The Influence of Physical Activity and Functional Capacity on Frailty and Dysphagia in Community-Dwelling Older...

The objectives of this study were to (a) confirm the relationship between frailty and dysphagia using objective measures and (b) determine the role of functional capacity and physical activity on the relationship between frailty and dysphagia in community-dwelling older adults.

Community-dwelling, English-speaking, prefrail or frail (per the FRAIL scale) older adults across Hamilton and Halifax, Canada, participated in this cross-sectional study. Dysphagia was assessed through Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scores based on videofluoroscopic swallowing studies and self-reported Eating Assessment Tool-10 (EAT-10) scores. Proxy measures of swallowing function (anterior and posterior maximum isometric tongue pressure, regular effort saliva swallow pressure, and voluntary peak cough flow) were also collected, along with measures of frailty (Fried Physical Frailty Phenotype), functional capacity (Short Physical Performance Battery), and physical activity (Physical Activity Scale for the Elderly [PASE]). The impact of frailty on each measure of swallowing was assessed using multiple linear regression and logistic regression (Objective 1). Subgroup analysis of functional capacity and physical activity was performed to determine the role of functional capacity and physical activity on frailty and dysphagia (Objective 2).

A total of 114 participants were enrolled in the study. Frailty was significantly associated with EAT-10 scores (β = 2.26, 95% confidence interval [CI] [1.37, 3.15], p < .001) but not DIGEST scores (β = 0.03, 95% CI [-0.08, 0.14], p = .61). Subgroup analysis demonstrated that this association was significant only among individuals with low levels of physical activity (PASE < 125.2), regardless of their level of functional capacity.

Findings from this study highlight the importance of screening frail older adults for dysphagia and suggest the potential benefits of expanding swallowing care to incorporate alternative strategies, such as physical activity into dysphagia care. Future research should explore the relationship between frailty, swallowing, and physical activity longitudinally.