Prevalence of dehydration in older hospitalized patients with oropharyngeal dysphagia

The diagnosis of dehydration among older patients with oropharyngeal dysphagia (OD) remains a clinical challenge. We aimed to assess the prevalence of dehydration in hospitalized older adults with OD and its relationship with other comorbidities. This is a cross-sectional study involving hospitalized older patients (≥ 70 years) with OD, assessed for OD using the Volume-Viscosity Swallowing Test. Treatment for impaired safety of swallow was based on xanthan gum thickened fluids with appropriate bolus viscosity (250 mPa·s or 800 mPa·s). Hydration status was evaluated using three different methodologies: (a) osmolarity equation (> 295 mmol/L), (b) blood urea nitrogen to creatinine ratio (BUN/Cr > 20 and (c) bioimpedance analysis (BIA): phase angle (PA) < 4.5. Nutritional status (Mini Nutritional Assessment-short form), functionality (Barthel Index), frailty (Fried Index), and sarcopenia (European Working Group on Sarcopenia in Older People) were also assessed. We included 218 hospitalized (9.1 ± 7.2 days) patients with OD (87.4 ± 5.5 years), 85.3% with safety impairments. On admission, (a) up to 58.3% needed fluid thickening for safe swallowing (90.6% of them at 250 mPa·s) and 93.6% textured modified diets, (b) According to BUN/Cr ratio, 78.9% were dehydrated and to osmolarity, 81.2% and (c) 61.1% of participants had values of PA < 4.5, and (d) hydration status was significantly worse in patients with lower functional status, frailty, malnutrition, and sarcopenia. Dehydration is a highly prevalent condition among hospitalized older patients with OD. Assessment of hydration status, and promotion and monitoring of safe fluid intake with multimodal hydration interventions, is mandatory in patients with OD.