Expert Consensus Statement on Acoustic Metrics for Swallowing Dysfunction Screening in Older Adults: A Delphi Study

Swallowing dysfunction poses significant health risks for older adults. Early detection is crucial to prevent complications such as aspiration pneumonia and sarcopenia. Acoustic analysis of voice, speech, and cough provides a promising, noninvasive method for screening for swallowing dysfunction. Here, we present an Expert Consensus Statement (ECS) on the use of select acoustic metrics for bedside screening of swallowing dysfunction in older adults (>65 years).

A multidisciplinary panel of 17 experts, spanning speech-language pathology, otolaryngology, geriatrics, neurology, nursing, emergency medicine, engineering, and computer science, developed this ECS using a modified Delphi method. Consensus discussions were guided by working definitions of swallowing dysfunction, aspiration, frailty, and dementia.

After three iterative Delphi survey rounds and four conference calls, nine items reached consensus. These statements emphasized the clinical relevance of "wet voice" as an indicator of airway invasion, the requirement for screening tasks to be feasible for alert older adults, and the necessity of instrumental validation (videofluoroscopic swallowing studies/flexible endoscopic evaluation of swallowing) as a reference standard. Furthermore, the panel reached consensus on artificial intelligence's potential to enhance screening, while stressing the importance of addressing algorithmic bias and ensuring equitable access across diverse populations.

The consensus highlights the potential of auditory-perceptual assessment and acoustic metrics to inform screening for swallowing dysfunction in older adults and offers expert insights for clinical investigators who aim to analyze voice, speech, and/or cough sounds as clinically meaningful indicators of laryngeal function to improve early detection and intervention, thereby enhancing patient outcomes.