | Overall dysphagia abnormal V-VST 7.3% (15/205)* Overall dysphagia EAT-10 score 23.4% 48/205 Overall suspected dysphagia determined by abnormal EAT-10 or V-VST 30.7% (63/205) NB – inconsistencies in terminology usage for prevalence |
Stipancic, et al. [48] Am J Speech Lang Pathol | Prospective cross-sectional AXIS 13/20; 65% | University hospital, USA Study period: NR | Stroke Inclusion: first time ischemic stroke, ≥ 18 years, alert and responsive enough to partake in evaluations Exclusion: history of oropharyngeal dysphagia, have a previous disorder known to be associated with dysphagia, non-English speakers, patients recently intubated Time of assessment: up to 57.5 h after admission | 100 (M = 63; F = 27) Mean age (SD): 72.33 (14.4) | Dysphagia; disordered swallowing | - Standardized clinical swallowing protocol Patients with sign/symptoms of dysphagia during clinical swallowing evaluation completed videofluoroscopic swallow study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) Dysphagia: impairment in any of the phases of swallowing; oral, oropharyngeal, pharyngeal, or phayngoesophageal, identified by either clinical or instrumental evaluation Tester: speech-language pathologist | Overall dysphagia 32% (32/100) (95% CI: 23, 41)* NB No data reported from VFSS or FEES |
Sugiyama et al. [26] Geriatr Gerontol Int | Retrospective cross-sectional AXIS 13/20; 65% | Randomly selected: Nursing homes (1517), Long-term care facilities (941), Sanatorium medical facilities (1134), Rehabilitation hospitals (742), Japan 1.September-30.October 2009 | NR Inclusion: Facility size and region Exclusion: facilities with fewer than 30 residents Time of assessment: NR | Nursing homes 440 (M = NR; F = NR) Mean age (SD): 85.9 (1.9) Long-term care facilities 275 (M = NR; F = NR) Mean age (SD): 84.8 (2.0) Sanatorium medical facility 204 (M = NR; F = NR) Mean age (SD): 80.8 (3.8) Rehabilitation hospitals 217 (M = NR; F = NR) Mean age (SD): 74.4 (4.8) | Swallowing difficulty: oral feeding using thickened liquid diet, choking with meal intake, and current or past history of aspiration pneumonia and swallowing problems | - Standardized questionnaire (number of residents): - use of feeding tubes - transitioning from tube feeding to oral intake - presence of swallowing problems Tester: institution dietician, nurse or other medical staff | Overall swallowing difficulties among orally-fed residents per 100 beds Nursing homes nmissing = 34 23.7% (17.0?) (97/406); Long-term care facilities nmissing = 1: 15.6% (13.9?) (43/274); Sanatorium medical facilities nmissing = 1: 19.2% (24.7?) (39/203); Rehabilitation hospitals nmissing = 4: 15.4% (15.9?) (33/213) Subgroup Tube fed patients per 100 beds Nursing homes 11.6% (8.5) (51/440); Long-term care facilities 7.4% (7.0) (20/275); Sanatorium medical facilities 36.3% (22.7) (74/204); Rehabilitation hospitals 7.9% (7.4) (17/217) NB Standard deviations appear large |
Tanigör and Eyigör [33] European Geriatric Medicine | Prospective cross-sectional AXIS 10/20; 50% | Rehabilitation inpatient clinic, Turkey Study period: NR | Mixed (neurological, musculoskeletal and rheumatic diseases) Inclusion: adult inpatient, comply with instructions, given consent Exclusion: severe cognitive dysfunction, severe comorbidity or medical emergency impeding evaluation, delirium and end-stage cancer patient Time of assessment: first week of hospitalization | 128 (M = 53; F = 75) Mean age (SD): 56.5 (NR) | Oropharyngeal dysphagia risk, swallowing difficulties | - History about eating habits, ev. difficulties with different consistencies/textures, severity rating (mild, moderate, severe) or associated signs (choking, wet voice, drooling xerostomia, mucositis, globus sensation, and dominant type of feeding (oral, nasogastric, gastro/jejunostomy) - Functional Oral Intake Scale (FOIS) (Crary et al.) [113], - Eating Assessment Tool - (EAT-10) (Belafsky et al.) [75], - MD Anderson Dysphagia Inventory (MDADI) (Chen et al.) [89] Dysphagia: FOIS score ≤ 5; EAT-10 score ≥ 3, MDADI score (NR) Tester: NR NB: Unclear criteria for determining dysphagia | Overall swallowing difficulties 22.6% (29/128) NB: Unclear which combination of screening tests were used to determine prevalence; one, two or all |
