Head flexion, trunk sway, and self-reported strategies in older adults screening positive for oropharyngeal dysphagia: An exploratory mixed-methods study

Background/Aim. Older adults with oropharyngeal dysphagia (OD) residing in nursing homes without clinical guidance may spontaneously adopt compensatory strategies through adjustments in eating and swallowing. How-ever, evidence regarding the spontaneous emergence of head flexion (HF) and postural adaptations remains limited. The aim of the study was to investigate adaptive head posture and trunk sway (TS) during swallowing in older adults screening positive for OD (spOD). Methods. Based on the presence of a swallowing disorder determined by the 100 mL water swallow test, a total of 45 older adults were classified into two groups: a group with spOD (spOD group) and a group without spOD (non-spOD group). Head posture was assessed using a smartphone-based accelerometer, and TS was evaluated with a Swaymeter. Data were analyzed using image processing techniques. Group comparisons were performed using multivariate analysis of covariance - MANCOVA with Bonferroni correction, followed by a confirmatory multivariable linear regression. Semi-structured interviews were conducted with the spOD group to explore their recognition of spontaneous strategies. Results. The spOD group (n = 21) showed significantly greater maximum HF during swallowing compared to the non-spOD group (n = 24) (p = 0.0002). No significant group differences were observed in TS parameters (p > 0.00625). Linear regression indicated a positive association between spOD and maximum HF: B = 13.46, 95% confidence interval: 6.50-20.41, p < 0.001. In interviews, the participants reported various conscious strategies (e.g., small bites, water use, breath-holding), but none mentioned HF or trunk sway. Conclusion. Despite the HF and TS results obtained in older individuals, this cross-sectional study cannot determine whether HF serves a compensatory function or is merely associated with OD. Therefore, no clinical recommendations can be drawn from these findings.