Background: Dysphagia is prevalent in older adults with dementia, particularly in the acute care setting. The objective of this study was to use an innovative approach to extract a more representative sample of patients with dysphagia from the electronic health record (EHR) to determine patient characteristics and outcomes associated with dysphagia in hospitalized persons with dementia.
Methods: A retrospective study of hospitalized adults (65+) with dementia was conducted in seven hospitals across the greater New York metropolitan area. Data was obtained from the inpatient EHR with the following inclusion criteria: age greater than or equal to 65; admitted to one of seven health system hospitals between January 1st, 2019 and December 31st, 2019; and documented past medical diagnosis of dementia (based on ICD-9). A diagnosis of dysphagia was defined as: nurse documentation of a positive bedside swallow screening; nurse documentation of “difficulty swallowing” as reason for not performing bedside swallow screening; and physician documentation of a dysphagia diagnosis. For multivariable analyses, logistic regression (binary outcomes of invasive mechanical ventilation, delirium, mortality, 30-day readmission) and linear regression (continuous outcome of LOS) were utilized to determine the association between dysphagia and hospital outcome, controlling for variables found in the univariate analyses.
Results: Of adults with dementia (N=8,637), the average age was 84.5, 61.6% were female, 18.1% were Black and 9.3% Hispanic. Dysphagia was identified in 41.8% (N=3,610). In multivariable models, dysphagia was associated with: invasive mechanical ventilation (Odds Ratio, OR:4.53, 95%CI:3.55-5.78), delirium (OR:1.53, 95%CI:1.40-1.68), increased length of stay (B=3.29, 95%CI:2.98-3.60), and mortality (OR:4.44, 95%CI:3.54-5.55).
Conclusions: Given its high prevalence, under recognition, and associated poor outcomes, improving large-scale dysphagia identification can impact clinical care and advance research in hospitalized persons with dementia.