van der Maarel-Wierink et al. [70] Int J Nurs Stud | Retrospective cross-sectional (IV) AXIS 16/20; 80% | Long-term care homes (119/360), Netherlands April 13 and November 2, 2010 | Mixed (psychological disorder, dementia, cerebrovascular disease, other nervous system disorders, cardiovascular disease, respiratory disease/disorder, diabetes mellitus) Inclusion: data of care home residents ≥ 65 years Exclusion: tube fed patients Time of assessment: NR | 8119 (M = 2116; F = 6003) Mean age (SD): 84 (7.0) Age group: 65–75 (978/8119); 76–85 (3348/8119); > 85 (3793/8119) | Subjective dysphagia; dysphagia; swallowing impairment: a symptom which refers to difficulty or discomfort during the progression of the bolus from the oral cavity to the stomach | - Data from the Dutch National Prevalence Survey of Care Problems: -subjective dysphagia self-report (dichotomous scale: yes/no swallowing problems); -if self-report not possible: ward care provider report using similar scale or resident’s file check for swallowing complaints and/or dysphagia Tester: trained coordinator at each of care homes instruct care providers; two care providers | Overall subjective dysphagia 9% (751/8119) Subjective dysphagia per gender M = 10% (214/2116); F = 8.9% (537/6003) Subjective dysphagia per age group 65–75 16.8% (126/978); 76–85 9.9% (332/3348); > 85 7.7% (293/3793) |
Vidal Casariego et al. [71] Nutrición Hospitalaria | Prospective cross-sectional (IV) AXIS 16/20; 80% | University hospital, neurology and internal medicine wards, Spain January-April 2019 | Mixed acute illness Inclusion: > 18 years; urgent admission to neurology and internal medicine units Exclusion: hospitalized < 24 h, admitted to neurology or internal medicine unit but in charge of other hospital services; terminal stage of disease; expected death in following hours NB no information on disease types Time of assessment: NR | 196 (M = 94; F = 102) Mean age (SD): 74.4 (17.5)/76.0 (17.9) | Dysphagia | - Eating Assessment Tool (EAT-10) (Burgos et al.) [105] NB No reference to original EAT-10 Tester: researchers | Overall dysphagia 26.6% (42/158; nunable to screen = 38)* Dysphagia per gender M = 33.3% (14/76); F = 66.7% (28/82) |
Wham et al. [49] Australas J Ageing | Prospective cross-sectional (IV) AXIS 14/20; 70% | Hospital and Residential care, New Zealand April – July 2014 | NR Inclusion: ≥ 65 years (European ethnicity) or ≥ 55 years (Mãori and Pacific); able to understand and give consent, undertake a questionnaire and anthropometric measures Exclusion: participants with any known dysphagia risk Time of assessment: NR | Hospital: 57 (M = 23; F = 34) Mean age (SD, range): 82.07 (6.92, 66.0–95.0) Residential care: 53 (M = 23; F = 30) Mean age, (SD, range): 87 (6.65, 65.0–103.0) | Swallowing difficulties; dysphagia; deglutitive disorders, swallowing problems; dysphagia risk | - Eating Assessment Tool (EAT-10) (Schindler et al.) [114] Dysphagia risk: EAT-10 scores ≥ 3 Tester: NR | Overall dysphagia risk per clinical setting: Overall in hospital 15.8% (9/57); Overall in residential care 32.1% (17/53) |
Young and Durant-Jones [34] Dysphagia | Retrospective cohort (III-2) AXIS 10/20; 50% | Hospital, USA 3 years | Stroke Inclusion: randomly selected patients with cerebral vascular accident (CVA); non-comatose: at least 18 years of age; hospital stay at least 7 days; no previous history of CVA; no previously reported neurological disease, including dysphagia Exclusion: comatose patients (9) Time of assessment: NR | 225 (M = NR; F = NR) Mean age (SD): NR | Dysphagia: any oral or pharyngeal stage, neuromuscular dysfunction that affected patients' ability to eat orally | - Patients identified by ICD-9 codes and chart review performed: -identified symptoms of dysphagia via a standardized form -physician bedside assessment: presence or absence of the gag reflex Tester: chart review by 2 speech-language pathologists | Overall dysphagia 28% (65/216; ncomatosed = 9) Suspected aspiration: 25.5% (55/216; ncomatosed = 9); Aspiration pneumonia: 11.1% (24/216; ncomatosed = 9); Choking: 4.1% (9/216; ncomatosed = 9); Coughing: 13.4% (29/216; ncomatosed = 9); Reduced gag reflex: 21.8% (47/216; ncomatosed = 9) NPO status: 24.5% (53/216; ncomatosed = 9); NG tube: 17.1% (37/216; ncomatosed = 9); G-tube: 3.7 (8/216; ncomatosed = 9) |