Dysphagia as a geriatric syndrome: nationwide outcomes from the GEMIDAS registry

Dysphagia in geriatric patients is associated with adverse outcomes, but often remains under-recognized in routine care. Evidence from nationwide real-world geriatric cohorts is limited, particularly regarding in-hospital outcomes and discharge pathways.

We conducted a retrospective nationwide cohort study using the Geriatric Minimum Data Set (GEMIDAS Pro), including 1403,790 geriatric hospital admissions between 2006 and 2024. Dysphagia was defined by ICD-10-GM code R13 recorded as a main or secondary diagnosis. Endpoints were in-hospital mortality, in-hospital aspiration pneumonia, and discharge destination. Multivariable logistic regression models were adjusted for age, sex, functional status at admission (Barthel Index), stroke, and dementia.

ICD-coded dysphagia was documented in 6.4% of admissions. In-hospital mortality was higher in admissions with dysphagia than in those without dysphagia (9.8%vs 2.7%), as was in-hospital aspiration pneumonia (7.7%vs 0.3%). After full adjustment, dysphagia remained independently associated with in-hospital mortality (OR 1.77, 95% CI 1.72-1.82) and in-hospital aspiration pneumonia (OR 10.37, 95% CI 9.95-10.81). Among patients discharged alive, dysphagia independently predicted institutional discharge (OR 1.48, 95% CI 1.45-1.51). In patients admitted from private households, dysphagia remained independently associated with non-home discharge after full adjustment including stroke and dementia (adjusted OR 1.42, 95% CI 1.40-1.45).

In this nationwide cohort of hospitalized geriatric patients, clinically documented, ICD-coded dysphagia was independently associated with in-hospital mortality, aspiration pneumonia, and adverse discharge pathways. These findings support interpreting clinically documented, ICD-coded dysphagia as a marker of systemic vulnerability and complex care needs within a geriatric-syndrome framework.