JMIR Publications

ABSTRACT

Background:

Demographic changes will raise the need for specialized care of geriatric patients with simultaneous consideration of economic aspects. Oropharyngeal dysphagia has recently been declared a geriatric syndrome reflecting its multifactorial background. Alongside multimorbidity, sarcopenia, frailty and disability swallowing disorders increase with advancing age with prevalence rates reported to be as high as 44 % in the acute geriatric hospital setting and as high as 80% in long-term care facilities. Hence systematic screening of geriatric patients to diagnose dysphagia and initiate treatment is of paramount importance to prevent bolus death, aspiration pneumonia, malnutrition and improve quality of life. There are several screening tools that have been evaluated in emergency and stroke units. However, there is no published dysphagia screening tool which is validated in the geriatric, hospitalized population using a gold standard in dysphagia diagnostics as a reference test. The validation of the proposed test is a first step. If the GEBS proves to be successful in the detection of dysphagia in geriatric patients, further studies to determine its effects upon systematic implementation in different geriatric settings concerning pneumonia rates, nutritional status and quality of life are warranted.

Objective:

The Geriatric Bedside Swallowing Screen (GEBS) study aims to validate a new screening tool developed specifically for geriatric inpatients against an instrumental swallowing evaluation, the FEES (flexible endoscopic evaluation of swallowing) which is considered a gold standard. Primary outcomes to be evaluated are sensitivity and specificity for the GEBS in the detection of dysphagia in a mixed geriatric population. Presence of dysphagia will be defined by an instrumental swallowing evaluation (FEES) analyzed by the standardized Penetration—Aspiration-Scale PAS.

Methods:

To validate the GEBS, a prospective cohort study will be carried out. Two institutions will aim to recruit a total of 100 patients aged 75 and older. One institution is an acute geriatric department and the other one a long-term care facility. After giving their informed consent, patients will undergo the full screening protocol described in the GEBS as well as an evaluation of swallowing function using the FEES. Investigators will be blinded to the results of the respective other testing. Analysis of pseudonymized datasets will be done by a third investigator. An ethics approval was obtained for both study centers.

Results:

Outcomes to be considered are sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood quotient and reliability of the proposed dysphagia screening tool using Kappa’s coefficient.

Conclusions:

If proven as a valid screening tool for the early detection of dysphagia, patients will be referred to speech language pathology for further diagnosis, thus having optimized care while streamlining personnel resources. Clinical Trial: ISCRTN 11581931