Developing and Validating a Simple Scoring System for Dysphagia After Fragility Fracture or Orthopedic Surgery in Older Adults
Koji Shibasaki, Mari Suzuki, Yuriko Tajima, Akiko Ajima, Miki Marubayashi, Risa Iwama, Minami Kogo, Tsukushi Murota, Chisato Ura, Toshiomi Asahi, Sumito OgawaABSTRACT
Aim
To develop and validate a simple scoring system for dysphagia after fragility fracture or orthopedic surgery in older adults.
Methods
This prospective cohort study included a total of 934 participants aged ≥ 65 years who were hospitalized due to fragility fractures or had undergone orthopedic surgery. The following outcomes were set: pneumonia during hospitalization, pneumonia‐related and dysphagia‐related mortalities (sum of pneumonia‐associated and choking‐associated deaths). The odds and hazard ratios were calculated for the candidate independent variables, and the risk factors for dysphagia were selected. Additionally, the weighted score of the scoring system was calculated using the odds and hazard ratios.
Results
Pneumonia was diagnosed in 43 (4.6%) patients during hospitalization. During 2.0 years follow up period, thirty‐eight (21.8%) and two (1.1%) patients died due to pneumonia and choking, respectively. Among the collected independent variables, male sex, < 800 kcal/day calorie intake, and poor form of rice or main dish were selected as risk factors for dysphagia. The weighted risk score was determined as follows: 1 point for male sex, < 800 kcal/day calorie intake, and when the dietary form was rice porridge or chopped main dish; 2 points when the dietary form was rice in a blender, main dish in a blender, tube feeding, and nothing by mouth. After adjusting for covariates, pneumonia‐related and dysphagia‐related mortalities were 2.67–3.84 times for 1 point, 7.08–9.82 times for 2 points, and 44.55–53.74 times higher for 3 or 4 points, in comparison to 0 points.
Conclusions
Early intervention is recommended for participants with score ≥ 1.