An epidemiologic study on aging and dysphagia in the acute care hospitalized population: 2000-2007

To describe total and yearly demographic trends relative to aging, dysphagia referral rates and oral feeding status in hospitalized patients from 2000 through 2007.

We evaluated a prospective, consecutive, referred sample of 4,038 hospitalized patients in an urban, tertiary, acute care teaching hospital. Dysphagia referral rates are described according to year, age (decade), sex, admitting diagnostic category, results of dysphagia evaluations and oral feeding status. Diagnosis of dysphagia and feeding status were assessed objectively with fiberoptic endoscopic evaluation of swallowing.

Dysphagia referral rates doubled between 2000 and 2007, with increases of 20% per year and increases in all decades from 2002 through 2007. Over 70% of dysphagia referrals were for older patients of 60 years and above, and over 42% of these were old old patients over 80 years. Referrals for 80 to 89-year-old patients almost doubled and for patients over 90 years more than tripled between 2000 and 2007. Of older patients over 60 years, 62.3% (1,771/2,843) did not exhibit dysphagia, 18.0% (513/2,843) benefited from specific diet modifications to reduce aspiration risk and 19.7% (559/2,843) were made nil-by-mouth due to severe dysphagia and aspiration.

From 2000 to 2007, dysphagia referrals across all ages increased by 20% each year, with more referrals for older (70.4%) than younger patients (29.6%). Referrals almost doubled for 80 to 89-year-old patients and more than tripled for patients over 90 years. This increase will necessitate additional trained dysphagia specialists at least through 2050 and probably longer.