Background: Oropharyngeal dysphagia (OD) is a common syndrome in hospitalized patients with Alzheimer’s disease and related dementias (ADRD). Although modified barium swallow study (MBSS) is considered the reference standard test for OD diagnosis and classifying OD severity, it is not routinely used in clinical practice. The objective of our study was to determine whether the use of MBSS impacts diet management in patients with ADRD and OD.

Methods: This is a retrospective cohort study of older adults (aged 65 +) with ADRD and OD admitted to the medicine service across 6 diverse hospitals in New York between January 8, 2017 to September 17, 2021; and who underwent at least one speech-language pathology (SLP) bedside swallow evaluation and one MBSS during hospitalization. Data elements were abstracted from the electronic health record. The main variable of interest was a change in the International Dysphagia Diet Standardization Initiative – Functional Diet Scale (IDDSI-FDS) (restriction, liberalization, no change) following a MBSS. Hospital outcomes included mortality, respiratory complications (e.g., aspiration pneumonia), and length of stay (LOS)

Results: Of included patients with ADRD, OD, and who had a MBSS (N=104), 46.2% (n=48) were 85+, 66.3% (n=69) were male, 55.8% (n=58) were white, 20% (n=21) were African American/Black and 10.6% (n=11) were Hispanic/Latino. Mean time from admission to the SLP evaluation recommending a MBSS was 103 hours, and 48 hours from SLP evaluation to MBSS. On average, MBSS occured on day 6.3 of the hospital stay and mean length of stay was 12.1 days. Mortality was 7.7% (n=8). The diets most often recommended by SLP evaluation were NPO (36%, n=37) and Pureed (30%, n=31); those most often recommended by MBSS were Pureed (36%, n=37), Minced and Moist (24%, n=25), and NPO (21%, n=22). Based on MBSS IDDSI-FDS compared to SLP evaluation IDSSI-FDS, diet recommendations were changed in 72.1% patients (n=75; liberalized in 48.1% [n=50] and restricted in 24.0% [n=25]); 27.9% (n=29) patients had no change. The rate of respiratory complications following MBSS diet recommendations was 12.5% (n=13); 26.9% (n=28) patients had palliative care consults, 20.2% (n=21) opted for comfort feeds, 15.4% (n=16) had hospice referrals, and 2.9% (n=3) had percutaneous endoscopic gastrostomy/jejunostomy tubes.

Conclusions: Our study highlights the need for prospective studies to evaluate the effect of MBSS on diet management in hospitalized patients with ADRD and OD.